Friday, February 04, 2005


Treatment Advocacy Center News Feb. 4, 2005


Visit our web site February 4, 2005

1. POIGNANT WITNESSES TO MENTAL-HEALTH NEEDS – Philadelphia Inquirer, February 1, 2005

2. LETTER TO THE EDITOR (untitled) -
National Law Journal, January 17, 2005

Pittsburgh Post Gazette, January 31, 2005

4. KILLING EXPOSES FLAWS IN MENTAL HEALTH SYSTEM – Collinsville Herald Journal, January 19, 2005

Collinsville Herald Journal, January 19, 2005


1. PHILADELPHIA INQUIRER, February 1, 2005

[Editor’s Note:

“I’m sorry; we can’t do anything for your loved one unless they are dangerous enough to commit to a hospital or willing to come in for help.’”

Yes indeed – to have those as the only two avenues to treatment leaves thousands stranded by the symptoms of severe mental illnesses.
We commend the New Jersey advocates striving for a greater access to care for those in crisis.]


By Marcia Windness Coward

Nothing alarms a parent like losing a child to mental illness. Thus, many family members gathered to urge New Jersey to fix its broken mental-health system at the public hearing of the Governor’s Task Force on Mental Health at Camden County College on Jan. 19.

Having had my son, Mark, die at age 38 after his five-year battle with rapid-cycling bipolar disorder, I empathized with parents at the hearing to whom trauma was no stranger. Parents seeking homeless offspring. Frustrated mothers watching their children lose health and hope. Parents becoming invisible in the information loop. Parents battling the judicial system. Mothers departing crisis centers when workers felt unqualified to handle their children’s mental illness and developmental disability. Families yearning to keep others’ sons and daughters from falling through the cracks.

Members of New Jersey’s Alliance for Persons Affected by Mental Illness pressed for continuity of care as essential to recovery. Their “continuity wish list” included generous increases in funding; treatment beds; training/retention/oversight; family-agency communication; varied, safe, affordable, accessible housing; and better integration of services for mental illness and co-occurring disorders such as addiction and brain injury – in a seamless stream.

I appealed for improved records and discharge procedures. I was thankful to see friends from South Jersey affiliates of the National Alliance for the Mentally Ill. We were all grateful to acting Gov. Richard J. Codey for his attentive task force and to timekeeper Terri Wilson, deputy commissioner for disability services of the state Department of Human Services, for her compassion.

It’s about time that families’ voices rang loud and clear, I thought. Too late for my family but, hopefully, in time to help others.

Jerry Lindauer, NAMI Mercer executive director, expressed our dream. “I’m here to ask you to eliminate this phrase from the vocabulary of the mental-health system: ‘I’m sorry; we can’t do anything for your loved one unless they are dangerous enough to commit to a hospital or willing to come in for help.’ “

He then posed a question that summed up the system’s dilemma: “What’s needed for a treatment system that can address the anguish of these families left to helplessly observe their loved one’s deterioration and one that will also support consumer autonomy and self-determination?”

I heard in Lindauer’s challenge the enormous potential of “consumers,” people with severe disorders such as major depression, schizophrenia and bipolar disorder – people like my son Mark, a devoted biostatistician at the University of Chicago Hospitals before life veered out of control. In fact, NAMI NJ’s recent Freedom From Stigma campaign honored Mozart, Beethoven, Lincoln, Emily Dickinson, Billie Holiday and Virginia Woolf – all mentally ill – for their luminous legacies.

The millions of individuals who are treatment-compliant are most likely to rebuild lives and bridges to loved ones. Their insight, perseverance and faith deserve celebration. However, mental illness often lies unrecognized, denied, untreated. If chaos ensues, how much autonomy can be expected of consumers?

Lindauer and others called for involuntary community treatment with safeguards for consumer rights and involuntary outpatient commitment when seriously impaired individuals appear at risk but do not meet legal criteria for involuntary hospitalization – that is, posing imminent danger to self, others or property. Most witnesses favored intervention.

No matter how wrenching the toll of mental illness, Kathleen Foster of National Park rejected incarceration as an alternative to treatment. The NAMI Gloucester County member serves as a facilitator at Marlton’s Rap Room Parent-to-Parent program, where she helps families find treatment settings for adult children. She knows the system nationwide.

So it carried weight that Foster joined the chorus for jail diversion. “Neither prison nor jail is equipped to recognize, manage, and/or alleviate psychiatric symptoms,” she indicated, also deploring punishments of mentally ill inmates sent to the Albert C. Wagner Youth Correctional Facility by state jails and prisons unable to manage psychotic episodes.

Foster’s dedication to the mental-health system was spurred by the death of her son, Christian, at age 28 while he awaited long-term treatment seven years ago. Foster said she was encouraged by two developments in the field. The first is the opening in February of Day Top-South, a long-term adolescent treatment facility in Pittsgrove. The second is the assumption of treatment of mentally ill inmates in all state prisons by the University of Medicine and Dentistry of New Jersey.

Yet another witness, whose 22-year-old succumbed in 1988, advocated for earlier intervention and treatment of juvenile mental illness. “Twenty percent of U.S. Children [may] have emotional disorders,” said Barbara Steltz of Barrington. “Suicide – the 11th cause of death overall – is the third-most prevalent killer in the 10-14 and the 15-21 age groups.” Steltz closed on the theme of family tragedy. She said, “We cannot afford to lose our children in any way.”

We all hoped New Jersey heard.

Marcia Windness Coward writes from Moorestown.

2. NATIONAL LAW JOURNAL, January 17, 2005

[Editor’s Note: Dr. Darold Treffert for years has championed for Wisconsin, first endeavoring for progressive treatment laws and then – once he had helped secure among the most advanced for his state – the use of such laws to aid those most lost to acute mental illnesses. Below Dr. Treffert brings his message to a broader audience, the readers of the National Law Journal.]

Letter To The Editor

As a psychiatrist long interested in providing a reasonable balance between clinical realities and civil liberties for the severely mentally ill, I was encouraged by “Mental health law: States allow courts to force treatment,” by Tresa Baldas [NLJ, Jan. 3, Page 4] reporting that 42 states have enacted laws to permit mandated treatment on an out-patient basis when necessary for certain seriously ill psychiatric patients.

But I was discouraged to read the remarks of a “civil rights” attorney that such treatment is “heavy handed” and “without evidence that it will make people’s lives any better or make society any safer.” Those comments ignore mounting evidence of the benefits of assisted outpatient treatment for patients and society.

For example, among the first 1,409 persons who received assisted outpatient treatment under Kendra’s Law in New York, 63% fewer experienced hospitalization, 55% fewer had episodes of homelessness, 75% fewer were arrested, and 69% fewer were incarcerated. Fewer hospital stays, less homelessness, fewer arrests and remaining in the community instead of being in jail or prison do qualify as “making people’s lives better.” Studies also show significant reductions in the risk of violence and victimization of the mentally ill so “society is safer” as well.

Wisconsin has one of the most progressive mental illness treatment laws in the country. The Wisconsin Supreme Court upheld the law when it was challenged, as have other courts, explaining that “[b]y permitting intervention before a mentally ill person’s condition becomes critical, the legislature has enabled the mental health treatment community to break the cycle associated with incapacity to choose medication or treatment, restore the person to an even keel, prevent serious and potentially catastrophic harm, and ultimately reduce the time spent in an institutional setting.” In Re Dennis H., 647 N.W.2d 851 [Wis. 2002].

For years I have been concerned about cases in which the mentally ill are “dying with their rights on”-circumstances where scrupulous concern for patient rights unreasonably overshadowed appropriate concern for the patient’s life. The recent trend toward better balancing the right to be free with the right to be rescued is to be commended because it does afford people who need our help the right to a better life. Lawmakers in Michigan and Florida deserve tremendous credit for using their legislative powers, and wisdom, to build a more compassionate and sensible system of care. [Readers are referred to Donald A. Treffert, “The MacArthur Coercion Studies: A Wisconsin Perspective,” 82 Marq. L. Rev. 759 [Summer 1999] for further reading.]

Darold A. Treffert, M.D.

Fond du Lac, Wis.

3. PITTSBURGH POST GAZETTE, January 31, 2005

[Editor’s Note: As mental health courts proliferate, so does the media coverage of them. A number of articles replete with their successes have been featured in the E-News. The one below on the Allegheny Mental Health Court brings us a strong figure, the kind that makes Sheriffs, Police Chiefs, and County Supervisors sit up in their chairs – in the first three years of the court program only 27 of 311participants in the program were arrested on new charges. That shows success not only in facilitating needed treatment and stability for those who go before the court but also in diminishing the burden and expense on Allegheny County correctional facilities.]


By Joe Fahy, Pittsburgh Post-Gazette

At a time when many communities are trying to keep criminal offenders with mental illnesses out of prisons and jails, the state’s first mental health court has shown promising results.

About 84 percent of people served by the Allegheny County Mental Health Court have stayed out of trouble with the law while under the court’s supervision, according to the county Department of Human Services.

From the start of the court in mid-2001 through last June, 27 of 311 people under the court’s jurisdiction were arrested on new charges, said Amy Kroll, the department’s director of forensic services. Twenty-two others were taken into custody for probation or parole violations.

Officials believe those results are encouraging as many communities struggle with rising inmate populations. Many inmates cycle in and out of incarceration at significant cost to taxpayers.

Failing to address the needs of mentally ill offenders “is a drain on the law enforcement community and the judicial and prison systems,” said state Sen. Robert Thompson, R-Chester. He noted that nearly one in five inmates in Pennsylvania prisons and jails are believed to have a mental illness, about three times the rate of the general population.

“If we can get these individuals in treatment and stabilized, we can begin to stabilize our costs,” said Thompson, chairman of the Senate Appropriations Committee.

Thompson co-authored a resolution approved by lawmakers last year to provide a report to the Legislature and the governor on the Allegheny County Mental Health Court and two initiatives for serving mentally ill criminal offenders in Chester County and Philadelphia.

That report will be based on a series of studies, coordinated by state officials and the Council of State Governments, of the fiscal impact of those programs and the advisability of replicating them in other communities. Preliminary results of the studies are expected later this year.

Reacting to requests from officials in many states, the Council developed the Criminal Justice/ Mental Health Consensus Project to improve the criminal justice system’s response to people with mental illness. Thompson co-chaired the steering committee for the project, which issued recommendations in a 2002 report.

County officials began developing the programs years ago “because we realized jails and prisons are not good places for people in terms of their health or prospects for rehabilitation,” said Patricia Valentine, deputy director of the Office of Behavioral Health.

Since the 1980s, the county has had a diversion program that works with district justices, with the goal of having minor charges dismissed after 90 days if offenders agree to mental health treatment, Kroll said. The program served 683 people in 2003.

The same year, she said, 870 people with mental illnesses were served by another program that works with people who typically face more serious charges or who have criminal records. It petitions judges to consider alternatives to incarceration, such as house arrest.

The mental health court, a collaboration involving the courts, the public defender’s and district attorney’s offices, and the county Department of Human Services, has an annual budget of about $700,000 that includes some in-kind services, Kroll said. Funding has come from foundations and public sources.

The court generally serves people with mental illnesses who do not have serious criminal histories and who are not facing a probation violation or criminal charges that include homicide, sex crimes, drug trafficking, certain thefts and assaults, or driving under the influence of alcohol.

If officials determine the case is appropriate for the court, a mental health service plan is prepared and submitted to the judge. The judge must accept the plan and participants must agree to abide by its terms before they are released from jail.

Staffers provide help with obtaining housing and mental health treatment and reinstating public assistance benefits. Participants continue to be supervised by the court throughout their probation, with “reinforcement hearings” held at least every 90 days to encourage compliance with the plan.

Mental health courts are modeled after drug courts, which originated in Florida in the 1980s, said Christy Visher, a principal research associate at the Urban Institute in Washington.

The courts are based on the premise that judges can be more persuasive in directing a defendant’s rehabilitation than probation officers or caseworkers, she said.

Evidence suggests the courts are effective, at least while participants are under court supervision, she said.

In general, the courts tend to cost more to operate than other courts, Visher said. Hearings can be longer and participants may make more court appearances.

But research indicates the courts can cut costs in other ways, primarily through the savings that result from reduced crime, she said.

Visher said Allegheny County would need to follow participants after court supervision ends to better assess the local mental health court’s success. But even short-term success is “better than doing nothing at all,” she said.

Michelle Leigh Bailey-Baird, the court’s public defender, expressed strong support for the court despite her concerns that rising case loads have made supervising participants more difficult.

The court experienced “growing pains” during its first 21*2 years, according to a report prepared by a consultant for a local foundation and posted on the Department of Human Services’ Web site.

The report noted that fewer people were accepted into the court than planned and average time spent in jail before release was longer than anticipated. Kroll said officials are working to address those issues.

Still, the results are encouraging, the report found, calling the number of participants who had subsequent problems with the law “remarkably low.”


[Editor’s Note: Whether by design or just how it works out in practice, mental health systems often gravitate towards the care of the less ill at the expense of those more gravely so. A common example of that is in the article below: Johnny Johnson missed appointments and was as a result dropped from his service program. Yet, in many if not most instances, should not missed appointments be a strident sign that a patient’s condition may be deteriorating and he or she is in more need of help than ever?

We know that it expends extra resources to track down patients unable to walk through a clinic’s door; we also, however, see the tragedies created by not doing so.]


By Bill McClellan

Johnny Johnson was convicted Monday of first-degree murder and on Tuesday a jury decided he should die for his crime. And why not? He had bludgeoned a 6-year-old girl to death with a rock after trying to rape her. What jury would spare the life of a man who committed such an unspeakable crime?

We can be sure that the jurors took into consideration the fact that Johnson was, and is, mentally ill. According to testimony at the trial, the 26-year-old Johnson has suffered from mental illness since his early teens. The first diagnosis was depression. Later, the diagnosis changed to schizoaffective disorder, which is similar to schizophrenia. In 2002, ADAPT of Missouri, which is a social service agency that works with the mentally ill, placed Johnson with a psychiatrist. From February through June of that year, Johnson regularly saw his caseworker, but then he missed appointments and a supervisor for ADAPT wrote Johnson a letter saying that the agency would cancel services to him on July 31. By the time that letter was written, Johnson had quit taking his medication. He moved out of his grandmother’s house. He was like an unstable element, waiting to explode. He killed Casey Williamson on July 26.

So you’re like me. You read about this case and you think, Why would an agency cancel services when a mentally ill person starts missing appointments? Isn’t that some kind of a warning sign?

A friend in the social service world told me that yes, of course, it’s a warning sign, but to understand why an agency would drop a person when he or she needs help the most, you have to understand the funding mechanism of something called the Community Psychiatric Rehabilitation Program. CPRP is the main state program that provides community-based services for the mentally ill. The problem with CPRP, my friend said, is that it funds only face to face contacts. Consequently, many agencies require their caseworkers to produce a certain number of hours of face to face contacts each week. An agency does not get paid to search for missing clients.

I called ADAPT of Missouri to find out if this might explain why the agency had decided to drop Johnson. I asked to speak to the chief and was directed to Bill Lertiz. “I have no comment,” he said.

I called my friend back. “I’m told ADAPT requires 22 hours a week of face to face contact,” my friend said. “That’s not unusual. But if you don’t think 22 hours is a lot, consider that it doesn’t include the mountains of paperwork, travel time to and from clients’ homes, phone calls to family, landlords, doctors, police and courts as the caseworker tries to assist the clients with their various needs. That’s unbillable time. You think you have time to go looking for somebody? All of these agencies have waiting lists of people who want help. So you get rid of those who miss appointments and replace them with somebody who will make their appointments.”

Of course, the clients who keep appointments are generally the ones who are maintaining pretty well. They’re taking their medications. They have a support system. It’s when they slip out of their support system – Johnson moved out of his grandmother’s house – that their cases hit crisis mode. And that is when agencies drop them.

You don’t have to be “soft on crime” to think something is wrong with this system. I called the Department of Mental Health. Nobody was available to discuss the program or its funding.

Truth is, though, you can’t blame the department. The funding is inadequate to help all the people who want services, much less all the people who need them. When you talk about funding, you have to talk about the Legislature. You can’t blame the legislators. There isn’t enough money to do everything. You can’t blame the agencies. If they don’t think about billable hours, they’ll end up going out of business.

That leaves Johnson. We can blame him. But when a man’s history reads like a road map to disaster and when the system rejects him when he needs help the most, should not the system bear some responsibility?

5. YORK DAILY RECORD (PA), January 12, 2005

[Editor’s Note: We have often pointed out the dire need for more inpatient psychiatric beds. Not surprisingly we view any hospital closure with trepidation. That feeling is compounded by the shock to any area’s mental health system by eliminating a large state hospital. Not only must appropriate inpatient care be found for some of the patients but the community care infrastructure must also be braced for an influx of a large group of clients whose conditions are among the most acute. The preparations take money and time. The Pennsylvania Department of Public Welfare has announced that it will close Harrisburg State Hospital and have appropriate care of its patients within one year. That proposed transition is perilously short.]


Mental Health Experts Worry About Funding After The State Hospital’s Closure.

By Jennifer Nejman

As Harrisburg State Hospital prepares to close, York County mental health experts have praised the effort to move more people to community living situations, such as group homes, but some have expressed concern about how quickly that will happen.

Last week, officials from the Pennsylvania Department of Public Welfare announced that they plan to close Harrisburg State Hospital within one year. This follows years of dropping patient counts at the oldest state hospital facility in Pennsylvania.

The hospital serves 258 patients who have diagnosed mental illnesses with a staff of about 540 people at its 200-acre campus in Dauphin County, according to the welfare department.

Of those patients, about 115 are York and Adams county residents, said Steve Warren, administrator of York/Adams Mental Health-Mental Retardation Program.

Warren said his program will play a role in the hospital’s closing by finding places for 60 residents of York and Adams counties to live in those counties. Those numbers could change based on evaluations, he said.

People who live in Harrisburg Hospital will be assessed and determinations made based on where they would like to live and on their clinical conditions, he said.

The other York and Adams county residents, who are determined to still require hospitalization like what was provided at Harrisburg State Hospital, will be moved to Wernersville State Hospital in Berks County, Warren said.

York/Adams Mental Health-Mental Retardation already has 250 people living in the two counties through programs. Through the Community Hospital Integration Projects Program, people may live in apartments and houses with supervision.

“They’ve been successful,” Warren said. “We’re looking at this as a significant CHIPP expansion.”

Warren said he believes that his program should meet the deadline and supports moving people to the community settings.

Funding for patients’ moves

Kristin Stroup, director of mental health services at Bell Socialization, said her organization’s main concern is that enough money follows Harrisburg Hospital patients into the community.

Bell Socialization works with the county’s mental health-mental retardation program through CHIPP. Stroup said she believed that her organization would be involved if hospital patients were transferred to York County.

Money from CHIPP comes from the state. Some years there have been no increases, which can make it difficult when the expenses to run the program – such as transportation, utilities and staff pay – increase, Stroup said.

Sometimes, the waiting list to get into a residential home program can be up to 6 months, she said.

She said she would feel more comfortable if the Harrisburg State Hospital were closing in a year and a half.

“I’m not saying it can’t be done,” Stroup said.

The state has not released details on how much money will be distributed to community programs, said Christina Novak, state welfare department spokeswoman.

In a statement last week, Welfare Secretary Estelle Richman said the state intends to return the millions of dollars used to run the hospital to support programs in the communities.

The logistics of offering services

Some mental health service providers cannot even begin to plan until they know more details.

York Hospital is the only hospital in York and Adams counties that has inpatient psychiatric services, said Allen Miller, director of behavioral health at WellSpan Health. The hospital regularly sees patients from the Harrisburg and Carlisle area.

Patients currently are transferred from York Hospital to Harrisburg State Hospital. When the hospital closes, patients may need to come to the hospital before moving to a residential situation, Miller said.

In addition, the hospital provides services for people who live in residential situations who may have depression or a medication issue that requires short-term hospitalization, he said.

So the volume of patients served at inpatient and outpatient programs should increase, Miller said.

A backup could occur if the proper services are not set into place, Miller said, explaining that patients have waited months in York Hospital’s inpatient unit to be transferred to Harrisburg State Hospital. If the hospital doesn’t exist anymore, that wait could lengthen if they are waiting to get into Wernersville or another facility, he said.

“We’re going to need a different level of care, some place for these people to go if they don’t go to the state hospital,” Miller said.

He said that he is in favor of the concept of moving patients out of Harrisburg State Hospital.

“It’s going so quickly – that, I think, is raising the concerns,” Miller said.

6. PATRIOT NEWS (Harrisburg, PA), January 14, 2005

[Editor’s Note: Below Dr. Cheryl Dellasega provides an analysis of the closing of Harrisburg State Hospital. She looks at whether it should be closed, whether the community system is and can be ready for the wave of released patients, and provides some interesting conjecture on why the announcement and timing are so unusually abrupt.]


Patients Or Property Behind Hospital Closure?

The bureaucratic leap from considering the closure of Harrisburg State Hospital to an actual plan has to amaze anyone familiar with the mental health system or state-level decision-making. Rarely do proposals get enacted with such speed, but when a prime piece of real estate is involved, the usual rules seem disregarded.

Not long ago, a five-year plan to downsize the hospital gradually to 150 beds was agreed upon after a summit involving community and professional stakeholders. Despite the work to forge this agreement, it now seems to have never existed. As with previous moves to deinstitutionalize, the public is being told having seriously ill patients treated in the community is not only good for patients, it’s better than being confined in a state hospital.

One wonders: If this is so beneficial how did state hospitals and similar institutions (prisons, for example) ever gain foothold, let alone survive?

The reality is not a single study shows deinstitutionalization to benefit patients or their families. The numbers cited in the recent Patriot- News article on what happened to 91 HSH patients released in 1994 can be deceptive if one focuses not on those with questionable outcomes but the 52 who “are served by mental health services in the community.” What we aren’t told is where they live in the community, or how many times they were arrested without incarceration, treated in emergency rooms or hospitalized.

These statistics are also misleading because 2004 is a different mental health world than 1994. The average wait time for an appointment with a psychiatrist is two months, and if you’re looking on behalf of a child, good luck. Within recent years, five inpatient units have closed (Edgewater, Carlisle, Hanover, Hershey Medical Center’s geriatric unit and York Memorial), and those that do remain open try to keep their length of stay under three days.

A 1999 article published in the American Journal of Psychiatry followed patients discharged from the Philadelphia State Hospital in 1990. During the first year after hospitalization, the 321 patients in their study required anywhere from 6 to 158 days of psychiatric hospitalization with an average of 76 days (about 25 of the typical three-day stays mentioned above).

Another study in Vermont showed that when patients left the state hospital, they had very little integration into the community, and 87 percent required at least one rehospitalization.

Digging further into the research literature, it quickly becomes apparent that while community placements are cheaper, they don’t reduce symptoms or improve the level of the patient’s function. Scientists evaluating the outcomes of several studies following deinstitutionalization noted that while it’s feasible to have mentally ill patients live in the community there is little evidence it enables them to function better.

These are just the hard costs of deinstitutionalization. When (and it seems to be a “when” rather than an “if” already) HSH closes, many patients will be transferred to Danville or Wernersville State Hospitals, requiring families from Dauphin and surrounding counties to travel nearly twice the distance to visit their loved one.

Then there is the safety issue. While a certain group of patients (probably those on the discharge track already), can be safely treated in the community, many cannot. Who among us would welcome a group home for persons with poorly controlled schizophrenia, manic depression or psychosis into our neighborhood? In the state hospital, these individuals are safe – to themselves as well as other people. Twenty-four hours a day, excellent nurses provide them with supervision and support.

Not so ironically, HSH is located on a property that is a lush green jewel in the midst of concrete urban Pennsylvania. It already has been stated that the facilities there will make ideal offices for state workers – perhaps the same ones pushing for closure. I suggest you visit the campus some time and see for yourself. EMPLOYEES NO doubt will benefit from an office complex on the grounds of what used to be HSH. The opportunity to have more space and to work in beautiful old buildings surrounded by trees and flowers, close to the city but without the parking problems, is appealing.

It’s patients who need the high-level security, support and services currently found in HSH and communities who have to serve as substitutes for it who will stop and wonder: Can any price be worth it?

Cheryl Dellasega, Ph.D., of Hershey is an author who writes on mental health issues.


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