Saturday, May 28, 2005


Funds Added for Mental Illness Treatment Services

House Clears Funding Bill for Veterans Medical Care -- $200 Million in Additional Funds Added for Mental Illness Treatment Services

May 27, 2005

The House this week completed action on legislation funding the Department of Veterans' Affairs for fiscal year 2006. The legislation includes record increases for treatment services for veterans living with mental illness. In particular, for the first time, Congress has chosen to set a minimum funding requirement for veteran's medical care with respect to mental illness treatment services. This effort was motivated out of concern that the VA needs to do significantly more to address the growing needs of veterans living with mental illness.

The legislation, known as the FY 2006 Military Quality of Life and Veterans Affairs Appropriations bill (HR 2528), represents the first step in the process of funding the VA. The measure now moves on to the Senate, which is expected to take up the bill later this summer.

Legislative Report Urges Making Mental Illness Treatment Services in the VA

The legislative report accompanying HR 2528 contains specific language directing the Department of Veterans' Affairs on how the fenced off funds for mental illness treatment services are to be used. This legislative direction to the VA is almost unprecedented and represents a clear direction from Congress that mental illness treatment is to be an elevated priority for the agency. In addition, the report notes that this direction is being put in place with the support of the Department's Undersecretary for Health.

Specifically the language dictates that not less than $2.2 billion is to be designated for mental illness treatment services. This is out of a total projected FY 2006 budget for veterans' medical care of $20.995 billion, a $1.6 billion increase above FY 2005 and a $1 billion increase above the President's request. The VA itself estimates that specialty mental health services in the VA will top $3 billion this year and that the entirety of health care supporting veterans with mental illness (both mental illness and general medical care) will soon approach $10 billion.

More importantly, the legislative report accompanying HR 2528 -- which has now been endorsed by the full House -- goes on to state:

"The Committee has taken the unusual action of fencing a portion of medical services funding for one category of treatment because the Committee recognizes the need to dedicate resources to such treatment and wishes to be assured that funding for mental health care will not be siphoned off for other purposes during the year of execution."

Congress Urges VA to Increase Funding for Mental Illness Research

In addition, this spending bill also calls on the VA to make mental illness research a higher priority and specifically chides the VA for dedicating only 7% of the total VA medical research budget of $784 million for mental illness research (estimated at $56 million in FY 2005). Further, the legislative report, the House Appropriations Committee notes a consensus among experts that mental illness will be the most pressing problem for the VA. The report goes to note:

"The Committee believes that more effort into research will lead to earlier identification of problems and more effective treatment, thereby reducing the long-term complications and costs associated with mental health issues. As a goal for fiscal year 2006, the Committee believes the Department should dedicate at 20% of its research budget to dealing with the issues of mental health diagnosis and treatment. The Committee directs the Department to establish this goal and work toward achieving the goal by focusing investments in facilities with mental health specialization."

Finally, the report sets forth a specific timetable for the VA to report back to Congress on how this 20% goal is to be reached, including plans for addressing any deviation from progress towards the goal. Again, this specific direction from the House Appropriations Committee represents an unprecedented effort by Congress to ensure that mental illness research becomes a top priority for the VA.

NAMI would like to offer thanks to key leaders in Congress who made the increased funding for mental illness treatment and research a reality. In particular, NAMI is grateful for the efforts of Military Quality of Life Subcommittee Chairman James Walsh of New York and Ranking Member Chet Edwards of Texas.


NAMI E-News Alerts are electronic newsletters provided free of charge as a public service. With more than 200,000 members and 1,200 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. Contributions to support our work can be made online at

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NAMI ~ 2107 Wilson Blvd. ~ Suite 300 ~ Arlington, VA 22201

Monday, May 23, 2005




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May 20, 2005




3. MEASURE WOULD FORCE MEDICATIONS - Kennebec Journal, May 19, 2005

4. KENDRA'S LAW WORKS AND SHOULD BE RENEWED - Albany Times Union, May 15, 2005

5. WORTH OF KENDRA'S LAW DEBATED - Rochester Democrat & Chronicle, May 15, 2005

6. JAIL: THE BEST TREATMENT FOR MENTAL ILLNESS? - American Daily, March 10, 2005



[Editor's Note: In the battle for treatment, there are many champions; yet each year we normally have only one award to bestow in recognition of extraordinary advocacy for those most affected by severe mental illnesses. This year, however, we selected co-winners for the Torrey Advocacy Commendation. There was simply no way to chose between Sheriff Donald Eslinger, Linda Gregory, and Alice Petree. For years this tragedy-forged triumvirate unrelentingly strove to bring assisted outpatient treatment to Florida - and this year they succeeded.]



For Immediate Release

May 18, 2005


Mutual Tragedy Spurs Successful Reform Of Florida Law For People With Severe Mental Illnesses

ARLINGTON, VA - The board of directors of the Treatment Advocacy Center today announced that Seminole County Sheriff Donald Eslinger, Linda Gregory of Jacksonville, and Alice Petree of Sanford are the winners of its annual national mental illness advocacy award. The Treatment Advocacy Center (TAC) is a national nonprofit organization dedicated to removing barriers to treatment of severe mental illnesses. May is national mental health month.

Eslinger, Gregory, and Petree won this year's national Torrey Advocacy Commendation for their successful advocacy for a new mental illness treatment law in Florida. The TAC award recognizes the courage and tenacity of those who selflessly advocate - despite criticism and opposition - for the right to treatment for those who are so severely disabled by severe mental illnesses that they do not recognize that they need treatment.

The board of directors of the Treatment Advocacy Center voted unanimously to recognize all three Florida advocates in an unusual move that paralleled an unusual advocacy partnership. "We are impressed by their heart-felt efforts over more than four years to get a more humane treatment law for Floridians with severe mental illnesses," said TAC board secretary Dr. Fred Frese. "We commend Sheriff Eslinger, Linda Gregory, and Alice Petree for their incredible dedication and effectiveness in spearheading a complex and critical reform of Florida's outdated treatment law."

The Florida House of Representatives cited the TAC award in a resolution sponsored by Rep. David Simmons and Rep. Sandra Adams that recognizes these three advocates for "their successful advocacy in honor of Deputy Sheriff Gene Gregory and Alan Singletary and all people with severe mental illnesses who will benefit from their efforts."

The result of their work is Florida's new law, which took effect January 1, 2005, that allows assisted (court-ordered) outpatient treatment for people with severe mental illnesses, like schizophrenia and bipolar disorder, who have a history of noncompliance combined with either repeated Baker Act admissions or serious violence. Court-ordered outpatient treatment is a less restrictive, less expensive alternative for those who need intervention but do not require inpatient hospitalization. New statistics from New York, a state with a similar law, show that for those in the program, 74% fewer experienced homelessness, 77% fewer experienced psychiatric hospitalization, 83% fewer experienced arrest, and 87% fewer experienced incarceration. Individuals enrolled were also more likely to regularly participate in services and take prescribed medication.

On July 8, 1998, Deputy Sheriff Gene Gregory and Alan Singletary, a man with a history of severe mental illness, died in a 13-hour standoff. Seminole County Sheriff Eslinger vowed to not let their deaths be in vain, and created a Mental Health Task Force to advocate for reforms in mental health and substance abuse services and laws. With the unlikely team of Alice Petree, the sister of Alan Singletary, and Linda Gregory, the widow of Deputy Sheriff Gene Gregory, Sheriff Eslinger worked, through the task force and with other community groups and stakeholders, to increase awareness of the need for treatment of mental illnesses. With the leadership of the Florida Sheriffs' Association, the efforts of these advocates and the community network they helped to create resulted not only in reforming the Baker Act to allow for assisted outpatient treatment, but also in other beneficial programs for those with mental illnesses such as jail diversion, forensic treatment programs, mental health screening at a county correctional facility, funding for a detox receiving facility, a voluntary identification program, and law enforcement crisis intervention teams.

About The Award -The Torrey Advocacy Commendation is presented annually by the Treatment Advocacy Center's Board of Directors. The award is named for Treatment Advocacy Center president and founder Dr. E. Fuller Torrey, M.D., a nationally known and respected psychiatrist, researcher, and advocate whose unflagging resolve to remove barriers to treatment for people with severe mental illnesses sparked a national reform movement. Recipients make a substantial difference for their community through advocacy, awareness, research, or legislation in this field.



Tune in to hear about the fruit of our award winners' labor starting this Saturday. Linda Gregory and our executive director, Mary Zdanowicz, will discuss the new Baker Act law on "Criminal Justice Forum" - the law is a new beginning for Florida, but only if it is widely understood and implemented. Mary and Linda will explain the law and its importance, discuss how it works, and talk about the successes other states are having with similar laws. Criminal Justice Forum will air on Saturday May 21st at 12:05pm on WTAN 1340 AM in Clearwater; 1350 & 1400 AM in New Tampa.

You can also listen live from anywhere in the country via the internet at (hit "listen Now" in upper left corner of page)

The program will air again on Tuesday May 24th at 11am on 1490 AM in Bradenton and 1280 AM in Sarasota. And, after then, the program will be posted in the Criminal Justice Forum online archives as a free download available at any time at



[Editor's Note: Advocates are still working to remove Maine from the short list of states that has no law for assisted outpatient treatment. That effort has garnered the endorsement of a powerful array of professional organizations and recently gained even more steam with the backing of the state department overseeing mental health services.]


By Gary Remal

AUGUSTA -- Debate about legislation that would speed forced medication on hospitalized psychiatric patients has grown into a larger battle likely to result in a clash in the Legislature.

Sen. John Nutting, D-Leeds, backs the idea of forcing mentally ill people living in community settings to take medication or face rehospitalization. He said he will introduce a measure to allow it.

The Legislature's Health and Human Services Committee is scheduled to discuss the proposal today at 3 p.m.

Known as "outpatient commitment," forcing medications on psychiatric patients is a highly charged issue in the mental health community -- with patients, medical professionals and some family members fighting over the power to control courses of treatment.

Nutting said outpatient commitment in New York during the past five years reduced the percentage of people with mental illness in New York jails by 28 percent.

He said compliance with prescribed medication also increased to 91 percent.

"Most of the states, 42, have it," Nutting said.

But Helen Bailey, public policy director at the Augusta-based Disability Rights Center, opposes Nutting's proposal. In response to concerns, Nutting said criteria for its use have been tightened, with the method not recommended for people younger than 21.

Nutting said such changes helped convince state Deputy Health and Human Services Commissioner Brenda Harvey to drop her opposition.

"We built a coalition supporting the bill that includes the Maine Psychiatric Association, the Maine Medical Association, the Maine Chiefs of Police Association, the Maine Sheriffs Association, the Maine Nurse Practitioners Association, as well as hundreds of parents (of the mentally ill) in support groups across the state," Nutting said.

Bailey, a lawyer who represents mental health patients in hospitals and community programs, said she and other advocates for the mentally ill want changes to the law that would get drugs to hospitalized patients faster.

Harvey said she changed her mind because Nutting's revised legislation called for increased support for people with mental illnesses living in their communities to help head off rehospitalization.



[Editor's Note: Some mental health departments and treatment providers take a "show me" attitude when assisted outpatient treatment comes to their state, but almost always experience with the treatment mechanism creates an appreciation for its ability to reach the most recalcitrant cases. In 1999, the New York State Department of Mental Health was less than enthusiastic when Kendra's Law was proposed. That department now vigorously endeavors to make Kendra's Law permanent.

Dr. Mary Barber's attitude was similarly transformed by running the assisted outpatient treatment program in Ulster County.]


By Mary Barber

Five years ago, Kendra's Law brought assisted outpatient to New York state. The program mandates outpatient psychiatric treatment through a court order for a small population with severe mental illnesses, mostly schizophrenia, who are too ill to make informed treatment decisions.

As the law expires this year, we at Ulster County Mental Health Department urge continuation of assisted outpatient treatment with state funding to ensure the long-term viability of the law.

We were initially skeptical about the program. It was an unfunded mandate that added only a couple of new intensive case management slots. We believed the law had no teeth and that court petitions would not change the behavior of a patient truly resistant to treatment. We guessed that case management resources might help some patients, but that court orders would add little beyond that.
We feel much differently after five years of experience with the law.

Kendra's Law makes counties responsible for their most high-risk, high-need people. With that responsibility comes the opportunity to exert more centralized control over housing, treatment and case management resources, which benefits the system as a whole.

Much of the effectiveness of assisted outpatient treatment comes from making providers accountable. The law allows and requires close communication among all providers. This helps avoid fragmentation of care and patients slipping through cracks in the system.

Assisted outpatient treatment also supports providers in helping those hardest to help. Providers are more willing to take in severely ill and high-risk patients when they know the assisted outpatient treatment team will help oversee these cases, including developing new strategies if patients become symptomatic or a particular housing or treatment arrangement doesn't work.

Many patients feel compelled to follow court orders, even knowing that the most severe consequence if they do not follow their treatment plan is being taken to an emergency room (something most of the patients who are placed on petitions have already experienced numerous times). We have witnessed many amazing successes for people on petitions.

The petitions, with their specific treatment plans, provide a much-needed consistency for patients. In the past, these patients have often been shuffled among different clinics, hospitals and jails. They have been given multiple short trials of different medications, with little communication between different parties involved in their care. The treatment plan written in a patient's court petition follows that patient for the duration of the petition and is adhered to by all involved providers. This consistency is crucial.

Intensive case management and oversight by the assisted outpatient treatment coordinator and psychiatrist benefit patients on enhanced services -- voluntary services that some patients accept in lieu of court orders. For some patients, however, adding services is not enough, and a court order is necessary.

We have conducted 90 assisted outpatient treatment investigations. Of these, 47 people received enhanced services and 15 have gone on to require a court petition. For this significant minority, court is an important addition. The most common reason for our county to not renew a petition at its expiration has been improvement by the patient to the point that he or she could participate voluntarily in treatment, which speaks to the positive effect these petitions have. For many, this is the first period of stability they have experienced in years.

Over a three-year period, among people on assisted outpatient treatment in Ulster County, hospital and jail stays are estimated to have been reduced by 3,500 days and 1,000 days, respectively. Clearly, assisted outpatient treatment petitions have saved patients from more restrictive institutional settings, saved our community money and kept our community safer by avoiding the incidents that lead to jail and hospital stays.

The centralized management of Ulster County's assisted outpatient treatment program by a coordinator and psychiatrist is key to its success, but this centralization is not cheap. Our local government fully funds the coordinator and psychiatrist positions, and our attorney hours. We have been fortunate as a county to have a legislature willing to support this level of service. In other counties, where these resources are lacking, enforcement of the law may not be as active.

We urge the state Legislature to renew Kendra's Law and to provide more funding to support it. This will ensure that programs will survive through difficult local budget cycles. It will also ensure more consistency across counties, rather than being dependent on the good graces of each local government.

Our initial doubts have been soundly invalidated by assisted outpatient treatment successes. Now that we know it works, let's support it fully.



[Editor's Note: The parties in New York debating Kendra's Law have differing opinions on exactly what the future of the program should be, but we have been pleased that among what they do agree on is that the program should have a future. We have no doubt that Joyce Claypool is pleased as well.]


Statute On Requiring Treatment For Mentally Ill Expires June 30

By Erika Rosenberg, Albany Bureau

(May 15, 2005) - ALBANY - For 15 years, Joyce Claypool watched as her brother's life was taken over by paranoid schizophrenia.

He went through bouts of hospitalization and homelessness. Fights with the police landed him in jail. He did things like stalk a woman, jump out of a moving car and cut himself. And he always maintained that he wasn't sick.

"He has no insight into his illness at all," said Claypool, who lives in Albany.

About five years ago, her brother was ordered into treatment by a court under a new law named for Kendra Webdale, a 32-year-old woman who in 1999 was pushed to her death in front of a New York City subway train by a schizophrenic man.

It hasn't been a panacea, but the court-ordered treatment has given Claypool's brother and their family more stability and peace than they've known in a while. He lives with his mother, and trips to the hospital are less frequent.

"The only thing that works is Kendra's Law mandating him. If he has to take the medication, he takes the medication," Claypool said. "Life has been so much better the past five years."

Now legislators are weighing what to do with the law setting up court-ordered treatment, which expires June 30. Some families and groups want to see it made permanent, but others are raising questions about why the law doesn't seem to be uniformly applied across the state and whether using the court system is a good way to help the mentally ill.

Lawmakers say they are likely to take a middle course of extending the law for several more years and ordering more study of it.

"I think the wisest course now is to extend it for three to five years, get the appropriate research and see if we can deal with the concerns of most advocates," said Sen. Thomas Morahan, R-New City, Rockland County, chairman of the Senate's mental health committee.

His counterpart in the Assembly, Peter Rivera, D-Bronx, held hearings on the law in Buffalo and New York City.

"It's a good law. All the parents who came and testified said that but for Kendra's Law, they would be living lives of desperation," Rivera said.

Not All Agree

The law is strongly supported by Gov. George Pataki, Attorney General Eliot Spitzer and the state chapter of the National Alliance for the Mentally Ill, one of the leading groups for families of mentally ill people. Both Pataki and Spitzer have proposed bills making the law permanent. "We don't see any point in continuing a trial period for a law that has definitively proven itself to be successful," said Assistant Attorney General Brian Stettin.

But another influential lobby group, the Association of Psychiatric Rehabilitation Services, is pushing for further study. Its director, Harvey Rosenthal, said the law was adopted in an atmosphere of fear of people who are mentally ill and under the false premise that many of them are violent. Rosenthal said that what's needed is better, more accessible treatment, not court coercion.

"I think it's unconscionable that people should have to go to court," Rosenthal said. "It's an inappropriate mechanism. The real answer is better services."

Since the law was adopted in August 1999, seven months after Webdale's death, more than 10,600 cases have gone to the courts and about 4,100 court orders have been issued. An additional 3,000 people have committed to voluntary agreements with counties to participate in outpatient mental health treatment.

In most cases, county mental health officials seek the court orders, sometimes on behalf of families. State psychiatric hospitals also try to obtain court orders for patients they are releasing but fear will not participate in outpatient treatment. Families can directly file for a court order, but that rarely happens.

How It Works

Under the law, there's a psychiatric evaluation and court hearing before a mentally ill person is placed under a court order. The person must have a history of hospitalization, violence, failure to stay in treatment or take care of herself, or other serious problems.

Someone who is an immediate danger to himself or others can be involuntarily committed to a psychiatric hospital; in contrast, Kendra's Law is aimed at people who can live in the community but need regular care to avoid hospitalization, suicidal tendencies and violence.

"Kendra's Law is not about the mentally ill in general. It's about a very special population of mentally ill folks who don't take their medicine or comply with other treatment," Stettin said.

A state study of the law found that 71 percent of people under court-ordered treatment had schizophrenia and 13 percent had bipolar disorder. The average court order lasts 16 months.

The Office of Mental Health report found that court-ordered treatment helped many, but not all, of the people involved to take their medicines and participate regularly in mental health services. Life skills, such as preparing meals, taking health care advice and keeping appointments, also improved.

The proportion of people abusing alcohol or drugs fell from about 45 percent to 23 percent, while those threatening suicide or hurting other people fell from 15 percent to 8 percent, according to the report.

"The patients are doing a lot better. There are fewer people roaming the streets, unmedicated and unmonitored," Stettin said.

Numbers Vary

Court orders are used much more frequently downstate than in most of upstate. While about 60 percent of cases in New York City led to court orders, just 16 percent of those in Monroe County did.

Officials and advocates aren't sure why, but they guess that counties have different philosophical approaches, and some might prefer to make voluntary agreements.

Kenneth Glatt, Dutchess County's commissioner of mental hygiene, said he was initially skeptical about the law and considered it toothless. People who defy their court orders aren't thrown in jail, though police can pick them up and take them to a hospital. But now Glatt acknowledges that the court orders have made a difference.

"The psychological impact of a court order has proven effective," he said. "It somehow is enough to touch the healthy part of them. It's really voluntary compliance."

But people ordered into treatment under Kendra's Law often don't like it. Some fight the court orders, and more than half of about 80 interviewed for the state report said they were angered or embarrassed by the experience.

Those around them, however, say the mentally troubled people sometimes have to be forced into doing what's good for them.

Jack Goldstein, a 48-year-old Rochester man who has depression and works at a community program to teach life skills to mentally ill peers, said he wants to use the law to get help for a troubled friend. The man is schizophrenic, living on the streets and sleeping in the woods. He carries books, magazines and clothes around in a soggy garbage bag that has been rained on, Goldstein said.

"I know when he was in the hospital, when he was on meds, he was a different person," he said. "We're trying, and I'm hopeful that he'll qualify for the program, because he really needs housing, first of all."


AMERICAN DAILY, March 10, 2005

[Editor's Note: Just as it respects neither nationality nor race, severe mental illness has no political affiliation. Whether it is with legislators, newspapers, or political commentators - the effort to reform treatment laws does not fall within boundaries marked by terms like liberal and conservative or Democrat and Republican.

Below a member of the right looks at the plight of untreated psychiatric disorders.]


By Paul M. Weyrich

My brand of conservatism is cultural conservatism. It's a completely different strand of thought than extreme libertarianism which sees no real place for government at all. Cultural conservatism believes in limited government and we often work in coalition with sensible libertarians and more free-market-oriented conservatives on important issues upon which we agree, namely reducing the size of the Federal Government. One important distinguishing feature of cultural conservatism is that we believe in upholding the importance of traditional values in a community. We also are concerned for those who cannot truly care for themselves but we place more faith in private and religious institutions than in government bureaucracies to truly help those in need.

Conservatives such as Tommy Thompson, when he was Governor of Wisconsin, demonstrated that concern when he promoted welfare reform. Many people in his state were ticked off - rightly so -- that people would receive government checks in lieu of working. They would have children without being able to support them independently. Thompson realized that the hardworking taxpayers had a legitimate gripe. He also knew that the welfare recipients were really the biggest victims. The government helped to lock them into poverty without providing the motivation to improve their lot in life.

Worse, the odds were that their children would also become trapped in that same poverty. Thompson pushed the boundaries by obtaining waivers from the Federal Government to permit the State Government to require welfare recipients to hold jobs in order to receive their benefits.

Wisconsin's efforts to break the cycle of poverty that started under Thompson continue.

CATO Institute issued a state report card on welfare reform last year. Wisconsin received an "A" for its program. "Thanks to Wisconsin's innovative Work First and Pay for Performance programs, plus the very real threat that nonworking people will simply be cut off, almost 67 percent of welfare recipients are working," wrote CATO Institute welfare policy analyst Jennifer Zeigler.

Thompson's leadership in reforming welfare helped to trigger a national revolution for the better. Wisconsin's welfare reform helped demonstrate to the poor that they could break the government chains that perpetuated their poverty. Left to the will of the government's bureaucrats in the state social service agencies, it's unlikely that welfare reform would ever have occurred.

Some people are truly helpless. America's mentally ill have been placed on the streets, often ill prepared or not being provided the medical care they need. This started during the 1960s when the state-operated hospitals for the mentally ill fell under fire for their poor management. Organizations such as the American Civil Liberties Union exacerbated the problem by pushing for deinstitutionalization. A lack of affordable housing, particularly the disappearance of single-residence occupancy housing, helped to exacerbate the problem. Turning the mentally ill out of the institutions brought about results that proved to be as disappointing as when they were in mismanaged institutions.

The result is that many mentally ill are homeless, wandering the streets, sometimes even posing a danger to the community, because their illness is untreated. It's quite likely you have seen an unkempt person acting belligerently, even threateningly, behaving in a manner as no rational person ever would dream of behaving. That person is mentally ill and the likelihood is that he has fallen through the cracks of our system particularly if he has no family or comes from one without the means to pay for expensive treatments.

However, there is a new de facto hospital for the mentally ill: America's prison system. The mentally ill, left to fend for themselves, often end up running afoul of law enforcement because of their aggressive behavior. Some very well may have broken the law but quite often the police do not understand the mentally ill person is displaying symptoms of illness. The police often do not realize that the mentally ill have grandiose feelings and that makes them very difficult to handle, adding to the burden already upon the police.

The problem is that the prisons are no place to house those who truly are mentally ill. When Cheri Nolan, Deputy Assistant Attorney General, Office of Justice Programs, testified before the House Judiciary Committee's Subcommittee on Crime, Terrorism and Homeland Security last year she stated: "If the crime is serious, incarceration is the appropriate response, regardless of whether the perpetrator has a mental illness. Our policy is clear: we will not absolve someone of any responsibility for committing a crime simply because he or she has a mental illness."

Nolan explained that many of the mentally ill are jailed for committing low-level crimes only to be placed on the streets where they will once again commit the same crimes. In this case the justice system is equivalent to the dog chasing its tail endlessly. The mentally ill who are jailed are strong candidates for return visits once they are released. Ms. Nolan testified that the Los Angeles County Board of Supervisor's Task Force on Incarcerated Mentally Ill found that 90 percent of the county's inmates who have mental illnesses are repeat offenders. Too many mentally ill leave jails where their needs for treatment have not been provided, ending up on the streets without the needed connections for treatment, housing and the support services they need and the result is they end up in prison once more.

Many localities and states are failing to come to terms with the problem of the mentally ill. The Treatment Advocacy Center says eight states do not mandate treatment in the community setting - Connecticut, Maine, Maryland, Massachusetts, Nevada, New Jersey, New Mexico and Tennessee. This can help push the mentally ill into the hands of law enforcement and prison guards rather than medical personnel. Pennsylvania's law governing the treatment of the mentally ill has required since the mid-1970s that dangerousness be a determining condition for arrests. Philadelphia's Police Chief ordered that the mentally ill be arrested for disorderly conduct rather than placed into custody under the Mental Health Act. The Treatment Advocacy Center in a February 2005 briefing paper on "Law Enforcement and People with Severe Mental Illnesses" says "That practice continues today when officers and deputies find there is no way to get psychiatric help for a person who is psychotic but not yet obviously dangerous."

Steve Leifman, a Judge who sits on Florida's Eleventh Circuit, which covers Miami-Dade County, explained the problem in a letter posted on January 9, 2005 on the Miami Herald's website: "[People with mental illness] are arrested and jailed for minor offenses and nuisance behavior, such as disorderly conduct or trespassing. Once incarcerated, they remain jailed eight times longer - and at a cost that is seven times greater - than those without mental illnesses arrested for the same offenses." The Judicial Circuit upon which he serves instituted a program to divert the mentally ill from the criminal justice system to obtain treatment for their illnesses. Law officers have received training in how to recognize and to better deal with the mentally ill. Leifman wrote that the recidivism rate among the mentally ill in Dade County has fallen dramatically and that taxpayers are saved over $2.3 million annually.

Memphis' police force has a special crisis intervention team which personnel specifically are trained to handle people with mental illnesses. The Treatment Advocacy Center states that police's Crisis Intervention Team (CIT) personnel "learn to interact with people with mental illness who are in crisis in a way that de-escalates, rather than inflames a tense situation. CIT officers can also divert a person to a mental health treatment facility rather than jail when appropriate." Portland, Oregon, Seattle, Houston and San Jose are some other cities that are using similar approaches.

More effort needs to be put forth to assure the police understand the problems of the mentally ill and how best to deal with them. In many cases sensible treatment is vastly preferable in terms of cost and compassion than incarceration. A return to institutionalization may be warranted for some hard-luck cases although it will be important to administer the facilities well to prevent the scandals that helped fuel the drive for deinstitutionalization in the first place. It's important that the law enforcement and the courts seek to provide appropriate responses to the mentally ill who have yet to commit true crimes of violence. Ensuring they receive treatment may even help to prevent even worse crimes from occurring. "Go directly to jail" is not the right path to take in such cases.

Paul M. Weyrich is Chairman and CEO of the Free Congress Foundation.


Treatment Advocacy Center E-NEWS is a publication of the Treatment Advocacy Center.

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Tuesday, May 10, 2005


Watch a Program about the Jailed Mentally Ill

Watch the video here:

Read about the problem here:

Discuss the program here:

Why are so many mentally ill behind bars? Who's to blame? What can I do as a citizen? Why is Ohio at the forefront of dealing with this issue?...

An interactive map displaying statistics on the mentally ill in state prisons and contact information in each state.

A look at the legacy of closing America's mental hospitals ... the push for mental health diversion courts ... why so many mentally ill cycle back into jails and prisons after being released.

Comments about the Show

As a California Department of Corrections professional who has worked 3 1/2 years as a State Correctional Officer inside a level 3 prison and who is now currently working as a seasoned California Parole Agent of eight years after watching your New Asylums broadcast one agonizing recurring thought kept jumping through my mind.

How manymore years and how many more millions and millions of dollars will be lost to fund an illegal war overseas and how many more millions and millions of dollars will be spent on elite overseas corporate expansionism until americans come to realize how critical components of our internal government systems such as department of corrections systems are falling apart at the seems.

It is a tragedy in the worst sense that mentally ill inmates and parolees do not have the care facilities to help them. I cannot even begin to relate to you my horror stories having worked with inner city LA San Diego and now even northern CA offenders in my never ending day to day struggles working as a CA Parole Agent.

Thank-you for your broadcast. It is the people of Frontline and the people involved with the making of this broadcast that will eventually move citizens to take political action to change a once great government system that has become corrupted beyond belief thanks to corporate greed such as the Enron scandal that competely ripped the guts out of California.

Sorry about the run on sentences and typos but I was too angered and teary eyed. I had to type what immediately came to my head.

Ken Palmer
Yuba City, California


After watching your program I was terrified at the current system for psychiatric care in this country. With an ever growing number of mentally ill people in this country how can our administration justify closing so many psychiatric hospitals? The client to therapist ratio is astonishing with many states equaling 50 clients to one therapist. Thank you for enlighting me and encouraging me to fight for change in our current system. Prisons for the mentall ill is something that would have occurred in the dark ages and should not be accepted now.

Brian C


Thank you so much for an amazingly powerful presentation of the problem facing every state. I can only add that you missed the women with mental illness who are in prison in proportionately higher numbers than males with even more complex persistent pathology.

Robert Powitzky Ph.D.
Oklahoma City, Oklahoma


I was fascinated at your documentary on "The New Asylums".
I spent 2 years in a county prison and am a mental health patient. ...
Eventually I started receiving my medication but in the two plus years I was in there not once was I seen by a psychiatric doctor.
Our prison systems definitely need some help on the lower levels not only the state prisons.

Carol Bolen


Your documentary was compelling to say the least. It is heartbreaking to see someone suffer and though these men have committed crimes I can still empathize wtih their demons and their feelings of "craziness." I was in a female institution thankfully only for several days and the whole time I was there I was closely monitored and treated for "mental illness". The level of care equalled or exceeded any I have experienced in a psychiatric hospital or drug rehabilitation center I have been unfortunate to be in. The other point I would like to make is that the lack of the mention of drug and alcohol addiction was startling in its absense. In my experience in the rehab aftercare and legal system in my state; I have heard professionals cite percentages of from 50-70% of crimes are committed either directly being in the drug trade or committing crimes under the influence. I know this first hand; as I would never once been in the legal system had I not abused alcohol. I have also suffered from intense anxiety and depression but I did not break the law without the alchol addiction added to the mix. That is my story but it is the story of many in the prison system as well.

Donna C
Vernon, CT


I am a psychologist who works with delinquent youth in California. We have developed a program that assesses young offenders in order to identify their mental health issues make recomendations to the courts for treatment and begin the process of getting them the most effective interventions possible. After four years in business our in-house research shows the recidivism rate of our clients is about half that of a control group in Juvenile Hall who did not recieve such services. I have worked for two other programs that provided people who are incarcarated services to help them succeed in the "real world" with similar results. My conclussion is that as long as we as a society focus on punishment over rehabilitation in our justice system we will continue down the same road of skyrocketing costs and unnecessarily destroyed lives. Thank you Frontline for taking on this serious issue.

paul jenkins
sacramento, CA


I have worked in the mental health field for over twenty five years. Half of this time was with the courts and jail system trying to divert the mentally ill from corrections whenever possible.

As a percentage we now have more mentally ill in jail and prisons than we did 100 years ago.

I now work in in a long term facility for the mentally ill. I daresay that the majority of the staff there feels the same as the general public.....that most mentally ill deserved to be punished or in prison.

We are trying to make a change in Indiana. Read about The PAIR Mental Health Diversion Program [].

Thanks for the program.

This is a dark time in the treatment of mental illness. Will it change in my lifetime?

Robert Cardwell
Indianapolis, IN


Treating the mentally ill in prison is neither humane nor effective. The lack of secure psychiatric hospitals contributes to the high recidivism of offenders who are mentally ill. Patient rights groups and the courts have compounded the problem by giving the profoundly mentally ill the right to refuse medications. These meds are
often the only intervention which subdue symptoms that may lead them to offend or become violent. The prisons in our country have become dual use facilities - penal colonies and colonies for the chronically mentally ill.

don Headland
Morro, CA


Thank you for being the conscience of our nation once again. I wonder how many of the tens of thousands of mentally ill inmates would ever have committed a crime had they had access to quality affordable appropriate care when they first became symptomatic? Not only is this program an indictment of the manner in which we treat our poor and indigent mentally ill who come to the attention of the criminal justice system it is also an indictment of the social and healthcare policies that make first rate psychiatric care a luxury rather than a necessity.

Susan Braider
Red Hook, NY


Thank you for being the conscience of our nation once again. I wonder how many of the tens of thousands of mentally ill inmates would ever have committed a crime had they had access to quality affordable appropriate care when they first became symptomatic? Not only is this program an indictment of the manner in which we treat our poor and indigent mentally ill who come to the attention of the criminal justice system it is also an indictment of the social and healthcare policies that make first rate psychiatric care a luxury rather than a necessity.

Susan Braider
Red Hook, NY


The "documentary" fails to document the decisions made by experts who advocated closing mental hospitals. People ill prepared to cope with society were released. Many landed on the streets Others inhabited facilities for the homeless. It would be interesting to know the percentage who survived and thrived.
It was unrealistic to think that most of the former patients would continue with their medications on their own.
While I feel sorry that some of these patients are confined in prisons I do not blame our society. The blame rests with those so-called experts whose advocacy unfortunately was followed.

Elinor Stickney


As a Mental Health Counselor for the Georgia Department of Corrections I must commend you for your portrayal of this situation in our prisons today. My hope is that programing such as this will not leave viewers simply angry and disgusted. Hopefully some will be motivated to lobby for change in their various communities. This is an underserved population who consequently have been politically silenced. Let our awareness lead to action.

Billy Yarbrough
Atlanta, Georgia


Several websites on the internet are dedicated to the exploration and photographic preservation of modern ruins and abandoned structures.
Without exception each site features an abandoned mental health facility.

There are dozens of them scattered throughout the country vast structures situated on beautiful tracts of land many still containing beds and medical equipment as if hurriedly vacated fenced off and patrolled by private security agencies while they collapse into decay with no apparent efforts being made to utilize or preserve them. What a shame to confine our mentaly ill to prisions while these hospitals lapse into ruin.

What possible justification could there be for this?

thomas cowart
lawrenceville , Georgia


There are no easy answers. That would be an understatement.

From personal experience I can tell you that state mental hospitals are prisons unto themselves. I have never been convicted of a crime and have always volunteered for mental health treatment and yet I have found myself imprisoned and in isolation for many days on end.

I fear the mental health system. Frontline should investigate further. Where can the impoverished mentally go and receive quality treatment???

Seth Brigham
Boulder, Colorado


I am glad that treatment for mental illness inside correctional institutions was finally brought to he forefront in this Frontline documentary. I think the next natural step is to address and investigate the community mental health system that these men are forced into once they are released and parolled into the community. As a social worker who has worked with persons with persistent mental illness I have seen what happens to these men when they are released from prison into the community to "halfway houses" and the community mental health system. As the documentary mentioned they often "fall through the cracks" of the community mental health system and end up decompensating and often end up back in prison. The community mental health system at least in Ohio is overloaded and grossly underfunded which directly impacts the recidivism of parolees with mental illness. If the community mental health system could be overhauled as well as the psychiatric treatment in the prisons has been then these men would actually have a better chance of recovery and I would hope be able to live a life free of criminal activity. Thank you for your continued effort at addressing mental illness with your program.

L. Mattes

Saturday, May 07, 2005


Suicide Prevention Funding

Senate Allies Push for Suicide Prevention Funding

May 6, 2005

A bipartisan coalition of House members -- led by Senators Gordon Smith (R-OR), Mike DeWine (R-OH), Christopher Dodd (D-CT), Jack Reed (D-RI) and Harry Reid (D-NV) -- are currently pushing their colleagues to include funding for recently authorized federal initiatives to expand effective youth suicide prevention services.

FY 2006 Funding for Youth Suicide Prevention Initiatives

This past fall, Congress passed -- and President Bush signed into law -- the Garrett Lee Smith Memorial Act (P.L. 108-355), authorizing new programs at SAMHSA to support states and local communities in developing comprehensive strategies for suicide prevention among adolescents and young adults. The new law also authorizes expansion of campus-based mental health services. NAMI strongly supports this new law. For FY 2005, Congress allocated $7 million for programs authorized under the Garrett Lee Smith Act, including planning grants to the states to develop comprehensive suicide prevention strategies. NAMI urges full funding in FY 2006 ($16.5 million) for suicide prevention activities authorized under the Garrett Lee Smith Act.

Action Required

Advocates are strongly encouraged to contact their Senators and urge them to sign the Smith-DeWine-Dodd-Reed-Reid letter in support of FY 2006 funding for suicide prevention and campus mental health initiatives authorized under the Garrett Lee Smith Act. All Senate offices can be reached by calling 202-224-3121 or at

In calling Senate offices, advocates are strongly encouraged to remind members of Congress that:

According to the Centers for Disease Control and Prevention, suicide is the third leading cause of death in youth aged 10 to 24.
About every two hours, a young person under the age of 25 commits suicide.
Tragically, over 4,000 young lives are lost each year to suicide.
More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic disease combined.
The good news is that with proper mental illness treatment, many of these suicides can be prevented.
To help ensure that at-risk youth get the services they need, the Garrett Lee Smith Act provides grant funding to states for development of a youth suicide prevention and intervention strategy.
By requiring states to distribute at least 85 percent of grant funding to entities that will carry out the implementation of the state strategy, this legislation will help ensure that federal funds will reach youth at risk for suicide.
Funds authorized under the Garrett Lee Smith Act can be used by school districts, juvenile justice systems, local governments and non-profit behavioral health entities to implement a variety of programs targeted at preventing youth suicide, including mental health screening and treatment services.
The Garrett Lee Smith Act also provides support for colleges and universities to establish or enhance their mental illness treatment and outreach services in campuses across the country.
The new law also establishes a federal Suicide Technical Assistance Center to provide guidance to grantees, establish standards for data collection, and collect, evaluate and disseminate data related to the program.
Thanks for your outstanding advocacy work.


NAMI E-News Alerts are electronic newsletters provided free of charge as a public service. With more than 200,000 members and 1,200 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. Contributions to support our work can be made online at

Thursday, May 05, 2005


NAMI Update

NAMI To Participate in Congressional Briefing on Children’s Mental Health

May 4, 2005

There is a critical need for our nation to improve the early identification of mental disorders in children and adolescents and to ensure early and appropriate intervention. This has now been well documented by the U.S. Surgeon General, President Bush’s New Freedom Commission and by numerous national experts in children’s mental illnesses.

Yet, there is currently a destructive campaign of misinformation underway about President Bush’s New Freedom Commission (NFC) report and mental health screening. Congressional briefings will be held, sponsored by the Campaign for Mental Health Reform (of which NAMI is a member), that are designed to set the record straight about the importance of early identification of mental illnesses in children and adolescents and the critical need for early intervention.

Dr. Ken Duckworth, NAMI’s Medical Director and a child and adolescent psychiatrist, will present as part of a distinguished panel of experts and will serve as the moderator for these briefings.

We urge you to contact your Congressional members today to ask them to attend these critically important briefings. Here are talking points that you may wish to use when contacting those offices:

These briefings will address the public health crisis in our nation in unidentified and untreated mental illnesses in children and adolescents and the often tragic consequences that ensue -- including youth suicide, locking youth with mental illnesses up in juvenile detention centers, school failure and families struggling with unthinkable crises.
These briefings will set the record straight on the recommendations on early identification and early intervention included in President Bush’s New Freedom Commission report on mental health. It will also address campaigns of misinformation about mental health screening that drive up stigma and unnecessarily prey on fears.
The briefings will include panelists who will establish the scientific basis for early intervention and the incredible cost of failing to provide needed mental health treatment.
"Dear Colleague" letters are being sent to all House and Senate offices from the members of Congress that are coordinating the briefings (Senators Gordon Smith, Christopher Dodd, Mike DeWine, Jack Reed, Arlen Specter and Tom Harkin and Representatives Tim Murphy and Grace Napolitano on behalf of the Congressional Mental Health Caucus).
Here are the specifics about the House and Senate briefings:

Briefing Title: Promoting Resilience and Mental Health: The Need for Early Intervention for Children and Adolescents

Date and Time: May 11, 2005

Senate Breakfast Briefing: 8:30 a.m. – 10:00 a.m.

House Lunch Briefing: 11:30 a.m. – 1:00 p.m.

Location: Senate Briefing – 902 Hart Senate Office Building

House Briefing – 345 Cannon House Office Building

All House and Senate members can be reached by calling the Capitol Switchboard at 202-224-3121 or online through .


NAMI E-News Alerts are electronic newsletters provided free of charge as a public service. With more than 200,000 members and 1,200 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. Contributions to support our work can be made online at

If you have any questions, concerns, or comments, please send an email to

NAMI ~ 2107 Wilson Blvd. ~ Suite 300 ~ Arlington, VA 22201

Tuesday, May 03, 2005


Schizo-Affective Disorder


What Is Schizoaffective Disorder?

Schizoaffective disorder is a major psychiatric disorder that is quite similar to schizophrenia. The disorder can affect all aspects of daily living, including work, social relationships, and self-care skills (such as grooming and hygiene). People with schizoaffective disorder can have a wide variety of different symptoms, including problems with their contact with reality (hallucinations and delusions), mood (such as marked depression), low motivation, inability to experience pleasure, and poor attention. The serious nature of the symptoms of schizoaffective disorder sometimes requires patients to be hospitalized at times for treatment. The experience of schizoaffective disorder can be described as similar to "dreaming when you are wide awake"; that is, it can be hard for the person with the disorder to distinguish between reality and fantasy.

How Common Is Schizoaffective Disorder?

About one in every two hundred people (1/2 percent) develops schizoaffective disorder at some time during his or her life. Schizoaffective disorder, along with schizophrenia, is one of the most common serious psychiatric disorders. More hospital beds are occupied by persons with these disorders than any other psychiatric disorder.

How Is the Disorder Diagnosed?

Schizoaffective disorder can only be diagnosed by a clinical interview. The purpose of the interview is to determine whether the patient has experienced specific "symptoms" of the disorder, and whether these symptoms have been present long enough to merit the diagnosis. In addition to conducting the interview, the diagnostician must also check to make sure the patient is not experiencing any physical problems that could cause symptoms similar to schizoaffective disorder, such as a brain tumor or alcohol or drug abuse.

Schizoaffective disorder cannot be diagnosed with a blood test, X-ray, CAT-scan, or any other laboratory test. An interview is necessary to establish the diagnosis.

The Characteristic Symptoms of Schizoaffective Disorder

The diagnosis of schizoaffective disorder requires that the patient experience some decline in social functioning for at least a six-month period, such as problems with school or work, social relationships, or self-care. In addition, some other symptoms are commonly present. The symptoms of schizoaffective disorder can be divided into five broad classes: positive symptoms, negative symptoms, symptoms of mania, symptoms of depression, and other symptoms. A person with schizoaffective disorder will usually have some (but not all) of the symptoms described below.

Positive Symptoms

Positive symptoms refer to thoughts, perceptions, and behaviors that are ordinarily absent in people in the general population, but are present in persons with schizoaffective disorder. These symptoms often vary over time in their severity, and may be absent for long periods in some patients.

Hallucinations. Hallucinations are "false perceptions"; that is, hearing, seeing, feeling, or smelling things that are not actually there. The most common type of hallucinations are auditory hallucinations. Patients sometimes report hearing voices talking to them or about them, often saying insulting things, such as calling them names. These voices are usually heard through the ears and sound like other human voices.

Delusions. Delusions are "false beliefs"; that is, a belief which the patient holds, but which others can clearly see is not true. Some patients have paranoid delusions, believing that others want to hurt them. Delusions of reference are common, in which the patient believes that something in the environment is referring to him or her when it is not (such as the television talking to the patient). Delusions of control are beliefs that others can control one's actions. Patients hold these beliefs strongly and cannot usually be "talked out" of them.

Thinking Disturbances. The patient talks in a manner that is difficult to follow, an indication that he or she has a disturbance in thinking. For example, the patient may jump from one topic to the next, stop in the middle of the sentence, make up new words, or simply be difficult to understand.

Negative Symptoms

Negative symptoms are the opposite of positive symptoms. They are the absence of thoughts, perceptions, or behaviors that are ordinarily present in people in the general population. These symptoms are often stable throughout much of the patient's life.

Blunted Affect. The expressiveness of the patient's face, voice tone, and gestures is diminished or restricted. However, this does not mean that the person is not reacting to his or her environment or having feelings.

Apathy. The patient does not feel motivated to pursue goals and activities. The patient may feel lethargic or sleepy, and have trouble following through on even simple plans. Patients with apathy often have little sense of purpose in their lives and have few interests.

Anhedonia. The patient experiences little or no pleasure from activities that he or she used to enjoy or that others enjoy. For example, the person may not enjoy watching a sunset, going to the movies, or a close relationship with another person.

Poverty of Speech or Content of Speech. The patient says very little, or when he or she talks, it does not amount to much. Sometimes conversing with the patient can be unrewarding.

Inattention. The patient has difficulty attending and is easily distracted. This can interfere with activities such as work, interacting with others, and personal care skills.

Symptoms of Mania

In general, the symptoms of mania involve an excess in behavioral activity, mood states (in particular, irritability or positive feelings), and self-esteem and confidence.

Euphoric or Expansive Mood. The patient's mood is abnormally elevated, such as extremely happy or excited (euphoria). The person may tend to talk more and with greater enthusiasm or emphasis on certain topics (expansiveness).

Irritability. The patient is easily angered or persistently irritable, especially when others seem to interfere with his or her plans or goals, however unrealistic they may be.

Inflated Self-Esteem or Grandiosity. The patient is extremely self-confident and may be unrealistic about his or her abilities (grandiosity). For example, the patient may believe he or she is a brilliant artist or inventor, a wealthy person, a shrewd businessperson, or a healer when he or she has no special competence in these areas.

Decreased Need for Sleep. Only a few hours of sleep are needed each night (such as less than four hours) for the patient to feel rested.

Talkativeness. The patient talks excessively and may be difficult to interrupt. The patient may jump quickly from one topic to another (called flight of ideas), making it hard for others to understand.

Racing Thoughts. Thoughts come so rapidly that the patient finds it hard to keep up with them or express them.

Distractibility. The patient's attention is easily drawn to irrelevant stimuli, such as the sound of a car honking outside on the street.

Increased Goal-Directed Activity. A great deal of time is spent pursuing specific goals, at work, school, or sexually.

Excessive Involvement in Pleasurable Activities with High Potential for Negative Consequences. Common problem areas include spending sprees, sexual indiscretions, increased substance abuse, or making foolish business investments.

Symptoms of Depression

Depressive symptoms reflect the opposite end of the continuum of mood from manic symptoms, with a low mood and behavioral inactivity as the major features.

Depressed Mood. Mood is low most of the time, according to the patient or significant others.

Diminished Interest or Pleasure. The patient has few interests and gets little pleasure from anything, including activities previously found enjoyable.

Change in Appetite and/or Weight. Loss of appetite (and weight) when not dieting, or increased appetite (and weight gain) are evident.

Change in Sleep Pattern. The patient may have difficulty falling asleep, staying asleep, or waking early in the morning and not being able to get back to sleep. Alternatively, the patient may sleep excessively (such as over twelve hours per night), spending much of the day in bed.

Change in Activity Level. Decreased activity level is reflected by slowness and lethargy, both in terms of the patient's behavior and thought processes. Alternatively, the patient may feel agitated, "on edge," and restless.

Fatigue or Loss of Energy. The patient experiences fatigue throughout the day or there is a chronic feeling of loss of energy.

Feelings of Worthlessness, Hopelessness, Helplessness. Patients may feel they are worthless as people, that there is no hope for improving their lives, or that they are helpless to improve their unhappy situation.

Inappropriate Guilt. Feelings of guilt may be present about events that the patient did not even do, such as a catastrophe, a crime, or an illness.

Recurrent Thoughts about Death. The patient thinks about death a great deal and may contemplate (or even attempt) suicide.

Decreased Concentration or Ability to Make Decisions. Significant decreases in the ability to concentrate make it difficult for the patient to pay attention to others or complete rudimentary tasks. The patient may be quite indecisive about even minor things.

Other Symptoms

Patients with schizoaffective disorder are prone to alcohol or drug abuse. Patients may use alcohol and drugs excessively either because of their disturbing symptoms, to experience pleasure, or when socializing with others.

How Is Schizoaffective Disorder Distinguished from Schizophrenia and Affective (Mood) Disorders?

Many persons with a diagnosis of schizoaffective disorder have had, at a prior time, diagnoses of schizophrenia or bipolar disorder. Frequently, this previous diagnosis is revised to schizoaffective disorder when it becomes clear, over time, that the person has sometimes experienced symptoms of mania or depression, but on other occasions has experienced psychotic symptoms such as hallucinations or delusions even when his or her mood is stable.

What Is the Course of Schizoaffective Disorder?

The disorder usually begins in late adolescence or early adulthood, often between the ages of sixteen and thirty. The disorder is usually life-long, although the symptoms tend to improve gradually over the person's life. The severity of symptoms usually varies over time, at times requiring hospitalization for treatment. However, most patients have at least some symptoms throughout their lives.

What Causes Schizoaffective Disorder?

The cause of schizoaffective disorder is not known, although many scientists believe it is a variant of the disorder of schizophrenia. Schizoaffective disorder (and schizophrenia) may actually be several disorders. Current theories suggest that an imbalance in brain chemicals (specifically, dopamine) may be at the root of these two disorders. Vulnerability to developing schizoaffective disorder appears to be partly determined by genetic factors and partly by early environmental factors (such as subtle insults to the brain of the baby in the womb during birth).

How Is Schizoaffective Disorder Treated?

Many of the same methods used to treat schizophrenia are also effective for schizoaffective disorder. Antipsychotic medications are an effective treatment for schizoaffective disorder for most, but not all, persons with the disorder. These drugs are not a "cure" for the disorder, but they can reduce symptoms and prevent relapses among the majority of people with the disorder. Antidepressant medications and mood stabilizing medications (such as lithium) are occasionally used to treat affective symptoms (depressive or manic symptoms) in schizoaffective disorder. Other important treatments include social skills training, vocational rehabilitation and supported employment, and intensive case management. Family therapy helps reduce stress in the family and teaches family members how to monitor the disorder. In addition, individual supportive counseling can help the person with the disorder learn to manage the disorder more successfully and obtain emotional support in coping with the distress resulting from the disorder.

Consult a mental health professional (such as a psychiatrist, psychologist, social worker, or psychiatric nurse) about any questions you have concerning this handout.


1. Schizoaffective disorder is a biological disorder which likely results from an imbalance in brain chemicals.

2. Schizoaffective disorder develops in less than 1 in 100 people.

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