Saturday, July 21, 2012

Friday, July 20, 2012

PICKET: Colo. shooting shows failure in treatment of mentally ill

PICKET: Colo. shooting shows failure in treatment of mentally ill

Resources from the Treatment Advocacy Center as the rampage murders in Colorado raise questions about the connection of mental illness and violence

Almost inevitably after the massacres in Tucson, Virginia Tech and elsewhere, the rampage that left 12 dead and scores wounded early Friday in Aurora raises questions about the relationship of severe mental illness and violence, according to the Treatment Advocacy Center, a national nonprofit that focuses on the most severe mental illnesses.

"People with mental illnesses who are being treated are not more dangerous than the general population," said E. Fuller Torrey, M.D., a leading authority on the association of violence and severe mental illness and founder of the organization. "But evidence has become overwhelming that untreated severe mental illnesses are a significant contributor to violent acts, including homicides and a large percentage of rampage murders."
In the event that severe mental illness is implicated in the latest mass murder, relevant data and information about mental illness and violence may be found in the following resources:
The Treatment Advocacy Center is the only national nonprofit dedicated to eliminating legal and other barriers to treatment for people with severe mental illness. The organization does not accept funding from companies or entities involved in the sale, marketing or distribution of pharmaceutical products.

New program aims to help the mentally ill

New program aims to help the mentally ill

KNOXVILLE, Tenn. (WVLT)-- Nearly a quarter of a million people in Tennessee live with mental illness and while not all mentally ill patients are violent, some do end up in trouble. Now, a new pilot project in Knox County will help families get help for their loved ones.
The idea started with former State Senator and now Knox County Mayor Tim Burchett six years ago. Since then State Senator Doug Overbey and newly elected Senator Becky Massey have been pushing the program in Nashville.
Knox County is the only county with this pilot program for two big reasons; five years ago, a deadly shooting committed by a mentally ill man and now because the Lakeshore Mental Health Institute is about to close.
The deadly shooting happened December 29, 2007 at Hooter's on Kingston Pike. Police say that 25-year-old David Rudd wounded a manager and killed a father of eight from Michigan after a dispute over a bar tab. The investigation found that Rudd suffered from a mental illness and his family told police if he would have stayed on his medicine, this wouldn't have happened.
In 2007, families didn't have the right to step in and legally make a loved one take their medicine or go to treatment. But now under this new pilot program called, Assisted Outpatient Treatment, they have the right.
State Senator Doug Overbey explains, "This gives them an option to file a petition with the court and the court can issue an order requiring the person to get back on their medication or get treatment. It would be an outpatient program that would be highly supervised by the Helen Ross McNabb Center."
Support for the AOT pilot program has gained strong support in the past couple of months due to the closure of Lakeshore Mental Health Institute.
"The State Department of Mental Health committed to keep some of the 20 million dollars from the closing of Lakeshore in the East Tennessee area and we [Senator Overbey and Senator Massy] thought what better way to utilize those funds than start a pilot project."
The hope is to keep mentally ill patients out of the hospital, out of jail and out of trouble.
Tennessee Commissioner of Mental Health and Substance Abuse Service, Doug Varney said "There's a due process that's part of this pilot to ensure the person does need the service and it's being done for the right reasons. We have to make sure we don't take the rights away from the patient."
If all goes well over the next two year with the AOT pilot program; the state hopes to expand it to other counties in Tennessee.
The specifics of the program are still being worked out but the pilot program will start in October with about 10 people.

NO ROOM AT THE INN Trends and Consequences of Closing Public Psychiatric Hospitals

No Room At The Inn
The number of public hospital beds for people in acute psychiatric crisis plunged in 2010 to levels not seen since 1850, exerting profound impacts on patients, law enforcement, jails, hospitals and public safety, according to a new study released today by the Treatment Advocacy Center.
No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals” reports that state hospital bed numbers dropped 14% from 2005 to 2010, falling to 43,318 beds nationwide. This compares with 50,509 beds in 2005 and 558,922 in 1955, the peak year of psychiatric hospitalization before the trend known as “deinstitutionalization” began.
The Treatment Advocacy Center called for a moratorium on further public hospital bed closures until a sufficient number of psychiatric beds for acutely and/or chronically ill individuals is available, either in state hospitals or community facilities.
“The elimination of hospital beds for people who are psychotic or otherwise acutely or chronically disabled by severe mental illness endangers them and society at large,” said Doris A. Fuller, executive director of the Treatment Advocacy Center and a co-author of the study.
“These closures are creating enormous strains on law enforcement, jails, prisons and hospital ERs, where acutely ill people are essentially ‘re-institutionalized’–or left to live on the streets,” she said. “Wherever they are, they exist in an alternate reality that deprives them of the ability to participate in life as they could with treatment.”
Nationwide, only 14.1 public hospital beds remained for each 100,000 people by 2010, the latest year for which data is available. The bed population has not been this low since 1850, when it was 14.0. A minimum of 50 beds per 100,000 is a consensus target for providing minimally adequate treatment to the public.
Among other consequences, the study found a statistically significant inverse association between lower state-hospital spending and higher numbers of arrest-related deaths. States that closed more public psychiatric beds between 2005 and 2010 appeared to experience higher rates of violent crime in general and of aggravated assault in particular.
Thirteen states were found to have closed 25% of their psychiatric beds during the five-year period, with two states–New Mexico and Minnesota–eliminating more than half their public beds. After its most recent closures, Minnesota provided only 3.9 beds per 100,000 people.    
Ten states added beds but continued to offer less than half the number of beds considered necessary to provide minimally adequate psychiatric care. Nevada, for example, increased its bed population by 60% but still provided only 11.2 beds per 100,000 people.
State hospital beds are reserved primarily for individuals with acute or chronic severe mental illness who meetstate criteria for civil commitment. In most cases, they cannot seek treatment voluntarily because they do not recognize they are ill, a neurological condition known as “anosognosia.” In some states, public beds numbers are reduced further because many of those remaining are reserved for forensic patients who have committed crimes.
The Treatment Advocacy Center is a national nonprofit organization dedicated to the elimination of legal and other barriers to the treatment of severe mental illness.

Monday, July 9, 2012

Recent News: CIT Teams Enhance Safety for All

Psychiatric News   |    
Volume 47 Number 13 page 9-9
American Psychiatric Association
Crisis Intervention Teams Enhance Safety of Police, Patients
Leslie Sinclair
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The Crisis Intervention Team model is based on a partnership of psychiatric emergency services, local mental health advocates, and police departments, facilitating treatment in lieu of incarceration.
“Physical force is rarely used in police encounters involving persons with serious mental illness, and the strongest predictor of the use of force by police officers is resistance by the subject,” said Michael Compton, M.D., M.P.H., director of Research Initiatives in Psychiatry and Behavioral Sciences at George Washington University School of Medicine and Health Sciences.
Michael Compton, M.D. 
Compton chaired and spoke at the symposium “Police Encounters With Individuals With Serious Mental Illnesses” at APA’s 2012 annual meeting in Philadelphia in May. He and his copresenters discussed the use of Crisis Intervention Team (CIT) training, a model of partnership between mental health and law enforcement that seeks to reduce use of force and enhance safety of officers and individuals with mental illness.
CIT training arose in the late 1980s in Memphis when the highly publicized death of a man with a mental illness led to an outcry for a more skilled approach to such cases. Since then, the so-called “Memphis model” has been implemented in numerous cities and counties.
The program provides a specialized 40-hour training that equips police officers with knowledge and skills needed to enhance their response to individuals with mental illness and safely handle mental health crisis situations. In addition, officers are educated about collaborations between mental health facilities and the police department, as well as other resources to assist in redirecting individuals with mental illness away from jails and into treatment facilities when appropriate.
Crisis Intervention Team (CIT) training helps police deescalate a crisis and avoid the use of force with someone who might be mentally ill. 
Glynnis Jones/Shutterstock
Compton has been instrumental in evaluating the effectiveness of CIT training, leading several studies of the implementation of CIT teams in communities. In the most recent of such studies, published in the July 2011Schizophrenia Bulletin, Compton and his colleagues hypothesized that CIT-trained officers would report a lower level of force used during an escalating crisis situation and that those officers would perceive lower levels of force as more effective than officers not trained in the CIT model.
The researchers sampled 135 officers in the Atlanta Police Department, 48 of whom had received CIT training. The study design was a vignette-based, self-administered survey requiring approximately 15 to 20 minutes. Each survey contained three scenarios depicting an escalating situation involving a subject with psychosis.
Their results supported their hypothesis, leading them to state, “Efforts are needed to reduce use of force toward individuals with psychotic disorders. … These findings suggest that CIT may be an effective approach. In addition to clinical and programmatic implications, such findings demonstrate a role for clinicians, advocates, and schizophrenia researchers in promoting social justice through partnerships with diverse social sectors.”
One question that has hounded the concept of CIT training is whether officers who choose to participate are pre-disposed to be more empathic. Compton and his colleagues considered that question and reported in the June 2011 Psychiatric Services the results of their before-and-after assessment of 177 officers—including 109 non-CIT-trained officers, 24 officers assigned to CIT training, and 44 officers who volunteered for the training. Associations between officer status and sociodemographic variables, past exposure to and experience with mental illness issues, and empathy and psychological mindedness were examined.
The researchers found that, although self-selected CIT officers were more likely to have prior exposure to mental health issues and professionals, there were no differences between the three groups on measures of empathy or psychological mindedness. “Although there may be other justifiable reasons to argue for the importance of volunteering, characterological empathy and psychological mindedness do not appear to be greater among officers self-selecting in CIT training,” they said.
Compton and his colleagues have also characterized the psychiatric disposition of patients brought in by CIT-trained officers in a 2005 Community Mental Health Journal report. Select sociodemographic and clinical variables were abstracted from the medical records of 300 patients during an eight-month period and compared according to mode of referral: family members, non-CIT officers, and CIT-trained officers.
Differences across the three groups were found regarding race, whether the patient was held on the locked observation unit, severe agitation, recent substance abuse, global functioning, and unkempt or bizarre appearance, but there were no differences between patients referred by CIT-trained and non-CIT officers. “Trained officers do not have a narrower view of people in need of emergency services (i.e., bringing in more severely ill individuals), and they do not have a broader view (i.e., bringing in those not in need of emergency services),” the researchers concluded. inline-graphic-1.gif
Watch Michael Compton, M.D., in an interview with Psychiatric Newsgo
“Use of Force Preferences and Perceived Effectiveness of Actions Among Crisis Intervention Team (CIT) Police Officers and Non-CIT Officers in an Escalating Psychiatric Crisis Involving a Subject With Schizophrenia” is posted “Do Empathy and Psychological Mindedness Affect Police Officers’ Decision to Enter Crisis Intervention Team Training?” is posted at “Characteristics of Patients Referred to Psychiatric Emergency Services by Crisis Intervention Team Police Officers” is posted at

AOT As A Recovery Oriented Practice

Saturday, July 7, 2012

A Preventable Tragedy occurred in Knoxville, Tennessee Last Night

This story just came to my attention.  Please note the statement in BOLD LETTERS toward the end of the article:
"During the investigation it was discovered that the suspect had a mental illness but was not taking any medication."
This is tragic news since Knoxville has a brand new Assisted Outpatient Treatment pilot program in effect beginning July 1, 2012.  Sadly, it seems this gentleman would have been a perfect candidate.  Law enforcement workers ARE NOT psychiatrists, nor should they be expected to play this role.  But they must do so every day simply because we are not catching these "untreated" psychotic, delusional individuals in time to prevent a tragedy.  We have a new law.  Let's start using it!   Let's be more proactive rather than reactive.  Let's get these folks into treatment and save lives for having done so.

KNOXVILLE - A Knoxville police officer shot and killed a man who attacked him during an assault call, according to a Knoxville Police Department spokesman.
The E-911 Center received an assault call about 10:50 p.m. Friday from a woman at 3804 Probus Road in North Ridge Crossing (formerly called Christenberry Heights), according to KPD spokesman Darrel DeBusk.
The woman, who uses a wheelchair, said her son was assaulting her.
The first officer to arrive on the scene. Brian Leatherwood, was attacked by a man, later identified as Paul Edward Capps, age 47, when he entered the residence, DeBusk said.
In a press release, DeBusk described what followed: "During the attack the suspect forcibly obtained the officer's flashlight that he (then) used in his continued attack on the officer. During the attack Officer Leatherwood attempted to use his taser, but it did not stop the assault. As the suspect continued to beat him with the flashlight, Officer Leatherwood used his service weapon to stop the threat."
Capps was pronounced dead at the scene.
Leatherwood was taken to the University of Tennessee Medical Center for treatment of non-life threatening injuries.
The woman was taken to KPD headquarters for questioning.
An autopsy on the suspect is scheduled for later today, DeBusk reported, adding: "During the investigation it was discovered that the suspect had a mental illness but was not taking any medication."
Leatherwood will be placed on administrative leave until the investigation is concluded - standard procedure for an officer involved in shooting, DeBusk said.
Leatherwood is a 13-year veteran of the department.