Friday, February 28, 2014

Shelters are taking up mental hospital slack: A report from our neighbors in Georgia.

The closure of Southwestern State mental health hospital in Thomasville has led to a dramatic increase in the number of people seeking help at Albany homeless shelters.
The Salvation Army and the Albany Rescue Mission say they're not equipped to deal with patients suffering from severe mental disorders. But they've seen a steady increase since December. A flood of people with nowhere to go will fill the empty bunks in the city's shelters tonight.   
Some have to be turned away because they're too dangerous to house.  "The other week, one went berserk out there and ended up lying under one of the picnic tables and they (police) had to pull him out of there," said Hample. "Some of them are having seizures, and we see an increase in this too." 

Sound familiar?  Read the entire article here:  Shelters take up mental hospital slack -, Albany News, Weather, Sports

"Money is not the problem …The elephant in the room is getting treatment to the most seriously ill." - DJ Jaffe op ed

Volume 48, No. 1, Winter 2014

The Real Mental Health Crisis in America
It’s not about money. It’s about misplaced priorities.

Prior to the 1960s, the United States mental health budget was primarily spent providing treatment to people with serious mental illnesses. Today, we’ve largely abandoned the most seriously mentally ill and used the budget for everyone else.

As a result of this shift, about 200,000 mentally ill are homeless, 240,000 seriously mentally ill are in prisons, and 125,000 are in jails. That’s more than three times as many as are in hospitals. In 1955, there were half a million public psychiatric beds for the seriously ill – which translated to 340 beds per 100,000 individuals. Today, there are less than 100,000 beds – which translated to 17 beds per 100,000 individuals. Because of this shortage, it’s harder to get into Bellevue than Harvard.

Anyone well enough to walk in and ask for treatment is not sick enough to be admitted. That makes involuntary admission – becoming a “danger to self or others” -- the only path to treatment. Hence, the “psychotic killer on a rampage” headlines we seem to be seeing so often these days. Community programs are no better. They largely accept the highest functioning and offload the most seriously ill to shelters, jails, prisons, and morgues. Programs that used to spend money treating those with serious mental illnesses now spend those same dollars on stigma campaigns for those without any mental illness.
In 1955, there were half a million public psychiatric beds for the seriously ill. Today, there are less than 100,000 beds. Because of this shortage, it’s harder to get into Bellevue than Harvard.

Most people with mental illness are not more violent than others. The same cannot be said, however, for the most seriously ill. Up to 50 percent of the three million people with schizophrenia have anosognosia. As a result of their illness, hallucinations and delusions trump reality and prevent them from recognizing they are ill. Not knowing they are ill, they refuse voluntary treatment. John Hinckley “knew” the best way to get a date with Jodie Foster was to shoot Ronald Reagan. Russell Weston “knew” there was a “ruby red satellite” in the U.S. Capitol that could be used to reverse time and shot two guards in order to find it. When people are that seriously ill, voluntary services will not work. If you build it, they will not come. A kind, compassionate system would help the most seriously ill get care, rather than pretend they don’t exist.

Congress is being misled by the non-profit mental health industry, which argues that ordinary life events like bad grades, being unemployed, having an unhappy marriage and this year’s cause célèbre, bullying, are the mental illnesses worthy of Congressional funding. They ignore the homeless and psychotic who can’t get treatment, sleep on the streets, forage through dumpsters for food, and scream at voices only they can hear.

Money is not the problem – mission creep is. Mental health spending totaled $100 billion in 2003, representing 6.2 percent of all health care spending. By 2014, it is expected to double to $204 billion. The elephant in the room is getting treatment to the most seriously ill. Instead of treatment, the non-profit mental health industry argues for public education. This is based on the mistaken assumption that the reason people do not get care is because they are so asymptomatic that the public needs special training to identify them, and that -- once identified -- treatment will be available. Neither is true for the seriously ill. As Creigh Deeds learned, families can -- and do -- beg for treatment for loved ones already identified as being ill. And yet they still can’t get it.
Money is not the problem … The elephant in the room is getting treatment to the most seriously ill.

If Congress wants to improve care, save money and reduce violence by the seriously ill, it should decrease mental health funding and increase mental illness funding. Replace mission creep with mission control. That’s the idea behind HR 3717, the Helping Families in Mental Health Crisis Act. Introduced this past December by Rep. Tim Murphy (PA-18), the legislation would:
  • Get treatment to people who are too sick to accept voluntary treatment -- HR 3717 funds demonstration Assisted Outpatient Treatment (AOT) projects. AOT is limited to the most seriously ill who have a past history of violence, incarceration or needless hospitalizations caused by going off treatment. It allows courts, after extensive due process, to order them to stay in mandated and monitored treatment as a condition of living in the community and, equally important, order community programs to provide the care rather than turn them away. New York’s AOT program (also known as “Kendra’s Law”) reduced homelessness, arrest, and incarceration in excess of 75% each and cut costs in half by reducing the use of more expensive incarceration and hospitalization. The Department of Justice certified AOT as an “effective crime prevention program.”

  • Free parents of seriously mentally ill from HIPAA Handcuffs -- Parents need information about the diagnosis, treatments and pending appointments of their children in order to facilitate care. But doctors hide behind federal privacy standards passed as part of the Health Insurance Portability and Accountability Act (HIPAA) and patient confidentiality laws included in the Family Educational Rights and Privacy Act (FERPA) to prevent parents from receiving it. School authorities identified Jared Loughner as being mentally ill and potentially dangerous before he shot Gabrielle Giffords, but HIPAA and FERPA laws kept his family in the dark. HR 3717 writes exceptions into the law so that won’t happen again.

  • Create an Assistant Secretary for Mental Health and Substance Abuse Disorders – More than anything, this individual is needed to end mission-creep, reduce duplication, coordinate piecemeal federal agencies and stop the federal funding of non-evidenced based programs. But beyond that, the new Assistant Secretary would also be a champion of programs that help the most seriously ill, and help disburse mental health block grants previously distributed by the Substance Abuse and Mental Health Services Administration (SAMHSA) in order to free states from SAMHSA policies that prevent those funds from reaching the most seriously ill.

  • Require SAMHSA and CMHS to focus on serious mental illness -- HR 3717 makes what should be non-controversial reforms to SAMHSA and CMHS. Among other things, it requires all grants to be evidence-based, reviewed by persons with clinical experience in mental health treatment, and prohibits SAMHSA from making grants not authorized by Congress. These reforms are needed because SAMHSA and CMHS fail to focus on serious mental illness, fund programs that lack independent evidence of effectiveness, and award taxpayer money to organizations that lobby against treatment for the most seriously ill. For example, in spite of the fact that getting the correct diagnosis is key to getting the right medication, SAMHSA distributes millions to “peer” groups that believe “psychiatric labeling is a pseudoscientific practice of limited value in helping people recover.”

  • Preserve psychiatric hospital beds -- HR 3717 rejects the mental health industry shibboleth that everyone can survive safely in the community by preserving a few inpatient psychiatric beds for those who can’t.

  • Increase the role of the criminal justice system in setting mental health policies -- Many of the policies espoused by the non-profit mental health industry, like closing hospitals and making civil commitment more difficult, increase the incarceration of people with serious mental illness. HR 3717 gives criminal justice powerful representation on federal advisory boards so they can prevent these policies from being adopted.
Many of the policies espoused by the non-profit mental health industry, like closing hospitals and making civil commitment more difficult, increase the incarceration of people with serious mental illness.

  • Refocus PAIMI – PAIMI stands for the Protection and Advocacy for Individuals with Mental Illness Program. Established with the noble purpose of providing representation to persons with serious mental illness who were being abused, the program has morphed into a political advocacy machine that ignores the psychotic and assumes all persons with mental illness are well enough to “self-direct” their own care. PAIMI lawyers “freed” William Bruce from involuntary hospital care over the objections of his Mom and Dad. William then killed his Mom. HR 3717 returns PAIMI to its original focus of helping people who need help, and prohibits PAIMI groups from using federal funds to lobby for other agendas.

  • Empower NIMH -- Under Dr. Thomas Insel, the National Institute of Mental Health has forsaken mission creep and now focuses on serious mental illness. HR 3717 turns over certain funds that were misspent by SAMHSA to NIMH, so they can find cures for serious mental illness.

HR 3717 is supported by mainstream mental health organizations like the American Psychiatric Association, American Psychological Association, and Treatment Advocacy Center. It is supported by major law enforcement organizations including the National Sheriff’s Association, and New York State Association of Chiefs of Police. And it has passionate support among families of the seriously mentally ill. The only opposition comes from those who have benefitted from the mission creep or run programs that lack evidence of efficacy.

There is a crisis. It involves people with untreated serious mental illness, not all others. Throwing money at mental health as Congress has done will not help those with serious mental illness. Passing HR 3717 is the best chance Congress has at addressing the real problem.   

DJ Jaffe is Executive Director of Mental Illness Policy Org., a non-partisan, science-based think tank focused on serious mental illness (not mental health).

Latest edition of Ripon Forum dedicated to Helping Families in Mental Health Crisis Act

cid:image001.gif@01CF0C94.F4722C50Tim Murphy
U.S. Congressman for the 18th District of Pennsylvania

ICYMI: Rep. Murphy ‘The Crusader’ on Mental Health Reform

For Immediate Release: Thursday, February 27, 2014
Contact:, 202.225.2301

(WASHINGTON, DC) — The Ripon Forum kicked off its 48th year of publication today with an edition focused on America’s mental health crisis and Congressman Tim Murphy’s effort to reform the way the country cares for and treats those with mental illness.

Dr. Murphy, a clinical psychologist with thirty years’ experienced, authored the bipartisan Helping Families in Mental Health Crisis Act(H.R. 3717) following a year-long investigation into the nation’s broken mental health system.
This edition of The Ripon Forum includes a feature article written by Rep. Murphy, which is reprinted below. The magazine also carries essays by other mental health reform advocates like DJ Jaffe, who writes that Rep. Murphy’s plan will finally focus federal programs on those in need of the help the most: persons with serious mental illness. 
“If Congress wants to improve care, save money and reduce violence by the seriously ill, it should decrease mental health funding and increase mental illness funding. Replace mission creep with mission control. That’s the idea behind HR 3717, the Helping Families in Mental Health Crisis Act,” writes Jaffe. “Passing HR 3717 is the best chance Congress has at addressing the real problem.”
Read the entire edition of the Ripon Forum by clicking here. For more information on the Helping Families in Mental Health Crisis Act (H.R. 3717) visit Murphy.House.Gov.
The Fight to Rebuild Our Broken Mental Health System
Over the last year, as chairman of the House Energy and Commerce Subcommittee on Oversight and Investigations, I embarked on a detailed review of the nation's mental-health system. With my 30-plus years of experience as a clinical psychologist, I was profoundly shocked to learn just how archaic and ineffective federal mental health policy is in our country.

Easily two million patients with serious and persistent mental illness, many of whom lack insight into their schizophrenia or bipolar disorder, go without medical treatment. Why? Because the federal government has never approached serious mental illness as a health care issue. This laissez-faire approach to brain illness has directly resulted in growing rates of homelessness and incarceration for the mentally ill over the last 20 years. Sadly, it has also led to numerous tragedies, including 38,000 annual suicides.
The result of my comprehensive review is legislation I introduced in December titled the Helping Families in Mental Health Crisis Act. This bipartisan legislation marks the most significant overhaul of the nation's mental health system since President John F. Kennedy established community mental health centers 51 years ago. It refocuses programs and resources on psychiatric care for patients and families most in need of services but who are currently the least likely to get it. My bill increases treatment options, integrates mental and physical care, and reduces barriers and the stigma associated with mental illness.

During my investigation, one barrier repeatedly showed up for families trying to help a loved one with a serious mental illness: Families and caregivers often are unable to share vital information with a physician about a loved one's medical history because of the consistent misinterpretation of the privacy rule under the Health Insurance Portability and Accountability Act (HIPAA). My legislation strengthens HIPAA by empowering parents to talk about and receive information about a mentally ill loved one, which will allow physicians to make an accurate diagnosis.

Clarifying HIPAA rules is only the beginning of changing the paradigm so those with serious mental illness are treated with dignity and compassion. The legislation also encourages states such as Pennsylvania to adopt "assisted outpatient treatment" (AOT) laws, which ensure that mental health providers target care and resources to the subset of seriously mentally ill who have repeat visits to the hospital emergency room. New York state's AOT statute, known as "Kendra's Law," has reduced incarceration, emergency-room visits, homelessness, and substance abuse by about 70 percent among the mentally ill.

The current approach to mental health can best be described by its deficits: too little integration with primary or physical care; too few psychiatric hospital beds; too few psychiatrists, psychologists, and clinical social workers, especially ones who are trained and specialize in treating the seriously mentally ill.
The Helping Families in Mental Health Crisis Act promotes integration of mental health with the rest of the medical system. It also expands the number of pediatricians and primary-care doctors trained in behavioral health so children and young adults can get immediate attention.

The inability to find qualified medical help deepens the severity of damage to the human brain, making recovery all the more difficult. Currently, patients wait on average two years after the first signs of psychosis before seeing a doctor. A breakthrough treatment project at the National Institute of Mental Health called Recovery After Initial Schizophrenia Episode, or RAISE, has shown tremendous results by treating the patient earlier with wrap-around services and low-dose medication.

Unfortunately, successful medical models such as RAISE are not getting out into the broader community. The Helping Families in Mental Crisis Act places a new emphasis on evidence-based models of care by establishing an assistant secretary for mental health and substance-use disorders, who must have clinical and research experience in treating mental illness. This individual will ensure federal tax dollars are spent on effective programs and treatments.

For far too long, those who need help the most have been getting it the least, and where there is no help, there is no hope. We can, must, and will take mental illness out of the shadows of ignorance, despair, and neglect and into that bright light of hope. It starts with theHelping Families in Mental Health Crisis Act (H.R. 3717).   RF
In his sixth term representing Pennsylvania’s 18th congressional district encompassing suburban Pittsburgh including parts of Allegheny, Washington, Westmoreland and Greene Counties, Rep. Tim Murphy also serves as a Lieutenant Commander in the Navy Reserve Medical Service Corps as a psychologist treating Wounded Warriors with post-traumatic stress disorder and traumatic brain injury. Prior to serving in Congress, Dr. Murphy, author of “The Angry Child” and “Overcoming Passive-Aggression,” was a practicing psychologist specializing in child and family treatment.
MurphyPress | Congressman Tim Murphy (PA-18)
2332 Rayburn House Office Building | Washington, DC  20515
(202) 225-2301 | (202) 225-1844

Thursday, February 27, 2014

“It's unacceptable that there are incidents where young people and even children can end up in a police cell because the right mental health service isn't available to them,” said Nick Clegg, the deputy prime minister.

England Moves to Decriminalize Mental Illness

(Feb. 19, 2014) England is planning to halve the number of times that police cells are used as an acceptable place to hold people in the midst of a psychiatric crisis (“Use of police cells during mental health crises to be halved,” the Guardian, Feb. 17).
The new agreement is a multi-organizational partnership that aims to coordinate law enforcement and mental health organizations to get people with mental illness into contact with mental health services before they end up in jail.
police_cell“It's unacceptable that there are incidents where young people and even children can end up in a police cell because the right mental health service isn't available to them,” said Nick Clegg, the deputy prime minister.
“That is why we’re taking action across the country and across organizations to make sure those with mental health problems are receiving the emergency care they need,” he continued.
The goals of the partnership include:
  • Access to support before a crisis
  • Urgent and emergency access to crisis care
  • The right quality of treatment and care
  • Recovery and staying well, and preventing future crises
Twenty-two organizations signed the agreement to prevent crises from happening whenever possible by meeting the needs of vulnerable people in an urgent situation.
Now the United States just needs to look to England’s example.
Instead, fewer than half the U.S. population lives in communities where the most basic methods of diverting people with severe mental illness from the criminal justice system are being used, according to our recent study “Prevalence of Mental Health Diversion Practices: A Survey of the States.”
SEE WHERE YOUR STATE RANKS on diverting people with severe mental illness from jail.
To comment, visit our Facebook page.
Visit our blog archive to read all our recent posts.

Two Moms Team Up, Using Tragedy to Spark Change in Mental Health System

Two Moms Team Up, Using Tragedy to Spark Change in Mental Health System

Wednesday, February 26, 2014

In Support of AOT: KNS Op Eds

For those of you who have requested, here are both op eds:

Op Ed 1:  Parkwest Shooting Points to Need for a New Law
Karen Easter, May 23, 2010, Knoxville News Sentinel

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.
Op Ed 2: Bill that would fund pilot programs for assisted outpatient treatment needed
Karen Easter and DJ Jaffe, February 22, 2014, Knoxville News Sentinel

The recent stabbing of Laurie Nichols, allegedly by her daughter Katie, shows the dire need for Gov. Bill Haslam and state legislators to overrule the Tennessee Department of Mental Health and pass a meaningful assisted outpatient treatment bill.

Assisted outpatient treatment would allow local courts to order and monitor treatment for the most seriously mentally ill, while a federal bill could provide the mechanism to fund it.

A neighbor told WVLT-TV journalists that Katie Nichols was “unstable.” After allegedly stabbing her mother, Katie Nichols told reporters, “The satanic cult in this city has been casting satanic spells on me for three or four days. I found out my mom was the ringleader. She was the Antichrist.”

Many people with untreated serious mental illness become psychotic with delusions and hallucinations. About four years ago and a mile down the road from where this stabbing occurred, Abdo Ibssa fatally shot a staff member and himself at Parkwest Medical Center because he believed doctors had implanted a tracking device in his body. People that ill will not accept voluntary services because they don’t believe they are ill.

Assisted outpatient treatment is one way to help. It allows courts — after extensive due process — to order a very small group of the most seriously ill to stay in mandated and monitored treatment as a condition of living in the community. Assisted outpatient treatment is reserved for those with a past history of violence, arrest, incarceration or needless hospitalization caused by a failure to remain in treatment.

Research shows assisted outpatient treatment reduces homelessness, arrest, hospitalization and violence by more than 70 percent each. It also cuts costs. Because Tennessee didn’t offer assisted outpatient treatment, Nichols is likely to be incarcerated or involuntarily committed at enormous expense to taxpayers.

Tennessee is one of only five states without an assisted outpatient treatment law, and blame rests with the state Department of Mental Health, which has forsaken helping the most seriously ill in favor of improving the mental health of all others. Commissioner E. Douglas Varney closed Lakeshore Mental Health Institute, leaving the most seriously ill with nowhere to go. Residents of Tennessee with mental illness are now three times as likely to be incarcerated as hospitalized.

Many with serious mental illness are too sick to recognize they are ill. In scientific terms, this is called anosognosia. We have to help these individuals rather than pretend they don’t exist.

State Sens. Doug Overbey and Becky Duncan Massey were able to get a tiny pilot assisted outpatient treatment program started in Knoxville over the objection of the department, but compromise made it so restrictive and deficient as to be practically useless. Tennesseans deserve better.

A proposed federal law, the Helping Families in Mental Health Crisis Act, would fund pilot assisted outpatient treatment programs. While Tennessee should implement assisted outpatient treatment with or without federal funding, this bill could provide a welcome offset to those who worry about cost. The closing of Lakeshore freed up $6 million.

Money is not lacking. Leadership is.

Tennessee Gets Graded for Involuntary Treatment Laws

Inpatient Commitment Grade: F

Outpatient Commitment Grade:  F 

Emergency Evaluation Grade: C 

Cumulative QOL Grade: F 

Use of Laws Grade: D


Executive Summary

The tragic consequences of ignoring the needs of individuals with the most severe mental illness who are unable or unwilling to seek treatment are on vivid display nationwide: on our city streets, where an estimated quarter million people with untreated psychiatric illness roam homeless; in our jails and prisons, which now house 10 times as many people with severe mental illness than do our psychiatric hospitals; in our suicide and victimization statistics, where individuals with psychotic disorders are grossly overrepresented; and in our local news, which reports daily on violent acts committed by individuals whose families struggled vainly to get them into treatment.
In the U.S., primary responsibility for treatment of this vulnerable and at-risk population falls to state and local governments. The performance of this vital public health function is guided by an array of laws, regulations, policies and budgeting choices, all of which vary markedly from one jurisdiction to the next. As a result, any individual’s likelihood of receiving timely and effective treatment for an acute psychiatric crisis or chronic psychiatric disease depends largely on the state and county where he or she happens to be located when such need arises.
For “Mental Health Commitment Laws: A Survey of the States,” the Treatment Advocacy Center comprehensively examined the laws each state uses to determine who within its population might qualify to receive involuntary treatment and for what duration and graded each state on two measures of their response to the treatment needs of this small but high-impact population:
  • Quality of involuntary treatment (civil commitment) laws: the adequacy of its statutory provisions to facilitate emergency hospitalization for evaluation in a psychiatric emergency; commitment to a psychiatric facility for treatment; and/or – in the 45 states where applicable – commitment to the less-restrictive option of a court order to remain in treatment as a condition of living in the community.
  • Use of involuntary treatment laws: the extent to which the state applies its laws to intervene and provide treatment for psychiatric crisis and/or chronic severe mental illness in the population that meets its civil commitment standard, according to mental health officials within the state.
The analysis found the following:
  • No state earned a grade of “A” on the use of its civil commitment laws.
  • Only 14 states earned a cumulative grade of “B” or better for the quality of their civil commitment laws.
  • 17 states earned a cumulative grade of “D” or “F” for the quality of their laws.
  • Only 18 states were found to recognize the need for treatment as a basis for civil commitment to a hospital, and several of those were found to have less than ideal standards.
  • While 45 states have laws authorizing the use of court-ordered treatment in the community, only 20 of those were found to have optimal eligibility criteria.
  • 27 states provide court-ordered hospital treatment only to people at risk of violence or suicide even though most of these states have laws allowing treatment under additional circumstances.
  • 12 states rarely or never make use of court-ordered outpatient treatment (often called “assisted outpatient treatment” or “AOT”), including eight states with laws on their books authorizing such treatment.
  • 20 states received penalty points for the prevalence of bed waits. In two of the most populous states – Florida and Texas – bed waits were reported to typically exceed two weeks.
  • Significant delays in delivering medication over objection were found in only five states, four of them in New England. In Vermont and New Hampshire, the typical delay in providing medication over objection to individuals in psychiatric crisis who were unable to recognize their need for treatment was found to be more than two months.
The deplorable conditions under which more than one million men and women with the most severe mental illness live in America will not end until states universally recognize and implement involuntary commitment as an indispensable tool in promoting recovery among individuals too ill to seek treatment. To that end, the Treatment Advocacy Center recommends:
  • Universal adoption of need-for-treatment standards to provide a legally viable means of intervening in psychiatric deterioration prior to the onset of dangerousness or grave disability.
  • Enactment of AOT laws by the five states that have not yet passed them – Connecticut, Maryland, Massachusetts, New Mexico and Tennessee
  • Universal adoption of emergency hospitalization standards that create no additional barriers to treatment.
  • Provision of sufficient inpatient psychiatric treatment beds for individuals in need of treatment to meet the standard of 50 beds per 100,000 in population.

Monday, February 24, 2014

Louisa man’s ordeal highlights gaps in system - Richmond Times-Dispatch: General Assembly

Andrew Maternick is photographed in September 2010 with his guitar. He has been diagnosed with schizoaffective disorder bipolar type. The image on the right is Andrew Maternick in 2013 being escorted from the Louisa County Courthouse back to jail. A judge found him not guilty by reason of insanity.
On Sunday evening, July 7, Andrew erupted. He punched holes in the wall of his room and bathroom. He began yelling, waking up Kyle, who had been napping upstairs. Andrew rushed outside, after first picking up a ceramic knife from the kitchen cutting board.
“He’s just like a whirlwind,” said his mother, who was frantically trying to turn on her charging cellphone to call 911.
And that’s when Andrew stabbed his brother in the right forearm with the knife.
Andrew Maternick, 25, has been diagnosed with schizoaffective disorder bipolar type, but his only treatment, other than a brief detention at a hospital in Petersburg and a 3½-week stay at Western State Hospital last fall, has been the medication the jail and his mother provide, and an occasional talk with a psychologist who visits the jail weekly.

Read his story here:  Louisa man’s ordeal highlights gaps in system - Richmond Times-Dispatch: General Assembly

Sunday, February 23, 2014

What kind of civilized nation uses emergency rooms and jails as the primary instruments of care for kids in crisis?

Yet another compelling story from a parent desperate for help for their severely ill child.

Read it here:  My-Daughter-Sleeps-in-Jail-Tonight-How-Mental-Health-Treatment-Fails-America-s-Youth-Part-I

“This tragedy, our tragedy, was not any single person’s fault, it was a fault with the entire system, and this bill, for the first time, makes some headway and will give families some hope and sense of control and safety. It’s a big bill. It’s a big problem and we need to get behind it." - Joe Bruce

Posted Feb. 14, 2014, at 11:32 a.m.
Joe Bruce, a retired Department of Transportation worker, might tell you that the worst day of his life was when he came home from work in June 2006 and found his wife, Amy, dead in the shower of the family’s home in Caratunk. She had been killed with a hatchet.
Surely it doesn’t get much worse.
But, in truth, he also might have to pause and consider the days and weeks and years that he and Amy spent in fear of that happening. All that time, they had worried whether they were safe from their son and whether he was safe from himself.
Those were pretty horrific days as well.
They knew the risk every night when they went to bed with their son in the house. They sought help from every service and venue they could and found none.
They tried to save their deeply disturbed son, who suffers from paranoid schizophrenia, as well as themselves, but were pitted against a concrete wall of bureaucracy they never could get beyond.
By the time he was at his sickest, their son was a young adult and “protected” from any intervention from his parents.
They had no say in his treatment, no rights to his medical records and were accused of trying to keep their son committed against his will.
“We knew that Will was so deep into his illness that he no longer knew he was sick, no longer knew he needed treatment. Those advocating for him were of the mindset that he was the best person to determine his treatment options. Of course that wasn’t true. He was essentially denied treatment because of laws and policies that are so one-sided they make no sense … policies that dictate that the most severely mentally ill patients have complete authority over their care, even though it is clear that they are not able to make those decisions,” Bruce said.
And so it was that Will was released from Riverview Psychiatric Center in Augusta and returned home to his parents.
Bruce went to his state job each day, called home several times a day to check on Amy’s well-being, and tried to navigate his way through the uneasy situation they were in, including their son’s habit of collecting and hiding knives and ranting to himself in the driveway.
Three months after his release, Will killed his mother with a hatchet and left her body in the shower.
He was found not guilty by reason of insanity and is now committed at Riverview.
With a great deal of effort to get past the red tape, Bruce was able to become Will’s legal guardian. He now has access to his son’s medical records and to his doctors. Father and son spend a great deal of time together and with proper medication and treatment Will is doing well at the Augusta hospital, where he has earned an increasing number of privileges, according to his father.
Since Amy’s death, Bruce retired from his DOT job and found himself in the position of advocating for better mental health services, especially focusing on the rights of the loved ones of those receiving services.
Last year he testified at hearings conducted by U.S. Rep. Tim Murphy, R-Pa., to investigate the psychiatric aspects of the mass killings at now-infamous places such as Newtown, Conn.; Littleton, Colo.; Aurora, Colo.; Tucson, Ariz.; and Virginia Tech.
Bruce notes that while the shootings probably had more to do with untreated mental illness than gun control, the national discussion didn’t reflect that.
In December, and as a result of those hearings, Murphy, a psychologist, introduced the Helping Families in Mental Health Crisis Act.
The bill would create a new assistant secretary for mental health and substance use disorders, redirecting authority from the Substance Abuse and Mental Health Services Administration. It also would clarify the type of information providers can share with families through the Health Insurance Portability Accountability Act, meaning doctors would have greater flexibility in sharing information with family members and caregivers of the most seriously mentally ill patients.
The act also would provide funds for research; address the shortage of mental health care providers, especially for children; and focus money and research on the most seriously ill.
“This bill is a chance for real relief for the millions of families that are dealing with a loved one with very serious mental illness,” Bruce said this week. “It addresses hundreds of millions of dollars in wasteful spending and redirects that money into areas that can actually make a difference to these people with severe mental illness.
“Those with the most serious mental illness have been denied treatment basically because of the severity of their illness and their family’s inability to have any input. My son was one of those cases. This bill would have offered my family some relief had its provisions been in place and it offers, for the first time in a long time, some hope to those families still dealing with this,” he said.
Bruce plugs along with his days, making the trek from Caratunk to Augusta to spend time with his son. He’s grateful each day for the care Will receives at the Riverview Psychiatric Center and mingles regularly with the same people who advocated for his son’s release back in 2006.
“This tragedy, our tragedy, was not any single person’s fault, it was a fault with the entire system, and this bill, for the first time, makes some headway and will give families some hope and sense of control and safety. It’s a big bill. It’s a big problem and we need to get behind it,” Bruce said.
You can reach Renee Ordway at

Saturday, February 22, 2014

HR3717 Details: Helping Families in Mental Health Crisis

Rep. Tim Murphy, PhD

More than 11 million Americans have severe schizophrenia, bipolar disorder, and major depression yet millions are going without treatment and families struggle to find care for loved ones.

The federal government’s approach to mental health has been a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies. Sadly, patients end up in the criminal justice system or on the streets because services are not available.

The Helping Families In Mental Health Crisis Act fixes the nation’s broken mental health system by focusing programs and resources on psychiatric care for patients & families most in need of services.

Bill Information


OP-ED: Overhaul of mental health care long overdue, by Rep. Tim Murphy, Philadelphia Inquirer (January 26, 2014)


Congressman: When It Comes to Mental Health, U.S. is 'acting like a third world country', Jake Tapper with CNN (January 27, 2014)

Family of grandson in fatal stabbing speaks out in support of Murphy MH Reform Bill, KDKA-TV, Pittsburgh (VIDEO)

Mental health pushed in Congress before Newtown anniversary, CNN (December 12, 2013)

New Bill Reduces and Improves LEO Interaction with Mentally Ill, Mental Illness Policy Org for Law Enforcement Today(December 14, 2013)


Sound Off: Mental health reform needed to help patients, Dottie Pacharis, News-Press (Fort Myers, FL) (January 20, 2014)

A Mental Health Overhaul, editors of the Wall Street Journal (December 26, 2013)

We need to take a proactive approach with mental illness, Guest Opinion by Liza Long (author of "I Am Adam Lanza's Mother") in the Idaho Statesman (January 13, 2014)

A Law to Fix Mental Health Care, Dr. Sally Satel for Bloomberg (December 22, 2013)

All in the Family: Mental Illness and Caregiving Across the Generations, Rachel Pruchno, Ph.D. for Psychology Today(January 15, 2014)

New Bill Decreases Mental Health Funding, Increases Mental Illness Funding, DJ Jaffe for Huffington Post (December 18, 2013)

Murphy’s bill a step toward mental health reform, Observer-Reporter (Washington, PA), (December 21, 2013)

San Fran should take up Laura’s Law again, Amy Yanello, San Francisco Chronicle (December 20, 2013)

Rep. Murphy’s Bill Would Shift Focus: Make Major Changes In Mental Health Care, Pete Earley, journalist and father of mentally ill son

Letters of Support

(Click on thumbnail to view Letter of Support)

University of Pittsburgh, Department of Psychiatry

New York State Association of Chiefs of Police, Inc.

National Alliance on Mental Illness (NAMI) of Ohio

National Alliance on Mental Illness (NAMI) of New York State

National Council for Behavioral Health

Mental Illness FACTS

Mental Health Association of Essex County, Inc.

No Health Without Mental Health

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Helping families in mental health crisis act