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.

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