Saturday, March 31, 2012

Long-term treatment in Genesee County could have prevented Texas firebombing, judge says

Long-term treatment in Genesee County could have prevented Texas firebombing, judge says

Published: Saturday, March 31, 2012, 9:00 AM
Khalil AlHajal | 
FLINT, MI -- Had Cedric Steele been compelled to undergo long-term treatment for mental illness in Flint two years ago, he might not have ended up in a Texas jail, accused of firebombing a lawmaker's officelast week, said Genesee County Probate Judge Jennie E. Barkey. 
Cedric Steele.jpgView full sizeFort Worth, Texas police believe Cedric Steele, formerly of Flint, threw bottles filled with lighter fluid at the office of state Sen. Wendy Davis, starting a small fire March 22.
Barkey said Steele was arrested in Flint in 2009 and admitted to Hurley Medical Center for mental illness before being released days later.
She said the "broken mental health system" should have prevented Steele from allegedly throwing a bag of six Molotov cocktails at the Fort Worth office of Texas state Sen. Wendy Davis on March 22.
No one was hurt in the small fire. Steele, 40, faces an arson charge. He told police and reporters after the incident that he worked for the government, that he found aliens in meteorites and that he caught Osama Bin-Laden.
Steele has a history of delusional behavior. Family members said he'd been picked up by police in Michigan several times in recent years, but never consented to long-term treatment.
He was arrested in downtown Flint in December 2009 after police found him banging on car windows, speaking of cyanide and falcons, saying he was a CIA agent and exhibiting suicidal and threatening behavior, according to court records.
He appeared before Barkey in Genesee County Mental Health Court and consented to be admitted to Hurley. He was released several days later after medication put a stop to the dangerous behavior, the judge said.
"This is exactly what's wrong with the mental health system," Barkey said. " We wait until there's a crisis. That's like waiting until the cancer has spread to your body before you use chemo."
She said two doctors reported Steele suffered from acute psychosis and delusional thought after the arrest.
"But as soon as he was no longer an immediate threat to himself or others, no one could force him to keep taking his medication," she said.
Barkey advocates for reform of mental health care laws that would change the standard for involuntary treatment and allow early intervention before crimes are committed.
"Their loved ones would not have to wait to file a petition (for involuntary treatment) until the crisis is on," Barkey said. "They didn't have to wait until the gun was pulled, the trigger was cocked. "What we have right now is not working."
Wayne County Probate Judge Milton L. Mack Jr., who lobbies for such reform, said advocates are rewriting parts of the state's mental health code with plans of introducing the proposed changes in the Legislature in the fall.
Mack said mental illness is the only type of illness in which a guardian cannot be appointed to make decisions on behalf of an incapacitated patient.
He said a person who refuses cancer treatment due to mental illness could have a guardian appointed to make cancer-related decisions. But that guardian would not be legally authorized to make mental health treatment decisions that could potentially restore the patient's decision-making capacity, Mack said.
"I would suggest that's an absurd situation," he said.
"If you want to eliminate stigma for mental illness, you'll treat mental illness like any other disease."
Others don't believe forcing treatment is the answer.
"Judge Mack is correct in the fact that there are too many people with mental illness who end up in our jails... But the answer is not to make the commitment process easier or more encompassing," said Mark Cody, legal director for the Michigan Protection and Advocacy Service.
The group advocates instead for more community mental health resources and training for law enforcement in dealing with the mentally ill.
"It's putting the right assets in place. It's not saying to the individuals with mental illness 'We're going to force your treatment,'" Cody said. "When there's forced medication, restraints and those types of things, you can see how some people would want to avoid the mental health system."
Barkey argues that there has to be some way to keep ill people on their medication.
"I don't want to punish mentally ill people," she said, "But they have a chemical imbalance. Unless the medication's right, they cannot function."

Friday, March 30, 2012

We must learn from Indianola tragedy. Access to mental health services can only help if people use them.

Kelli Sly apparently killed her 2-year-old son before taking her own life last weekend. According to her family, the Indianola woman struggled for years with severe depression and bipolar disorder. “She was in pain, and she couldn’t see a world where she wouldn’t be in pain,” Sly’s mother said later.

Many tragedies are the direct result of a person with severe mental illness. They make headlines when the lives of others are taken. A football coach. A convenience store clerk. A teenager who kills his parents, locks their bedroom door and throws a party. A toddler.

If Sly’s son were still alive, you might have only seen the obituary of a young woman in this newspaper. There might have been a short story about a car accident on Iowa Highway 28. The public would not have known about her mental health struggles.

This tragedy is a reminder that millions of Americans suffer silently with some form of mental illness. It raises questions about what else can be done to help them.

State lawmakers are redesigning Iowa’s mental health services. For decades, this state made counties responsible for managing and partially funding services for uninsured people with mental illness. That created disparities in care. The hope is a redesigned system will offer more equitable access to services, regardless of where people live.

But none of that will matter if people are not willing to use the services. Sly had refused treatment in the past and had recently stopped taking her psychiatric medications.

Resistance to getting help “boils down to the ongoing problem of stigma,” said Nancy Hale, director of the Iowa chapter of the National Alliance on Mental Illness. “They don’t equate a mental illness with other illnesses. They don’t seek service because they are embarrassed. It is an absolute tragedy.”

Society can battle stigmas surrounding mental illness by recognizing it as legitimate as any other health problem. That is why laws that require insurers to cover mental health treatment are so important.

Hale said families struggling to convince a loved one to get help should frame treatment in a positive light. “It’s not that there is anything wrong with their personality or who they are,” she said. “They are having symptoms of an illness. You would say, ‘We want you to feel better.’ ”

Reducing stigmas also requires mainstreaming mental health services into the rest of the health care system. Lawmakers must consider this to avoid building on a decades-old practice of relegating those with psychiatric problems to their own “system.” That singles out people based solely on specific health problems and perpetuates treating their illnesses as different from other illnesses.

Iowa has never had “county-based” cancer treatment programs. We don’t carve the state into regions to serve only diabetics. Public officials don’t debate which government entity should be responsible for providing help for multiple sclerosis.

None of that would make sense. Neither does carving out a separate system to help those with mental illness. But history set us on this course.

Dating back to the 1800s, government took on the responsibility of providing help to those with mental health problems. It opened asylums, coordinated community-based services and devised funding streams to pay for services. Meanwhile, the rest of the country’s health care infrastructure evolved. Mental health services were frequently not a part of it.

Now here we are. When you have chest pains or a ruptured appendix, you go to the nearest hospital. When your autistic child is having a breakdown or your husband is suicidal, you might call the police or a county hotline.

There is no way to make sense of the deaths of a young mother and her son. What we can do is learn from the tragedy.

That means sending a message that it is as acceptable to seek treatment for suicidal thoughts as it is for high blood pressure. It means recognizing mental illness can be as serious and deadly as any physical ailment.


Thursday, March 29, 2012

Mental Illness Policy Org: Statement on Kingsboro Psychiatric Hospital Not Cl...

Mental Illness Policy Org: Statement on Kingsboro Psychiatric Hospital Not Cl...: The provision that would have closed Kingsboro Psychiatric Hospital in Brooklyn was removed from the New York State budget, meaning the hosp...

Monday, March 26, 2012



The "Crime Solutions" rating by the OJP is reserved for crime prevention strategies that “have strong evidence indicating they achieve their intended outcomes when implemented with fidelity,” including more than one study confirming the results.

aot-with-logoIn making the determination, the Office of Justice Programs cited multiple studies showing that assisted outpatient treatment (AOT) “significantly” reduces arrests for violent offenses, other arrests and violent behavior. In one cited study, the combination of at least six months of court-ordered outpatient treatment and outpatient services, the probability of violent behavior was cut in half.
“The federal government’s recognition of the growing mountain of evidence that AOT reduces crime is most welcome,” said Treatment Advocacy Center Policy Director Brian Stettin. “We hope the determination will encourage more states and communities to fully implement their AOT laws.”
Crime Solutions is “intended to be a central, reliable, and credible resource to help practitioners and policy makers understand what works in justice-related programs and practices” and to “assist in practical decision making and program implementation,” according to the Office of Justice Programs website. 
Advocates for assisted outpatient treatment are encouraged to send the determination to their lawmakers, mental health agency directors and others in a position to reform or implement involuntary treatment laws in their states. Visit Get Involved for tips on effective advocacy.
For detailed information about AOT, see our “Assisted Outpatient Treatment Laws” backgrounder updated in January. For information about your state’s AOT law, choose your state from the drop-down menu to the right or visit our civil commitment laws page.

Plans to close Alabama's state psychiatric are dropped. “The main concern is they are going to shut down the state hospitals and not have the resources in place in the community,” said Connie Ewing, president of the Mobile Chapter of the National Alliance on Mental Illness."

Community concerns persist after deadline to close Searcy dropped

Published: Monday, March 26, 2012, 7:11 AM
Casandra Andrews, Press-Register 
searcy hospital.jpgSearcy Hospital
MOBILE, Alabama -- What’s next for Searcy Hospital and its 240 patients?
Concerns persist among local mental health advocates and family members of the mentally ill about the Mount Vernon hospital’s eventual closing, and events that would follow.
Leaders with AltaPointe Health System, which operates a psychiatric hospital in Mobile, 22 group homes and plans to soon open another hospital in Daphne, say they are ready to serve many Searcy patients, so long as adequate funding is available.
Searcy Hospital, established in 1902, provides care for adult psychiatric patients in south Alabama. Of the patients there now, about 120 hail from the Mobile area.
It’s immediate future is in flux.
A month ago, the state announced a plan to shut Searcy, Greil Memorial Psychiatric Hospital in Montgomery and North Alabama Regional Hospital in Decatur by Sept. 30, eliminating more than 900 jobs.
Such closures have been a longtime goal of the state Department of Mental Health, so that patients could flow into community-based treatment programs, putting them closer to their homes and families and to familiar surroundings.
But, 10 days ago, Gov. Robert Bentley and Mental Health Commissioner Zelia Baugh said they were re-evaluating the plan and considering keeping some of the hospitals open, at least temporarily.
“The main concern is they are going to shut down the state hospitals and not have the resources in place in the community,” said Connie Ewing, president of the Mobile Chapter of the National Alliance on Mental Illness.
“We don’t really want people institutionalized. We support closing state hospitals. We are just not prepared yet.”
Ewing said she has a son who was hospitalized for a mental illness a few years ago. He spent time at AltaPointe’s BayPointe hospital in Mobile, and now lives in an apartment, although he is unable to work.
Ewing described a recent public meeting at which state mental health officials asked those in attendance what communities needed to be prepared to handle patients who would be moving back.
“I think everything is just so up in the air,” Ewing said. “There’s no real actual plan ... it seems kind of backward.”
Ewing said she has a friend with a son who’s been at Searcy for four years. The friend, she said, is “scared to death” that he’ll drift into harm’s way.
Beatrice McClean, Searcy’s executive director, referred questions this week to Tony Thompson, a spokesman for the Department of Mental Health. Thompson could not be reached for comment.
Not all Searcy patients would be able to leave. About 40 — many of whom were the subjects of criminal cases and insanity rulings — would remain in state care, likely at a hospital in northern Alabama, according Tuerk Schlesinger, CEO of AltaPointe, who is familiar with Searcy’s daily census.
It’s unclear whether other area hospitals, besides those owned by AltaPointe, could or would treat psychiatric patients released from Searcy.
Stan Hammack, a vice president with University of South Alabama Health Systems who oversees USA Medical Center, was on vacation last week, but offered a prepared statement through a spokesman. “Medical acute care hospitals cannot be the solution for psychiatric patients displaced by state budget problems,” he said. “The hospitals do not have the appropriate setting, security, staff or financial resources.”
Mark Nix, CEO of Infirmary Health, which operates Mobile Infirmary, Infirmary West, Thomas Hospital in Fairhope and North Baldwin Infirmary in Bay Minette, was out of the country and couldn’t be reached for comment.
Providence Hospital, located in west Mobile, is not licensed to accommodate any patient with a primary psychiatric diagnosis, according to a spokesman. Springhill Medical Center also has no beds licensed for inpatient psychiatric care.
Schlesinger expressed confidence that AltaPointe could accommodate most Searcy patients from the Mobile area, although he questioned how much funding that the state would offer.
“I think this commission is going in the right direction shutting down institutions,” Schlesinger said, noting that AltaPointe would be “glad to employ staff from the state hospital.”

Saturday, March 24, 2012

Finally - a good place to start the AOT journey in Tennessee!

Persistence pays off:

Latest news coming from the Tennessee Legislature:  "There shall be created a pilot project in Knox County, Tennessee ... for 10 patients to received assisted outpatient treatment."    

Stay tuned.  More details posted here as they develop!

Friday, March 23, 2012

AOT Myths: Debunked

There is a lot of misinformation about assisted outpatient treatment. Here is a quick look at some of the myths and realities involved.

MYTH: Assisted Outpatient Treatment is going to fill hospital wards.
REALITY: Assisted Outpatient Treatment is designed to help people succeed out of the hospital. It helps those with a history of non-compliance induced dangerousness comply with treatment and therefore prevents them from deteriorating to the point where they need hospitalization.

MYTH: Assisted Treatment will empty hospital wards.
REALITY: Inpatient hospitalization will still be needed for those incapable of surviving safely in the community. Assisted outpatient treatment facilitates early short-term rehospitalization for those noncompliant and likely to become dangerous.

MYTH: Assisted outpatient treatment does not work.
REALITY: Studies in Iowa, North Carolina, Hawaii, Arizona and other states have definitively proven assisted outpatient treatment works.

MYTH: Assisted Outpatient Treatment will bust the budget.
REALITY: Assisted Treatment is not expensive because it does not mandate any services that individuals with brain disorders are not already entitled to (example: case management, medications, rehabilitation). Assisted Outpatient Treatment Orders merely require the system to facilitate compliance for non-compliant individuals by giving them the services they need to keep well and the surrounding community safe.

MYTH: Assisted outpatient treatment is unconstitutional.
REALITY: Forty-one states and the District of Columbia have assisted outpatient treatment laws. The Supreme Court has overturned none of these laws.

MYTH: Assisted treatment infringes on civil liberties.
REALITY: It is the illness, not the treatment that restricts civil liberties. Medicines can free individuals from the “Bastille of their psychosis” and enable them to engage in a meaningful exercise of their civil liberties. Assisted outpatient treatment cuts the need for incarceration, restraints, and involuntary inpatient commitment, allowing individuals to retain more of their civil liberties.

For more information:

Resisting treatment for mentally ill is foolhardy

Resisting treatment for mentally ill is foolhardy

Thursday, March 22, 2012

Tennessee AOT status update: It's not good, it's not fair and it's not acceptable.

Advocates who have been working faithfully since 2007 to get AOT laws on Tennessee's books were hoping that the newest SB0608 would fit the bill as well as the budget, since it was specifically designed to have minimal if any financial impact. But, quite astonishingly, that has not happened.

Read on about what has gone very wrong with no real satisfactory explanation "why":

With the arrival of a new governor and mental health commissioner in 2011, Tennessee mental health advocates had reason to hope for a fresh start at enacting an assisted outpatient treatment law. We helped Sen. Doug Overbey (R-Maryville) craft a bill that would be impervious to any charge of budget busting. Where prior Tennessee bills had ambitiously provided for counties to establish formal AOT programs, the new proposal was simply to empower courts to order AOT in individual cases – and only if a family member or caregiver could establish that treatment providers had already agreed to participate. In other words, the bill would do nothing more than allow court orders to be integrated with existing services, to boost the likelihood of patient adherence.

Last spring, when Sen. Overbey made an agreement with the Tennessee Department of Mental Health
(DMH) to table the bill in exchange for their promise to study it carefully and issue a report to the Legislature, we fretted over whether the report would be fair. But, at the very least, we
expected the report to concern itself with the scaled-back approach to AOT that had been proposed. No such luck.

In November, DMH released its report, estimating an implementation cost of $40 million over three years and rehashing old claims about the challenges of establishing AOT programs, hiring new staff, providing additional psychiatric evaluations, monitoring patients and compelling local providers to participate. That the bill at issue would mandate none of these things went

Even beyond this obvious misrepresentation,the findings mystify. For example, DMH assumes (absurdly)that the number of AOT recipients in Tennessee would be proportional to the numbers that have been served in New York. By that logic, Tennessee would have no reason to expect more than 270 AOT orders per year. And yet the report somehow estimates 600 patients in the first year and 800 in the second.
(Exerpt from The Catalyst, Spring 2012, Treatment Advocacy Center)

Wednesday, March 21, 2012

When a Mentally Ill Child Becomes a Mentally Ill Adult

It's a Catch-22 that strikes many family members of patients—mostly young males—who are severely mentally ill and refuse to seek care. They've learned that as difficult it is to provide safety for a mentally ill child, it is exceedingly more difficult when that child becomes a mentally ill adult. Laws that previously gave parents control over their child's treatment disappear and are replaced by new laws that protect the individual's freedom and privacy. Barred from their child's medical decisions, parents find themselves in an abyss of helplessness and guilt.

An interesting exchange took place on The Daily Show when comedian Jon Stewart interviewed the secretary of Housing and Urban Development (HUD) about homelessness.

"Between shelters, emergency rooms and jails, Donovan told Stewart, it costs “about $40,000 a year to have a homeless person on the streets.”

An interesting exchange took place on The Daily Show when comedian Jon Stewart interviewed the secretary of Housing and Urban Development (HUD) about homelessness.

In response to a question about what's planned on the homelessness front, Secretary Shaun Donovan told Stewart, “The thing we finally figured out is that it’s actually not only better for people but cheaper to solve homelessness than it is to put a Bandaid on it ...”(The Daily Show, March 5, at about 2 minutes in).

(We’ll second that.)

To which Stewart responded, “But isn’t so much of it tied up also in the mental health system? Because an awful lot of people on the street are suffering from disabilities and illnesses that are untreated?”

(Which we’ll second while raising a cheer from the bleachers for getting it.)

To which Donovan replied: “You know what’s amazing particularly on that point? A veteran is 50% more likely to be homeless than the average American.”

(Uh, hello?)

So Donovan had nothing to say – then or anywhere in the 5:57-minute segment – about the role of untreated severe mental illness in homelessness.

The nugget that the head of HUD did drop, however, is something that every advocate for assisted outpatient treatment (AOT) should scoop up and share with any public official who says local governments can’t afford AOT.

Between shelters, emergency rooms and jails, Donovan told Stewart, it costs “about $40,000 a year to have a homeless person on the streets.”


Per homeless person.

With a price tag like that, decision makers owe constituents evidence that they can't afford a community-based treatment option that's been proven to help people too ill to seek treatment voluntarily get off the streets and stay out of ERs and jails.

"One of the greatest diseases is to be nobody to anybody." - Mother Teresa

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

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 were convinced that these stories were powerful, compelling, and had the potential to change the way society views mental health and illness.

This documentary film will be told through the eyes of several subjects 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 these individuals 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 bare 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!

For more information:

Sunday, March 18, 2012

Mental Illness Policy Org: Recent Trends in Mental Illness

Mental Illness Policy Org: Recent Trends in Mental Illness: Trend: More psychiatric hospitals close. Local NAMIs start to fight back. The trend towards closing state psychiatric hospitals in spite o...

Mental Health: Roadblocks to Recovery: Forcing Dignity, a Sheriff draws a line!

Mental Health: Roadblocks to Recovery: Forcing Dignity, a Sheriff draws a line!:      Recently, the Sheriff in Summit County, Drew Alexander, made the startling declaration that he would refuse to accept inmates with seve...

Friday, March 9, 2012

Mentally Ill and Homeless?

Former New Jersey Gov. Richard Codey went undercover as a homeless man this week and emerged with more bad news about being mentally ill and homeless.
nj-senator-codey-headshot“The indictment here is of a system that says if you’re male, or have an illness that’s mental, they don’t want you," he told the Star-Ledger (“NJ Sen. Codey goes undercover to research Newark homeless shelter,” by James Queally, March 6). "And if you’re not on a public entitlement program, there’s no bed at the inn."
Codey said he called more than 20 homeless shelters and care facilities in Newark and was often told by employees that they would not accept patients that suffered from mental illnesses.” Robert Davidson, executive director of the Essex County Mental Health Association, said studies indicate 90% of New Jersey’s homeless population suffer from a mental illness, which means that 9 out of 10 of the state's homeless are being left - literally - out in the cold.
Codey previously went undercover in 1989 to expose shoddy hiring practices at a state mental hospital. A champion for mental illness issues since the 1981 day when he first stepped onto the New Jersey Senate floor, he was one of four New Jersey advocates honored by the Treatment Advocacy Center with its 2011 Torrey Advocacy Commendation. The award is given to recognize courage and tenacity in fighting for the right to treatment of those too disabled by severe mental illness to seek or accept care.