Tuesday, February 14, 2006
TAC Newsletter 2/10/06
ENEWS - TREATMENT ADVOCACY CENTER
TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
February 10, 2006
******************************
1. KILLINGS LOOM OVER DEBATE ON TREATING MENTALLY ILL - New York Times,
February 8, 2006
2. LETTER TO MICHELLE LUJAN GRISHAM, J.D., SECRETARY, DEPARTMENT OF HEALTH,
STATE OF NEW MEXICO – From the Commissioner of the New York Office of Mental
Health, February 8, 2006
3. BILL’S NEW VERSION RANKLES OPPONENTS – Santa Fe New Mexican, February 9, 2006
4. BOTTOM LINE: KENDRA'S LAW SAVES LIVES: ASSISTED OUTPATIENT TREATMENT WILL
HELP NEW MEXICO'S MENTALLY ILL ACCESS TREATMENT, FREE THEM FROM PRISON OF
PSYCHOSIS – Statement by TAC Executive Director Mary Zdanowicz, February 8, 2006
******************************
1. NEW YORK TIMES, February 8, 2006
[Editor’s Note: The battle to bring assisted outpatient treatment to New Mexico
drew national attention this week with an indepth piece in the New York Times.
As U.S. Senator Pete Domenici said in announcing his support for this bill,
“Some argue that it is wrong to force individuals to undergo treatment against
their will. We argue that the tragic consequences are simply too monumental not
to require help under certain circumstances. The success rate of the AOT program
in other states has been well documented in both research and in practice.”
We couldn’t agree more.]
KILLINGS LOOM OVER DEBATE ON TREATING MENTALLY ILL
By Randal C. Archibold
SANTA FE, N.M., Feb. 7 — Against the vivid backdrop of recent killings by
mentally ill people, both sides in the national debate over whether mentally ill
people who have not committed a crime can be forced into treatment are preparing
for a showdown in the Legislature here.
New Mexico lawmakers are considering a bill, backed by Gov. Bill Richardson,
that would make the state the 43rd with a law allowing family members, doctors
or others to seek a court order forcing the mentally ill into outpatient
treatment. Typically under the laws, if mentally ill people refuse the
treatment, they can face confinement in a hospital.
Across the country, proponents have pushed the laws as a pragmatic approach to
the mentally ill who fall through the cracks of the mental health system,
particularly those who have committed no crime but could harm themselves or
others as their sickness worsens. These mentally ill people often do not need to
be in a hospital, but do need to stick to treatment, which could include
medication, therapy or both.
"We are talking about a small group of people who do not get help because they
don't want help or know they need help," Mary T. Zdanowicz, executive director
of the Treatment Advocacy Center, based in Virginia, said in a break from
lobbying lawmakers here.
But opponents say the laws infringe on the civil rights of the mentally ill, and
they suggest that teams of social and psychiatric workers could accomplish the
same thing with direct intervention on the streets. Critics also say that most
states have not provided adequate money for the services needed by those forced
into treatment.
One of the more glaring examples, the opponents say, is California. Three years
after adopting an outpatient treatment law, none of its counties, which are
charged with carrying it out, have found the money or will to put it into
practice.
Michael Allen, senior lawyer with the Bazelon Center for Mental Health Law in
Washington, who also lobbied lawmakers here, said the measures were "a political
quick fix in response to tragedies."
Like other states, New Mexico provides that violent offenders who are mentally
ill can be committed to inpatient treatment at a psychiatric hospital for a
certain period. But the proposed law is intended for the mentally ill who have
not committed crimes and have resisted treatment.
The proposal — called Kendra's law after one in New York named for Kendra
Webdale, who was killed when a schizophrenic who had been in and out of
treatment centers pushed her in front of a New York City subway train in 1999 —
arose after an Albuquerque man on a long descent into mental illness shot to
death five people, including two police officers, in August.
Jennifer San Marco, the former postal worker who capped a growing history of
psychological problems by killing seven people and herself last week in Goleta,
Calif., lived in a village about 70 miles west of Albuquerque. There is
speculation Ms. San Marco could have been helped by a forced-treatment law,
though advocates have not pushed this line of reasoning hard because little is
known about what treatment she was getting, if any.
Still, just as in many other states that have considered laws allowing forced
outpatient treatment, a specter hangs heavy over the proceedings.
The widows of the slain police officers testified in favor of the law last week,
while several people with mental illness spoke against it.
State Representative Joni Marie Gutierrez, a Democrat and the chief sponsor of
the bill, said it would provide another tool to help the severely mentally ill.
"A lot of families have been keeping this under wraps and trying to take care of
loved ones on their own," Ms. Gutierrez said. "They don't have the legal means
to petition the court for treatment."
Sherri Pabich, who said she had sought treatment for a mentally ill acquaintance
for 13 years, said the law would help because "a lot of mentally ill people do
not realize they are sick and won't seek treatment on their own."
Officials estimate that up to 100 people a year would get treatment under the
law. People who defy the court order could be committed to a state hospital.
But opponents said New Mexico already had an underfinanced mental health
treatment system that could frustrate even those who sought treatment
voluntarily.
"There already are long waits for treatment here," said Sarah Couch, an
Albuquerque woman who has bipolar disorder. Ms. Couch and others want more
financing for voluntary mental health programs, rather than the threat of court
action.
Both sides have been conscious of history; more than 30 years ago, states moved
away from warehousing the mentally ill in large institutions that earned a
reputation for abuse and shoddy care.
A wave of patients' rights laws made it difficult to commit people against their
will or force them to take medication, and proponents of a new law here have
been careful to assert that the vast majority of mentally ill are not violent
and will not face court orders.
Both sides have offered competing studies on the effectiveness of the approach,
with a New York State report last year getting particular attention.
Reviewing information from case managers from 1999 to 2004, the New York Office
of Mental Health said people ordered into treatment under the law committed
fewer crimes and were less likely to end up homeless or in psychiatric hospitals
or harm themselves or others.
A little over one-third of the 10,000 cases referred to court, most of them in
New York City, resulted in forced outpatient treatment, according to the report,
which Gov. George E. Pataki cited in declaring Kendra's law a success.
But Harvey Rosenthal, executive director of the New York Association of
Psychiatric Rehabilitation Services, flew to New Mexico this week to dispute the
state report's findings.
Mr. Rosenthal cited a report by a legal advocacy group, New York Lawyers for the
Public Interest, which asserted that blacks were five times as likely as whites
to face court orders. In addition, he said, counties have unevenly applied the
law, skewing the results of the study.
"New York's law is not the model it is made out to be," he said.
In recent years, opponents of the laws have scored victories in New Jersey and
Connecticut, which considered laws for involuntary outpatient commitment but did
not approve them and are among the eight states without them.
In addition to New Mexico, the others are Maine, Massachusetts, Maryland,
Tennessee and Nevada, Ms. Zdanowicz said.
The bill's fate here is uncertain, but it has support from influential
politicians like Mr. Richardson, a Democrat, and Senator Pete V. Domenici, a
Republican who has been an advocate for mental health causes across the nation.
Mr. Richardson's advisers had argued against the proposal, but his health
secretary said she now supported it because legislators agreed to provide about
$2 million for outpatient programs.
Representative Gutierrez said lawmakers were considering setting a two- or
four-year limit for the law, which could then be renewed after a review.
Ms. Gutierrez said the state would still face challenges in providing treatment
for people forced into treatment. New Mexico has a shortage of doctors and
mental health professionals, she said, and the state's rural nature often means
patients have long drives to few clinics.
State officials are trying to recruit more professionals and, in a move watched
by other states, recently consolidated the work of 15 public agencies to enhance
and more efficiently deliver mental health and substance abuse services.
"We are working towards doing better every day," Ms. Gutierrez said. "This bill
is part of it."
******************************
2. LETTER FROM THE COMMISSIONER OF THE NEW YORK OFFICE OF MENTAL HEALTH,
February 8, 2006
[Editor’s Note: Who knows better if Kendra's Law is working in New York than
the New York Office of Mental Health? The Commissioner calls the successes of
New York’s Kendra’s Law “undeniable and well documented” – and offers her
assistance to her colleague in New Mexico.]
LETTER TO MICHELLE LUJAN GRISHAM, J.D., SECRETARY, DEPARTMENT OF HEALTH
STATE OF NEW MEXICO
RE: Implementing Kendra’s Law in New Mexico
Dear Secretary Grisham:
I understand that you and Governor Richardson are working to establish a version
of assisted outpatient treatment (AOT, a.k.a. “Kendra’s Law”) in New Mexico,
similar to the New York State statute proposed and signed into law by Governor
Pataki in 1999.
Kendra’s Law has proven extremely successful in New York State, so it is unclear
why reports of our program’s purported failure have entered the debate in your
state. Our evaluation of AOT has clearly shown that Kendra’s Law is working,
and is working well.
To evaluate the program, New York has collected extensive and targeted data on a
spectrum of measures and from a variety of sources. We know conclusively that
the program has been invaluable for individuals who, without Kendra’s Law,
previously had limited success in using voluntary mental health services.
Individuals receiving services under Kendra’s Law are able to make and maintain
real gains in their recovery, and show significantly increased participation in
case management, substance abuse, and other treatment services. During
participation in the AOT program, rates for hospitalizations, homelessness,
arrests and incarcerations have declined dramatically, as have those for harmful
behaviors.
Perhaps most encouraging are the reports from people in the program, which were
collected and assessed via an independent survey. Three out of every four
reported that Kendra’s Law had helped them regain control of their lives; four
out of five said that it helped them to get and stay well.
Our experience with Kendra’s Law has resulted in fundamental changes to New
York’s system of care for those incapacitated by the symptoms of severe
psychiatric illness, including those who do not meet the program’s eligibility
criteria. Under Governor Pataki’s leadership, we are seeing improved access to
mental health services, improved coordination of service planning, enhanced
accountability, and improved collaboration between the mental health and court
systems.
Given that the success of Kendra’s Law in New York has been undeniable and well
documented by statewide data, renewal of the law was strongly backed by Governor
Pataki and had virtually no opposition from our stat’s legislators. Discussion
of the program in the last legislative session focused not on whether to
maintain Kendra’s Law, but on quality improvement issues. After reviewing the
data, even those who had opposed the adoption of Kendra’s Law in 1999 urged a
time-limited renewal of the program. When the law was extended last year,
several changes were made to further strengthen the program.
In addition, I have established a quality panel of experts and stakeholders
which met for the first time this past January. This panel will fine-tune an
already proven and effective treatment program, and their efforts will go far to
expand the benefits of Kendra’s Law in areas of our state that have not yet
fully utilized the program.
I would be pleased to pass on the lessons of our experience with Kendra’s Law to
help your office further the adoption and implementation of assisted outpatient
treatment in New Mexico.
Sincerely,
Sharon E. Carpinello, R.N., Ph.D.
Commissioner
New York State Office of Mental Health
******************************
3. THE NEW MEXICAN, February 9, 2006
[Editor’s Note: Assisted outpatient treatment is obviously not the single answer
to the many and complex problems facing state mental health treatment systems.
Most certainly, an AOT law cannot ensure care for every person who wants or
needs it or repair decades of problems with service availability.
Consumers who are able to testify at legislative hearings and speak cogently to
reporters are unlikely to meet the strict criteria for Kendra’s Law – but
ironically, passage would help them anyway. Because these laws go beyond helping
the small group of desperately ill people who need them, by improving the system
as a whole and making existing services more effective. That will benefit
voluntary users as well as the 75-100 people who will likely be in the program
(based on the number in New York).]
BILL’S NEW VERSION RANKLES OPPONENTS
By David Miles
Safeguards for patients were added Wednesday to a bill to allow court-ordered
outpatient treatment for mentally ill adults who are judged to be in danger of
harming themselves or others, but opponents said they remained unhappy with the
measure.
The House Judiciary Committee temporarily set aside the bill (committee
substitute for HB174) on Wednesday. The panel plans to make more changes to the
measure Friday.
The latest version of the bill specifies that before courts can order mentally
ill New Mexicans to receive outpatient treatment, noncompliance with treatment
must have been a significant factor in necessitating hospitalization or other
services at least twice in the previous 36 months or resulted in at least one
act of “serious violent behavior” in the previous four years.
The bill already included the following requirements for court-ordered
outpatient treatment — mentally ill New Mexicans who are at least 18 years old;
are unlikely to live safely without supervision; are unlikely to voluntarily
receive treatment; would likely benefit from treatment; and need treatment to
prevent “serious harm” to themselves or others.
“This bill might not be the answer, but it’s one step,” said Rep. Joni Marie
Gutierrez, a Las Cruces Democrat who sponsored the bill.
Albuquerque Police Department Sgt. Carol Oleksak, who was shot in the head by a
mentally ill transient in 2003, called the bill an important piece of
legislation. “This may not be perfect, but even if we can save one or two lives
on this, it’s very important,” Oleksak said.
But others complained that New Mexico lacks the necessary services and bed space
for the mentally ill.
Sarah Couch, an Albuquerque resident with bipolar disorder, said she has
struggled for years to receive necessary medications and treatment. “If there
had been a Kendra’s Law when I was first struggling, I would not have had the
courage to be evaluated, and if the law passes, I will carefully censor what I
share with my doctors and my family members,” Couch said.
The bill is named Kendra’s Law after Kendra Webdale, a New Yorker who was killed
in 1999 when a schizophrenic pushed her in front of a subway train.
Peter Bochert, statewide drug-court coordinator for the Administrative Office of
the Courts, said the legislation would necessitate an additional eight to 14
judges in New Mexico, as well as more staff and attorneys. “Each petition will
require several court hearings,” Bochert said.
Michelle Lujan Grisham, secretary of the state Department of Health, said that
while there is no appropriation in the bill, a separate state budget measure
(committee substitute for HB2) contains an additional $2 million for behavioral
health services.
Under the bill, family members of mentally ill New Mexicans; psychiatrists;
other health and social-service providers; and parole and probation officers
could file a petition at their district court for an order for outpatient
treatment. The petition would have to be accompanied by an affidavit from a
physician who had examined or attempted to examine the mentally ill person.
Contact David Miles at 986-3036 or dmiles@sfnewmexican.com.
******************************
4. STATEMENT BY TREATMENT ADVOCACY CENTER EXECUTIVE DIRECTOR MARY ZDANOWICZ,
February 8, 2006
[Editor’s Note: Kendra’s Law bill sponsor Rep. Joni Gutierrez (D-Las Cruces)
introduced this measure because "existing New Mexico law essentially forces
people who lack insight into their illness to hit rock bottom before they can be
helped ... Forced deterioration is cruel and inhumane."
Debate over AOT laws often becomes emotional, but the bottom line is that the
research, the data, and the experiences of participants all prove that assisted
outpatient treatment laws save lives. There are only eight states that do not
have such a law. We hope soon, because of the compassion and wisdom of Rep.
Gutierrez and so many New Mexico legislators, there will be seven.]
BOTTOM LINE: KENDRA'S LAW SAVES LIVES:
Assisted outpatient treatment will help New Mexico's mentally ill access
treatment, free them from prison of psychosis
It is because of so many dedicated local advocates that New Mexicans may soon
have access to a law proven effective time and time again, in national studies
and real-world implementation, to improve the quality of life of people with
severe mental illnesses.
New Mexico is one of only 8 states without an assisted outpatient treatment
(AOT) law. That means someone too ill to make an informed treatment decision
must be left untreated until they are in a crisis, posing a "likelihood of
serious harm to themselves or others."
Proposed legislation (HB174 and SB335) would allow New Mexico courts to order
someone with a severe mental illness into outpatient treatment if a judge finds
they meet specific requirements.
This law has broad bipartisan support, including Gov. Richardson, Albuquerque
Mayor Chavez, and U.S. Sen. Domenici, as well as the New Mexico chapter of the
National Alliance for the Mentally Ill.
Some lobbying against this bill have been swayed by easy cliches, perhaps
unaware of the overwhelming research that assisted outpatient treatment both
saves lives and makes precious existing services more effective.
Calls to protect civil liberties betray a profound misunderstanding of that
term. There is nothing "civil" about leaving people lost to disease to live
homeless on the streets, suffering rape and victimization. There is nothing
"right" about leaving someone untreated and psychotic, rendering them incapable
of discerning whether they are attacking a CIA operative or their own mother.
Assisted outpatient treatment laws are meant to help those who are too ill to
make rational treatment decisions. It would in no way adversely affect people
with mental illnesses who are able to make informed treatment decisions, usually
those who testify at hearings or press conferences. In New Mexico, only about 75
to 100 people would be placed in the program each year. For that small group - a
group for whom voluntary services will never be enough - these laws have been
shown to reduce hospitalizations, arrests, incarcerations, victimizations,
homelessness, and caregiver stress, and improve medication compliance and
quality of life. In New York, 81% of interviewed participants said Kendra's Law
helped them get and stay well.
AOT laws also reduce violence. People with mental illnesses are usually no more
violent than the general public, but the opposite is true for people with severe
mental illnesses who are not taking medication. Pretending this statistic
doesn't exist does a grave disservice to those who are in desperate need of
help, and their families. Stigma comes not from news articles about a crime, but
from the crime itself. Helping people who are in need means fewer crimes, less
stigma, and better outcomes for the people who are ill.
Kendra's Law will improve the quality of life for a small group of New Mexicans
with the most severe mental illnesses. Don't ignore the research and science in
favor of emotion. These laws save lives. Let's work together to ensure there is
no discrimination against those who are the sickest - and that they have the
true civil right to be free of psychosis.
The Treatment Advocacy Center (www.psychlaws.org) is a national nonprofit
dedicated to removing barriers to treatment of severe mental illnesses.
Additional materials available at
http://tacenews.c.topica.com/maaet0SabodttbfGwZEb/
Read a letter from NY OMH Commissioner to NM Secretary of Education at
http://tacenews.c.topica.com/maaet0SabodtubfGwZEb/
CONTACT: Alicia Aebersold aebersolda@psychlaws.org or 703 294 6008
******************************
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TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
February 10, 2006
******************************
1. KILLINGS LOOM OVER DEBATE ON TREATING MENTALLY ILL - New York Times,
February 8, 2006
2. LETTER TO MICHELLE LUJAN GRISHAM, J.D., SECRETARY, DEPARTMENT OF HEALTH,
STATE OF NEW MEXICO – From the Commissioner of the New York Office of Mental
Health, February 8, 2006
3. BILL’S NEW VERSION RANKLES OPPONENTS – Santa Fe New Mexican, February 9, 2006
4. BOTTOM LINE: KENDRA'S LAW SAVES LIVES: ASSISTED OUTPATIENT TREATMENT WILL
HELP NEW MEXICO'S MENTALLY ILL ACCESS TREATMENT, FREE THEM FROM PRISON OF
PSYCHOSIS – Statement by TAC Executive Director Mary Zdanowicz, February 8, 2006
******************************
1. NEW YORK TIMES, February 8, 2006
[Editor’s Note: The battle to bring assisted outpatient treatment to New Mexico
drew national attention this week with an indepth piece in the New York Times.
As U.S. Senator Pete Domenici said in announcing his support for this bill,
“Some argue that it is wrong to force individuals to undergo treatment against
their will. We argue that the tragic consequences are simply too monumental not
to require help under certain circumstances. The success rate of the AOT program
in other states has been well documented in both research and in practice.”
We couldn’t agree more.]
KILLINGS LOOM OVER DEBATE ON TREATING MENTALLY ILL
By Randal C. Archibold
SANTA FE, N.M., Feb. 7 — Against the vivid backdrop of recent killings by
mentally ill people, both sides in the national debate over whether mentally ill
people who have not committed a crime can be forced into treatment are preparing
for a showdown in the Legislature here.
New Mexico lawmakers are considering a bill, backed by Gov. Bill Richardson,
that would make the state the 43rd with a law allowing family members, doctors
or others to seek a court order forcing the mentally ill into outpatient
treatment. Typically under the laws, if mentally ill people refuse the
treatment, they can face confinement in a hospital.
Across the country, proponents have pushed the laws as a pragmatic approach to
the mentally ill who fall through the cracks of the mental health system,
particularly those who have committed no crime but could harm themselves or
others as their sickness worsens. These mentally ill people often do not need to
be in a hospital, but do need to stick to treatment, which could include
medication, therapy or both.
"We are talking about a small group of people who do not get help because they
don't want help or know they need help," Mary T. Zdanowicz, executive director
of the Treatment Advocacy Center, based in Virginia, said in a break from
lobbying lawmakers here.
But opponents say the laws infringe on the civil rights of the mentally ill, and
they suggest that teams of social and psychiatric workers could accomplish the
same thing with direct intervention on the streets. Critics also say that most
states have not provided adequate money for the services needed by those forced
into treatment.
One of the more glaring examples, the opponents say, is California. Three years
after adopting an outpatient treatment law, none of its counties, which are
charged with carrying it out, have found the money or will to put it into
practice.
Michael Allen, senior lawyer with the Bazelon Center for Mental Health Law in
Washington, who also lobbied lawmakers here, said the measures were "a political
quick fix in response to tragedies."
Like other states, New Mexico provides that violent offenders who are mentally
ill can be committed to inpatient treatment at a psychiatric hospital for a
certain period. But the proposed law is intended for the mentally ill who have
not committed crimes and have resisted treatment.
The proposal — called Kendra's law after one in New York named for Kendra
Webdale, who was killed when a schizophrenic who had been in and out of
treatment centers pushed her in front of a New York City subway train in 1999 —
arose after an Albuquerque man on a long descent into mental illness shot to
death five people, including two police officers, in August.
Jennifer San Marco, the former postal worker who capped a growing history of
psychological problems by killing seven people and herself last week in Goleta,
Calif., lived in a village about 70 miles west of Albuquerque. There is
speculation Ms. San Marco could have been helped by a forced-treatment law,
though advocates have not pushed this line of reasoning hard because little is
known about what treatment she was getting, if any.
Still, just as in many other states that have considered laws allowing forced
outpatient treatment, a specter hangs heavy over the proceedings.
The widows of the slain police officers testified in favor of the law last week,
while several people with mental illness spoke against it.
State Representative Joni Marie Gutierrez, a Democrat and the chief sponsor of
the bill, said it would provide another tool to help the severely mentally ill.
"A lot of families have been keeping this under wraps and trying to take care of
loved ones on their own," Ms. Gutierrez said. "They don't have the legal means
to petition the court for treatment."
Sherri Pabich, who said she had sought treatment for a mentally ill acquaintance
for 13 years, said the law would help because "a lot of mentally ill people do
not realize they are sick and won't seek treatment on their own."
Officials estimate that up to 100 people a year would get treatment under the
law. People who defy the court order could be committed to a state hospital.
But opponents said New Mexico already had an underfinanced mental health
treatment system that could frustrate even those who sought treatment
voluntarily.
"There already are long waits for treatment here," said Sarah Couch, an
Albuquerque woman who has bipolar disorder. Ms. Couch and others want more
financing for voluntary mental health programs, rather than the threat of court
action.
Both sides have been conscious of history; more than 30 years ago, states moved
away from warehousing the mentally ill in large institutions that earned a
reputation for abuse and shoddy care.
A wave of patients' rights laws made it difficult to commit people against their
will or force them to take medication, and proponents of a new law here have
been careful to assert that the vast majority of mentally ill are not violent
and will not face court orders.
Both sides have offered competing studies on the effectiveness of the approach,
with a New York State report last year getting particular attention.
Reviewing information from case managers from 1999 to 2004, the New York Office
of Mental Health said people ordered into treatment under the law committed
fewer crimes and were less likely to end up homeless or in psychiatric hospitals
or harm themselves or others.
A little over one-third of the 10,000 cases referred to court, most of them in
New York City, resulted in forced outpatient treatment, according to the report,
which Gov. George E. Pataki cited in declaring Kendra's law a success.
But Harvey Rosenthal, executive director of the New York Association of
Psychiatric Rehabilitation Services, flew to New Mexico this week to dispute the
state report's findings.
Mr. Rosenthal cited a report by a legal advocacy group, New York Lawyers for the
Public Interest, which asserted that blacks were five times as likely as whites
to face court orders. In addition, he said, counties have unevenly applied the
law, skewing the results of the study.
"New York's law is not the model it is made out to be," he said.
In recent years, opponents of the laws have scored victories in New Jersey and
Connecticut, which considered laws for involuntary outpatient commitment but did
not approve them and are among the eight states without them.
In addition to New Mexico, the others are Maine, Massachusetts, Maryland,
Tennessee and Nevada, Ms. Zdanowicz said.
The bill's fate here is uncertain, but it has support from influential
politicians like Mr. Richardson, a Democrat, and Senator Pete V. Domenici, a
Republican who has been an advocate for mental health causes across the nation.
Mr. Richardson's advisers had argued against the proposal, but his health
secretary said she now supported it because legislators agreed to provide about
$2 million for outpatient programs.
Representative Gutierrez said lawmakers were considering setting a two- or
four-year limit for the law, which could then be renewed after a review.
Ms. Gutierrez said the state would still face challenges in providing treatment
for people forced into treatment. New Mexico has a shortage of doctors and
mental health professionals, she said, and the state's rural nature often means
patients have long drives to few clinics.
State officials are trying to recruit more professionals and, in a move watched
by other states, recently consolidated the work of 15 public agencies to enhance
and more efficiently deliver mental health and substance abuse services.
"We are working towards doing better every day," Ms. Gutierrez said. "This bill
is part of it."
******************************
2. LETTER FROM THE COMMISSIONER OF THE NEW YORK OFFICE OF MENTAL HEALTH,
February 8, 2006
[Editor’s Note: Who knows better if Kendra's Law is working in New York than
the New York Office of Mental Health? The Commissioner calls the successes of
New York’s Kendra’s Law “undeniable and well documented” – and offers her
assistance to her colleague in New Mexico.]
LETTER TO MICHELLE LUJAN GRISHAM, J.D., SECRETARY, DEPARTMENT OF HEALTH
STATE OF NEW MEXICO
RE: Implementing Kendra’s Law in New Mexico
Dear Secretary Grisham:
I understand that you and Governor Richardson are working to establish a version
of assisted outpatient treatment (AOT, a.k.a. “Kendra’s Law”) in New Mexico,
similar to the New York State statute proposed and signed into law by Governor
Pataki in 1999.
Kendra’s Law has proven extremely successful in New York State, so it is unclear
why reports of our program’s purported failure have entered the debate in your
state. Our evaluation of AOT has clearly shown that Kendra’s Law is working,
and is working well.
To evaluate the program, New York has collected extensive and targeted data on a
spectrum of measures and from a variety of sources. We know conclusively that
the program has been invaluable for individuals who, without Kendra’s Law,
previously had limited success in using voluntary mental health services.
Individuals receiving services under Kendra’s Law are able to make and maintain
real gains in their recovery, and show significantly increased participation in
case management, substance abuse, and other treatment services. During
participation in the AOT program, rates for hospitalizations, homelessness,
arrests and incarcerations have declined dramatically, as have those for harmful
behaviors.
Perhaps most encouraging are the reports from people in the program, which were
collected and assessed via an independent survey. Three out of every four
reported that Kendra’s Law had helped them regain control of their lives; four
out of five said that it helped them to get and stay well.
Our experience with Kendra’s Law has resulted in fundamental changes to New
York’s system of care for those incapacitated by the symptoms of severe
psychiatric illness, including those who do not meet the program’s eligibility
criteria. Under Governor Pataki’s leadership, we are seeing improved access to
mental health services, improved coordination of service planning, enhanced
accountability, and improved collaboration between the mental health and court
systems.
Given that the success of Kendra’s Law in New York has been undeniable and well
documented by statewide data, renewal of the law was strongly backed by Governor
Pataki and had virtually no opposition from our stat’s legislators. Discussion
of the program in the last legislative session focused not on whether to
maintain Kendra’s Law, but on quality improvement issues. After reviewing the
data, even those who had opposed the adoption of Kendra’s Law in 1999 urged a
time-limited renewal of the program. When the law was extended last year,
several changes were made to further strengthen the program.
In addition, I have established a quality panel of experts and stakeholders
which met for the first time this past January. This panel will fine-tune an
already proven and effective treatment program, and their efforts will go far to
expand the benefits of Kendra’s Law in areas of our state that have not yet
fully utilized the program.
I would be pleased to pass on the lessons of our experience with Kendra’s Law to
help your office further the adoption and implementation of assisted outpatient
treatment in New Mexico.
Sincerely,
Sharon E. Carpinello, R.N., Ph.D.
Commissioner
New York State Office of Mental Health
******************************
3. THE NEW MEXICAN, February 9, 2006
[Editor’s Note: Assisted outpatient treatment is obviously not the single answer
to the many and complex problems facing state mental health treatment systems.
Most certainly, an AOT law cannot ensure care for every person who wants or
needs it or repair decades of problems with service availability.
Consumers who are able to testify at legislative hearings and speak cogently to
reporters are unlikely to meet the strict criteria for Kendra’s Law – but
ironically, passage would help them anyway. Because these laws go beyond helping
the small group of desperately ill people who need them, by improving the system
as a whole and making existing services more effective. That will benefit
voluntary users as well as the 75-100 people who will likely be in the program
(based on the number in New York).]
BILL’S NEW VERSION RANKLES OPPONENTS
By David Miles
Safeguards for patients were added Wednesday to a bill to allow court-ordered
outpatient treatment for mentally ill adults who are judged to be in danger of
harming themselves or others, but opponents said they remained unhappy with the
measure.
The House Judiciary Committee temporarily set aside the bill (committee
substitute for HB174) on Wednesday. The panel plans to make more changes to the
measure Friday.
The latest version of the bill specifies that before courts can order mentally
ill New Mexicans to receive outpatient treatment, noncompliance with treatment
must have been a significant factor in necessitating hospitalization or other
services at least twice in the previous 36 months or resulted in at least one
act of “serious violent behavior” in the previous four years.
The bill already included the following requirements for court-ordered
outpatient treatment — mentally ill New Mexicans who are at least 18 years old;
are unlikely to live safely without supervision; are unlikely to voluntarily
receive treatment; would likely benefit from treatment; and need treatment to
prevent “serious harm” to themselves or others.
“This bill might not be the answer, but it’s one step,” said Rep. Joni Marie
Gutierrez, a Las Cruces Democrat who sponsored the bill.
Albuquerque Police Department Sgt. Carol Oleksak, who was shot in the head by a
mentally ill transient in 2003, called the bill an important piece of
legislation. “This may not be perfect, but even if we can save one or two lives
on this, it’s very important,” Oleksak said.
But others complained that New Mexico lacks the necessary services and bed space
for the mentally ill.
Sarah Couch, an Albuquerque resident with bipolar disorder, said she has
struggled for years to receive necessary medications and treatment. “If there
had been a Kendra’s Law when I was first struggling, I would not have had the
courage to be evaluated, and if the law passes, I will carefully censor what I
share with my doctors and my family members,” Couch said.
The bill is named Kendra’s Law after Kendra Webdale, a New Yorker who was killed
in 1999 when a schizophrenic pushed her in front of a subway train.
Peter Bochert, statewide drug-court coordinator for the Administrative Office of
the Courts, said the legislation would necessitate an additional eight to 14
judges in New Mexico, as well as more staff and attorneys. “Each petition will
require several court hearings,” Bochert said.
Michelle Lujan Grisham, secretary of the state Department of Health, said that
while there is no appropriation in the bill, a separate state budget measure
(committee substitute for HB2) contains an additional $2 million for behavioral
health services.
Under the bill, family members of mentally ill New Mexicans; psychiatrists;
other health and social-service providers; and parole and probation officers
could file a petition at their district court for an order for outpatient
treatment. The petition would have to be accompanied by an affidavit from a
physician who had examined or attempted to examine the mentally ill person.
Contact David Miles at 986-3036 or dmiles@sfnewmexican.com.
******************************
4. STATEMENT BY TREATMENT ADVOCACY CENTER EXECUTIVE DIRECTOR MARY ZDANOWICZ,
February 8, 2006
[Editor’s Note: Kendra’s Law bill sponsor Rep. Joni Gutierrez (D-Las Cruces)
introduced this measure because "existing New Mexico law essentially forces
people who lack insight into their illness to hit rock bottom before they can be
helped ... Forced deterioration is cruel and inhumane."
Debate over AOT laws often becomes emotional, but the bottom line is that the
research, the data, and the experiences of participants all prove that assisted
outpatient treatment laws save lives. There are only eight states that do not
have such a law. We hope soon, because of the compassion and wisdom of Rep.
Gutierrez and so many New Mexico legislators, there will be seven.]
BOTTOM LINE: KENDRA'S LAW SAVES LIVES:
Assisted outpatient treatment will help New Mexico's mentally ill access
treatment, free them from prison of psychosis
It is because of so many dedicated local advocates that New Mexicans may soon
have access to a law proven effective time and time again, in national studies
and real-world implementation, to improve the quality of life of people with
severe mental illnesses.
New Mexico is one of only 8 states without an assisted outpatient treatment
(AOT) law. That means someone too ill to make an informed treatment decision
must be left untreated until they are in a crisis, posing a "likelihood of
serious harm to themselves or others."
Proposed legislation (HB174 and SB335) would allow New Mexico courts to order
someone with a severe mental illness into outpatient treatment if a judge finds
they meet specific requirements.
This law has broad bipartisan support, including Gov. Richardson, Albuquerque
Mayor Chavez, and U.S. Sen. Domenici, as well as the New Mexico chapter of the
National Alliance for the Mentally Ill.
Some lobbying against this bill have been swayed by easy cliches, perhaps
unaware of the overwhelming research that assisted outpatient treatment both
saves lives and makes precious existing services more effective.
Calls to protect civil liberties betray a profound misunderstanding of that
term. There is nothing "civil" about leaving people lost to disease to live
homeless on the streets, suffering rape and victimization. There is nothing
"right" about leaving someone untreated and psychotic, rendering them incapable
of discerning whether they are attacking a CIA operative or their own mother.
Assisted outpatient treatment laws are meant to help those who are too ill to
make rational treatment decisions. It would in no way adversely affect people
with mental illnesses who are able to make informed treatment decisions, usually
those who testify at hearings or press conferences. In New Mexico, only about 75
to 100 people would be placed in the program each year. For that small group - a
group for whom voluntary services will never be enough - these laws have been
shown to reduce hospitalizations, arrests, incarcerations, victimizations,
homelessness, and caregiver stress, and improve medication compliance and
quality of life. In New York, 81% of interviewed participants said Kendra's Law
helped them get and stay well.
AOT laws also reduce violence. People with mental illnesses are usually no more
violent than the general public, but the opposite is true for people with severe
mental illnesses who are not taking medication. Pretending this statistic
doesn't exist does a grave disservice to those who are in desperate need of
help, and their families. Stigma comes not from news articles about a crime, but
from the crime itself. Helping people who are in need means fewer crimes, less
stigma, and better outcomes for the people who are ill.
Kendra's Law will improve the quality of life for a small group of New Mexicans
with the most severe mental illnesses. Don't ignore the research and science in
favor of emotion. These laws save lives. Let's work together to ensure there is
no discrimination against those who are the sickest - and that they have the
true civil right to be free of psychosis.
The Treatment Advocacy Center (www.psychlaws.org) is a national nonprofit
dedicated to removing barriers to treatment of severe mental illnesses.
Additional materials available at
http://tacenews.c.topica.com/maaet0SabodttbfGwZEb/
Read a letter from NY OMH Commissioner to NM Secretary of Education at
http://tacenews.c.topica.com/maaet0SabodtubfGwZEb/
CONTACT: Alicia Aebersold aebersolda@psychlaws.org or 703 294 6008
******************************
Treatment Advocacy Center E-NEWS is a publication of the Treatment Advocacy
Center.
This E-NEWS is provided as a public service by the Treatment Advocacy Center.
There is no fee. If you would also like to receive a free subscription to the
Catalyst, our periodic hardcopy newsletter, please forward your mailing address
to info@psychlaws.org.
The Center does not accept donations from pharmaceutical companies. Support from
individuals who share our mission, however, is essential to our ability to
effectively help our most vulnerable citizens. The Treatment Advocacy Center is
a 501(c)(3) not-for-profit organization. All contributions are tax-deductible to
the extent allowed by law. Donations to the Treatment Advocacy Center should be
sent to:
200 N. Glebe Road
Suite 730
Arlington, VA 22203
703/294-6001 (main no.)
703/294-6010 (fax)
Friday, February 10, 2006
A Look At Mental Illness in Jail
2. HENDERSONVILLE TIMES NEWS (NC), January 4, 2006
[Editor’s Note: Their stories are not so well chronicled as that of Phil Wiggins
but those of others affected by North Carolina’s shearing of its capacity for
inpatient psychiatric treatment can also be found in the Henderson County Jail.]
NURSE SEES JAIL AS 'DUMPING GROUND' FOR MANY OF THE MENTALLY ILL
By Joel Burgess
It was a normal day in the classification pod of the Henderson County Jail. Of
the dozen or so inmates, one was schizophrenic, two were from group homes, which
often treat those with developmental disabilities, one was on suicide watch and
a handful were withdrawing from alcohol, heroin or other drug addictions.
Of the 151 inmates in the jail that day, head nurse Karen Styles estimated 90
had some degree of mental illness and more than 100 had "alcohol or drug
issues."
"I would say there are probably 24 that have major mental health medications
that they are on," said Styles, an eight-year veteran of correctional medicine.
Considering what it has been like for the past year, this was just another day
for Styles.
"I call it little Broughton, without the medications," she said, referring to
the state hospital in Morganton where the jail sends inmates with extreme mental
illnesses. Or at least that was where the jail used to send such cases, she
said, before sweeping state mental health changes effectively cut off that
avenue of treatment.
Now the jail has become the "dumping ground," she said, for many of the
community's seriously mentally ill.
'The Archangel'
One such person was jailed two months ago after being picked up with a stolen
car in Henderson County. Styles cannot give out names of mentally ill inmates
because of medical confidentiality rules, but said before being incarcerated the
man had been staying with his sister in Buncombe County.
"He disappeared into the cold one night, and she took out commitment papers,
because she knew about his mental illness," Styles said.
The man, "Inmate A," told jail officers he was "the archangel" and was going to
kill himself and that he could take his eyeballs out.
Using the small length of cord on an inmate telephone he tried to hang himself.
An officer intervened and stopped him.
Though there have been many attempts, the jail has never had a suicide, due
largely, Styles said, to officers' diligence.
Officers took Inmate A's clothes and put him into a safety gown, a loose garment
that cannot be tied, burned or torn. They placed him into a small padded cell
absent of any furniture or fixtures except a light and a hole in the center of
the floor with a grate over it.
Styles, realizing the man needed more treatment than she or local facilities
could offer, got on the phone to try to get him committed to Broughton.
She found out about the commitment papers the sister had taken out and got in
touch with her.
"I learned that in Georgia he literally did pull his eyeball out because he
thought it was the end times," she said. Intensive surgery was required to save
his eye.
While on the phone Styles said she heard a "pop."
Inmate A had smashed his head against the padded wall and blood was now running
from a wound.
Officers took him from the room and transported him to Pardee Hospital. At the
hospital a psychiatric social worker evaluated him and said he was commitable to
Broughton.
The hospital has its own psychiatric ward, but it is not set up to handle
inmates.
Broughton refused admission, saying the inmate could be kept safely in the jail.
"So we had a person that was truly psychotic, good and strong physically, that
had injured himself before, hanged himself in his cell, we moved him into the
rubber room and he bounced and hit the wall so hard that he lacerated his head,
and they won't take him," Styles said.
Inmate A's injury required further medical attention and he was transferred to
Mission Hospitals in Asheville, ending the jail's responsibility for him. Styles
has tried unsuccessfully to get in touch with his sister and has been unable to
find out what became of Inmate A.
Much Different
Before the overhaul of the mental health system, the situation would have played
out much differently, Styles said.
If an inmate was having a psychotic episode, Styles would call Trend Mental
Health, the public mental health care provider for Henderson and Transylvania
counties.
Officers would transport the inmate to Trend for an evaluation and if necessary
Trend would call Broughton. Broughton routinely accepted such patients.
That changed with the reforms.
With the stated goal of achieving parity in mental health services and providing
users with more choices, the state dismantled the existing system of small local
public providers.
County programs such as Trend no longer give direct care such as counseling or
drug prescriptions. Instead, private contractors are supposed to provide care
under the umbrella of a central administrative unit, or Local Management Entity.
For Henderson, Transylvania, Polk and five other counties, the LME is Western
Highlands, based in Asheville.
Meanwhile, state mental hospitals that in the past dealt with the most severe
cases are reducing the number of beds for mental patients and cutting the length
of stays. The idea is to force communities to play a greater role in caring for
mentally ill residents.
Broughton administrators question whether the problems experienced by the
Henderson County Jail are really part of the reform, saying they are more likely
due to the exploding population in the mountains.
Hospital Director Seth Hunt said at Broughton and the other three state
hospitals that specialize in mental illness the patient population has
"increased pretty dramatically."
"When you look at the 2000 census you see that the population has changed but
without any exponential increase in services," Hunt said. "That is not
necessarily a problem with reform."
Broughton serves 37 counties that contain 36.4 percent of the state's
population, he said.
The hospital does not have beds designated for mentally ill inmates, but takes
them on a case-by-case basis according to the degree of sickness and potential
danger they could present.
"I don't know that we're being any more strict, but we're having to make
adjustments," he said.
State cutbacks have taken Broughton from 500 beds to 339 with further reforms
set to reduce that number to between 278 and 290.
The situation has the potential to get better with the construction at Broughton
and at Butner in Eastern North Carolina of 50-bed forensics units designed to
handle inmates.
At Broughton the $6 million unit could be completed by the summer of 2007.
Broughton has about 20 to 30 inmate patients and after the completion of the
unit will likely take back 10 to 15 western inmates from Dorothea Dix Hospital
in Raleigh, leaving it with five to 10 beds "wiggle room," Hunt said.
Trickle-down
Though Hunt sees no direct link, mental health providers in Henderson County say
that the reforms happened shortly before the jail began having difficulty
getting higher-level care for inmates.
"It's the trickle-down effect," said Barry Beavers, director of adult services
at Mountain Laurel Community Services. "As the state hospitals get further along
in their attempts to downsize they are having to get firmer with directives of
how to deal with clients that we would historically refer to them."
Mountain Laurel is a private nonprofit mental health organization that handles
many of the services formerly provided by Trend.
Beavers said emergency rooms are not equipped to deal with these people and he
thinks the new forensics unit at Broughton will help.
"But my perspective on mental health reform and what we need to do as a
community at this point is to move away from the idea that our state hospital
system is the answer to a lot of our ills and concerns," he said. "It's a lot
about our partnerships and what we can do here in our community."
Already Beavers has been working with Styles and other jail nurses to help the
inmates, going to the jail for assessments rather than making officers bring
them to Mountain Laurel.
The biggest problem in this type of work is a prohibition against billing for
services to incarcerated individuals. For this reason many of the new private
programs will be reluctant to pick up this area of last resort.
Though this puts a strain on Mountain Laurel's budget, Beavers said the service
is an important link in the chain of overall care.
"There are certain things we are just going to have to reach out and take care
of," he said.
Styles, meanwhile, said she is hoping for a change.
The increased number of severe mentally ill people in the jail has stretched
staff to the limits, she said, and left her with no time to sit down and work
through a solution.
She points to one inmate who she said had a "long violent history," and was put
in jail without the medication he needed for mental illness.
"He was constantly threatening to kill the officers and the other inmates. He
kicked the door every day and was just really violent," she said.
Styles tried to get him committed to Broughton but was refused. The inmate only
had a $400 bond. He was soon back on the streets.
As far as she knows there have been no incidents where inmates who needed mental
health treatment have left the jail and injured someone, she said, "but it
will."
[Editor’s Note: Their stories are not so well chronicled as that of Phil Wiggins
but those of others affected by North Carolina’s shearing of its capacity for
inpatient psychiatric treatment can also be found in the Henderson County Jail.]
NURSE SEES JAIL AS 'DUMPING GROUND' FOR MANY OF THE MENTALLY ILL
By Joel Burgess
It was a normal day in the classification pod of the Henderson County Jail. Of
the dozen or so inmates, one was schizophrenic, two were from group homes, which
often treat those with developmental disabilities, one was on suicide watch and
a handful were withdrawing from alcohol, heroin or other drug addictions.
Of the 151 inmates in the jail that day, head nurse Karen Styles estimated 90
had some degree of mental illness and more than 100 had "alcohol or drug
issues."
"I would say there are probably 24 that have major mental health medications
that they are on," said Styles, an eight-year veteran of correctional medicine.
Considering what it has been like for the past year, this was just another day
for Styles.
"I call it little Broughton, without the medications," she said, referring to
the state hospital in Morganton where the jail sends inmates with extreme mental
illnesses. Or at least that was where the jail used to send such cases, she
said, before sweeping state mental health changes effectively cut off that
avenue of treatment.
Now the jail has become the "dumping ground," she said, for many of the
community's seriously mentally ill.
'The Archangel'
One such person was jailed two months ago after being picked up with a stolen
car in Henderson County. Styles cannot give out names of mentally ill inmates
because of medical confidentiality rules, but said before being incarcerated the
man had been staying with his sister in Buncombe County.
"He disappeared into the cold one night, and she took out commitment papers,
because she knew about his mental illness," Styles said.
The man, "Inmate A," told jail officers he was "the archangel" and was going to
kill himself and that he could take his eyeballs out.
Using the small length of cord on an inmate telephone he tried to hang himself.
An officer intervened and stopped him.
Though there have been many attempts, the jail has never had a suicide, due
largely, Styles said, to officers' diligence.
Officers took Inmate A's clothes and put him into a safety gown, a loose garment
that cannot be tied, burned or torn. They placed him into a small padded cell
absent of any furniture or fixtures except a light and a hole in the center of
the floor with a grate over it.
Styles, realizing the man needed more treatment than she or local facilities
could offer, got on the phone to try to get him committed to Broughton.
She found out about the commitment papers the sister had taken out and got in
touch with her.
"I learned that in Georgia he literally did pull his eyeball out because he
thought it was the end times," she said. Intensive surgery was required to save
his eye.
While on the phone Styles said she heard a "pop."
Inmate A had smashed his head against the padded wall and blood was now running
from a wound.
Officers took him from the room and transported him to Pardee Hospital. At the
hospital a psychiatric social worker evaluated him and said he was commitable to
Broughton.
The hospital has its own psychiatric ward, but it is not set up to handle
inmates.
Broughton refused admission, saying the inmate could be kept safely in the jail.
"So we had a person that was truly psychotic, good and strong physically, that
had injured himself before, hanged himself in his cell, we moved him into the
rubber room and he bounced and hit the wall so hard that he lacerated his head,
and they won't take him," Styles said.
Inmate A's injury required further medical attention and he was transferred to
Mission Hospitals in Asheville, ending the jail's responsibility for him. Styles
has tried unsuccessfully to get in touch with his sister and has been unable to
find out what became of Inmate A.
Much Different
Before the overhaul of the mental health system, the situation would have played
out much differently, Styles said.
If an inmate was having a psychotic episode, Styles would call Trend Mental
Health, the public mental health care provider for Henderson and Transylvania
counties.
Officers would transport the inmate to Trend for an evaluation and if necessary
Trend would call Broughton. Broughton routinely accepted such patients.
That changed with the reforms.
With the stated goal of achieving parity in mental health services and providing
users with more choices, the state dismantled the existing system of small local
public providers.
County programs such as Trend no longer give direct care such as counseling or
drug prescriptions. Instead, private contractors are supposed to provide care
under the umbrella of a central administrative unit, or Local Management Entity.
For Henderson, Transylvania, Polk and five other counties, the LME is Western
Highlands, based in Asheville.
Meanwhile, state mental hospitals that in the past dealt with the most severe
cases are reducing the number of beds for mental patients and cutting the length
of stays. The idea is to force communities to play a greater role in caring for
mentally ill residents.
Broughton administrators question whether the problems experienced by the
Henderson County Jail are really part of the reform, saying they are more likely
due to the exploding population in the mountains.
Hospital Director Seth Hunt said at Broughton and the other three state
hospitals that specialize in mental illness the patient population has
"increased pretty dramatically."
"When you look at the 2000 census you see that the population has changed but
without any exponential increase in services," Hunt said. "That is not
necessarily a problem with reform."
Broughton serves 37 counties that contain 36.4 percent of the state's
population, he said.
The hospital does not have beds designated for mentally ill inmates, but takes
them on a case-by-case basis according to the degree of sickness and potential
danger they could present.
"I don't know that we're being any more strict, but we're having to make
adjustments," he said.
State cutbacks have taken Broughton from 500 beds to 339 with further reforms
set to reduce that number to between 278 and 290.
The situation has the potential to get better with the construction at Broughton
and at Butner in Eastern North Carolina of 50-bed forensics units designed to
handle inmates.
At Broughton the $6 million unit could be completed by the summer of 2007.
Broughton has about 20 to 30 inmate patients and after the completion of the
unit will likely take back 10 to 15 western inmates from Dorothea Dix Hospital
in Raleigh, leaving it with five to 10 beds "wiggle room," Hunt said.
Trickle-down
Though Hunt sees no direct link, mental health providers in Henderson County say
that the reforms happened shortly before the jail began having difficulty
getting higher-level care for inmates.
"It's the trickle-down effect," said Barry Beavers, director of adult services
at Mountain Laurel Community Services. "As the state hospitals get further along
in their attempts to downsize they are having to get firmer with directives of
how to deal with clients that we would historically refer to them."
Mountain Laurel is a private nonprofit mental health organization that handles
many of the services formerly provided by Trend.
Beavers said emergency rooms are not equipped to deal with these people and he
thinks the new forensics unit at Broughton will help.
"But my perspective on mental health reform and what we need to do as a
community at this point is to move away from the idea that our state hospital
system is the answer to a lot of our ills and concerns," he said. "It's a lot
about our partnerships and what we can do here in our community."
Already Beavers has been working with Styles and other jail nurses to help the
inmates, going to the jail for assessments rather than making officers bring
them to Mountain Laurel.
The biggest problem in this type of work is a prohibition against billing for
services to incarcerated individuals. For this reason many of the new private
programs will be reluctant to pick up this area of last resort.
Though this puts a strain on Mountain Laurel's budget, Beavers said the service
is an important link in the chain of overall care.
"There are certain things we are just going to have to reach out and take care
of," he said.
Styles, meanwhile, said she is hoping for a change.
The increased number of severe mentally ill people in the jail has stretched
staff to the limits, she said, and left her with no time to sit down and work
through a solution.
She points to one inmate who she said had a "long violent history," and was put
in jail without the medication he needed for mental illness.
"He was constantly threatening to kill the officers and the other inmates. He
kicked the door every day and was just really violent," she said.
Styles tried to get him committed to Broughton but was refused. The inmate only
had a $400 bond. He was soon back on the streets.
As far as she knows there have been no incidents where inmates who needed mental
health treatment have left the jail and injured someone, she said, "but it
will."
TAC 2/3/06
ENEWS - TREATMENT ADVOCACY CENTER
TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
February 3, 2006
******************************
1. MENTALLY ILL MAN ON LONG ROAD - Raleigh News & Observer, January 19, 2006
2. NURSE SEES JAIL AS 'DUMPING GROUND' FOR MANY OF THE MENTALLY ILL -
Hendersonville Times News, January 4, 2006
3. YATES TAKEN TO MENTAL HOSPITAL - ASSOCIATED PRESS, February 2, 2006
4. CARLSBAD MAN GETS 16 YEARS TO LIFE FOR ATTACK ON FAMILY - San Diego
Union-Tribune, January 30, 2006
5. SUICIDE A LIFE SENTENCE; LOVED ONES STRUGGLE WITH PAIN, DEPRESSION - Antelope
Valley Press, November 20, 2005
******************************
1. RALEIGH NEWS & OBSERVER (NC), January 19, 2006
[Editor’s Note: The latest on Phil Wiggins offers a ray of hope, but one that
comes only after many months and the application of extensive, concentrated and
coordinated mental health resources - a targeted effort in large brought on by
the dogged efforts of his sister, Louise Jordan, and more than likely the public
spotlight on his progress created by reporter Ruth Sheehan.]
MENTALLY ILL MAN ON LONG ROAD
By Ruth Sheehan, Staff Writer
Phil Wiggins' emergence from 44 years in a state psychiatric hospital has been a
series of highs and lows, mirroring the promise -- and challenges -- of the
mental health reform effort he personifies.
Over the last seven months, he has shown glimmers of great promise. Bursts of
humor. A renewed interest in reading science texts.
He has also churned through five community-based social workers, the folks who
stay with him all day. He has begun "cheeking" his medicine for schizophrenia
and impulse control, refusing to swallow it.
And then of course, last fall, his sister, Louise Jordan of Raleigh, received
notice that Wiggins was being evicted from his group home in Zebulon after
trying to start a fire in the back yard with baking soda and cologne.
For two months, Jordan visited a grim selection of other homes. But the new year
brought good news. With his sixth social worker, Wiggins seems to be making
progress again -- so he's being allowed to stay at the group home.
I've followed Wiggins for nearly two years now in his journey back into the
community. I've been struck by the beneficial effects of more freedom and
interaction with the outside world. And I've been stunned at how quickly those
advances can be lost when logistical obstacles arise -- a break between social
workers or a delay in testing to make sure he's still swallowing his meds.
Keeping a patient as profoundly mentally ill as Wiggins on the right track
requires a huge investment.
First of all, 56 hours per week of one-on-one care. Forty hours with one worker
and 16 hours on the weekend with another.
That does not include the day program his social worker will soon begin
attending with him, to help him learn to socialize.
Nor does it include the basic care he receives at the group home, from the
psychiatric nurse who is on duty during daylight hours, and from the additional
person the group-home owner has hired to be on hand overnight in case Wiggins
wanders. Which he does.
On top of all that is Anita High, his uber-social worker, and the team that
arranges for every necessity from clothing to psychiatric care.
But when things are going well, even a man as sick as Wiggins is capable of
tremendous progress.
On a recent Wednesday, I met Wiggins and his new social worker, along with
Jordan and High at a Ruby Tuesdays in North Raleigh.
The wait for our food seemed endless. Yet Wiggins sat quietly. He even commented
on the restaurant's lively decor.
It was such a contrast from 21 months ago, when we first met. Then, Wiggins
could not sit for five minutes in a meeting at a state psychiatric hospital in
Goldsboro about his future. The meetings would barely begin and he'd shout,
"Louise! How about we go to Hardees?"
He had no clue about his future, much less about the decor of any room he sat
in.
So at Ruby Tuesdays, as we fought over the bill at the end of the meal, we all
roared with laughter when Wiggins told his social worker to let Jordan pay.
"Save your money," he said, "and spend it on me."
A small victory? Yes. But in it lies some hope that mental health reform can
succeed.
******************************
2. HENDERSONVILLE TIMES NEWS (NC), January 4, 2006
[Editor’s Note: Their stories are not so well chronicled as that of Phil Wiggins
but those of others affected by North Carolina’s shearing of its capacity for
inpatient psychiatric treatment can also be found in the Henderson County Jail.]
NURSE SEES JAIL AS 'DUMPING GROUND' FOR MANY OF THE MENTALLY ILL
By Joel Burgess
It was a normal day in the classification pod of the Henderson County Jail. Of
the dozen or so inmates, one was schizophrenic, two were from group homes, which
often treat those with developmental disabilities, one was on suicide watch and
a handful were withdrawing from alcohol, heroin or other drug addictions.
Of the 151 inmates in the jail that day, head nurse Karen Styles estimated 90
had some degree of mental illness and more than 100 had "alcohol or drug
issues."
"I would say there are probably 24 that have major mental health medications
that they are on," said Styles, an eight-year veteran of correctional medicine.
Considering what it has been like for the past year, this was just another day
for Styles.
"I call it little Broughton, without the medications," she said, referring to
the state hospital in Morganton where the jail sends inmates with extreme mental
illnesses. Or at least that was where the jail used to send such cases, she
said, before sweeping state mental health changes effectively cut off that
avenue of treatment.
Now the jail has become the "dumping ground," she said, for many of the
community's seriously mentally ill.
'The Archangel'
One such person was jailed two months ago after being picked up with a stolen
car in Henderson County. Styles cannot give out names of mentally ill inmates
because of medical confidentiality rules, but said before being incarcerated the
man had been staying with his sister in Buncombe County.
"He disappeared into the cold one night, and she took out commitment papers,
because she knew about his mental illness," Styles said.
The man, "Inmate A," told jail officers he was "the archangel" and was going to
kill himself and that he could take his eyeballs out.
Using the small length of cord on an inmate telephone he tried to hang himself.
An officer intervened and stopped him.
Though there have been many attempts, the jail has never had a suicide, due
largely, Styles said, to officers' diligence.
Officers took Inmate A's clothes and put him into a safety gown, a loose garment
that cannot be tied, burned or torn. They placed him into a small padded cell
absent of any furniture or fixtures except a light and a hole in the center of
the floor with a grate over it.
Styles, realizing the man needed more treatment than she or local facilities
could offer, got on the phone to try to get him committed to Broughton.
She found out about the commitment papers the sister had taken out and got in
touch with her.
"I learned that in Georgia he literally did pull his eyeball out because he
thought it was the end times," she said. Intensive surgery was required to save
his eye.
While on the phone Styles said she heard a "pop."
Inmate A had smashed his head against the padded wall and blood was now running
from a wound.
Officers took him from the room and transported him to Pardee Hospital. At the
hospital a psychiatric social worker evaluated him and said he was commitable to
Broughton.
The hospital has its own psychiatric ward, but it is not set up to handle
inmates.
Broughton refused admission, saying the inmate could be kept safely in the jail.
"So we had a person that was truly psychotic, good and strong physically, that
had injured himself before, hanged himself in his cell, we moved him into the
rubber room and he bounced and hit the wall so hard that he lacerated his head,
and they won't take him," Styles said.
Inmate A's injury required further medical attention and he was transferred to
Mission Hospitals in Asheville, ending the jail's responsibility for him. Styles
has tried unsuccessfully to get in touch with his sister and has been unable to
find out what became of Inmate A.
Much Different
Before the overhaul of the mental health system, the situation would have played
out much differently, Styles said.
If an inmate was having a psychotic episode, Styles would call Trend Mental
Health, the public mental health care provider for Henderson and Transylvania
counties.
Officers would transport the inmate to Trend for an evaluation and if necessary
Trend would call Broughton. Broughton routinely accepted such patients.
That changed with the reforms.
With the stated goal of achieving parity in mental health services and providing
users with more choices, the state dismantled the existing system of small local
public providers.
County programs such as Trend no longer give direct care such as counseling or
drug prescriptions. Instead, private contractors are supposed to provide care
under the umbrella of a central administrative unit, or Local Management Entity.
For Henderson, Transylvania, Polk and five other counties, the LME is Western
Highlands, based in Asheville.
Meanwhile, state mental hospitals that in the past dealt with the most severe
cases are reducing the number of beds for mental patients and cutting the length
of stays. The idea is to force communities to play a greater role in caring for
mentally ill residents.
Broughton administrators question whether the problems experienced by the
Henderson County Jail are really part of the reform, saying they are more likely
due to the exploding population in the mountains.
Hospital Director Seth Hunt said at Broughton and the other three state
hospitals that specialize in mental illness the patient population has
"increased pretty dramatically."
"When you look at the 2000 census you see that the population has changed but
without any exponential increase in services," Hunt said. "That is not
necessarily a problem with reform."
Broughton serves 37 counties that contain 36.4 percent of the state's
population, he said.
The hospital does not have beds designated for mentally ill inmates, but takes
them on a case-by-case basis according to the degree of sickness and potential
danger they could present.
"I don't know that we're being any more strict, but we're having to make
adjustments," he said.
State cutbacks have taken Broughton from 500 beds to 339 with further reforms
set to reduce that number to between 278 and 290.
The situation has the potential to get better with the construction at Broughton
and at Butner in Eastern North Carolina of 50-bed forensics units designed to
handle inmates.
At Broughton the $6 million unit could be completed by the summer of 2007.
Broughton has about 20 to 30 inmate patients and after the completion of the
unit will likely take back 10 to 15 western inmates from Dorothea Dix Hospital
in Raleigh, leaving it with five to 10 beds "wiggle room," Hunt said.
Trickle-down
Though Hunt sees no direct link, mental health providers in Henderson County say
that the reforms happened shortly before the jail began having difficulty
getting higher-level care for inmates.
"It's the trickle-down effect," said Barry Beavers, director of adult services
at Mountain Laurel Community Services. "As the state hospitals get further along
in their attempts to downsize they are having to get firmer with directives of
how to deal with clients that we would historically refer to them."
Mountain Laurel is a private nonprofit mental health organization that handles
many of the services formerly provided by Trend.
Beavers said emergency rooms are not equipped to deal with these people and he
thinks the new forensics unit at Broughton will help.
"But my perspective on mental health reform and what we need to do as a
community at this point is to move away from the idea that our state hospital
system is the answer to a lot of our ills and concerns," he said. "It's a lot
about our partnerships and what we can do here in our community."
Already Beavers has been working with Styles and other jail nurses to help the
inmates, going to the jail for assessments rather than making officers bring
them to Mountain Laurel.
The biggest problem in this type of work is a prohibition against billing for
services to incarcerated individuals. For this reason many of the new private
programs will be reluctant to pick up this area of last resort.
Though this puts a strain on Mountain Laurel's budget, Beavers said the service
is an important link in the chain of overall care.
"There are certain things we are just going to have to reach out and take care
of," he said.
Styles, meanwhile, said she is hoping for a change.
The increased number of severe mentally ill people in the jail has stretched
staff to the limits, she said, and left her with no time to sit down and work
through a solution.
She points to one inmate who she said had a "long violent history," and was put
in jail without the medication he needed for mental illness.
"He was constantly threatening to kill the officers and the other inmates. He
kicked the door every day and was just really violent," she said.
Styles tried to get him committed to Broughton but was refused. The inmate only
had a $400 bond. He was soon back on the streets.
As far as she knows there have been no incidents where inmates who needed mental
health treatment have left the jail and injured someone, she said, "but it
will."
******************************
3. ASSOCIATED PRESS, February 2, 2006
[Editor’s Note: The saga of Andrea Yates continues. After being awarded a new
trial, mainly because of false statements by an expert witness for the
prosecution, she will now spend her time awaiting that trial in a psychiatric
facility, perhaps where she should have been all along.]
YATES TAKEN TO MENTAL HOSPITAL
By Pam Easton, Associated Press Writer
HOUSTON (AP) -- Andrea Yates left jail early Thursday for a state mental
hospital where she will await her second capital murder trial for the drowning
deaths of her young children.
Yates' attorney posted her $200,000 bond, releasing her from incarceration for
the first time since the five children were drowned in the family bathtub in
June 2001.
State District Judge Belinda Hill set the bond Wednesday.
Yates, 41, didn't speak as she left the jail. She carried a brown paper sack and
wore jeans and a blue-and-white striped shirt as she entered a car with her
attorney and a private investigator for the drive to the mental hospital.
The judge said she couldn't order Yates to commit herself to the East Texas
hospital, but said she set the bond based on Yates remaining at the hospital
until her March 20 trial.
Once the trial gets under way, Yates will return to the Harris County Jail for
the duration of the trial, expected to last four to six weeks.
Yates faces capital murder charges for drowning three of the children and has
pleaded innocent by reason of insanity.
A jury rejected her original insanity defense in 2002 and sentenced her to life
in prison for the drowning of 7-year-old Noah, 5-year-old John and 6-month-old
Mary. Prosecutors presented evidence about the drownings of Paul, 3, and Luke,
2, but Yates was not charged in their deaths.
An appeals court last year overturned the convictions based on testimony by the
state's expert witness about a nonexistent episode on television's "Law & Order"
series. The expert, Park Dietz, said a show about a woman with postpartum
depression who drowned her children aired shortly before Yates killed her five
children.
******************************
4. SAN DIEGO UNION-TRIBUNE, January 30, 2006
[Editor’s Note: And as Andrea Yates, at least for a while, enters an inpatient
psychiatric facility, Thomas Earl Johnson will enter prison, still maintaining
that “he is an alien, is currently 2,000 years old and expects to be recycled
into a younger body.”]
CARLSBAD MAN GETS 16 YEARS TO LIFE FOR ATTACK ON FAMILY
By Jose Luis Jimenez, Union-Tribune Staff Writer
VISTA - Thomas Earl Johnson, the mentally disturbed 57-year-old Carlsbad man
convicted of second-degree murder and attempted murder for attacking his family,
was sentenced Monday to 16 years to life in prison.
Although the Probation Department recommended the maximum possible sentence of
33 years to life in prison, Superior Court Judge Marguerite Wagner chose the
lowest sentence, citing Johnson's long, documented struggle with mental illness.
In an interview with probation officials, Johnson explained his family pushed
him “over the line” the day of the Feb 16, 2004 attack in the family's Woodridge
Circle home. He also maintains he is an alien, is currently 2,000 years old and
expects to be recycled into a younger body, which will free him from prison.
In November, the former Air Force flight engineer was convicted of second-degree
murder in the stabbing death of his frail father, Robert Johnson, 84, and two
counts of attempted murder for trying to kill his mother Rita Johnson, 80, and
his 5-year-old great nephew, Corey Lucas.
He stabbed his father in bed, beat and choked his mother, and stabbed and broke
the jaw of the little boy.
Johnson, who pleaded not guilty by reason of insanity, was found to be sane by a
Superior Court jury on Dec. 8.
He was arrested 12 days after the attack. He was found sleeping in his car in
Monterey with his father's blood still on his jeans, according to testimony
during the six-week trial.
******************************
5. ANTELOPE VALLEY PRESS (CA), November 20, 2005
[Editor’s Note: Three suicides, one family. Not surprisingly, also can be
found among the members of that family are two of the main conditions found in
those who take their own lives - substance abuse and severe mental illness.]
SUICIDE A LIFE SENTENCE; LOVED ONES STRUGGLE WITH PAIN, DEPRESSION
By Titus Gee, Valley Press Staff Writer
Suicide haunts Linda Marquez .
Three of her loved ones took their own lives - her mother, her husband, her son.
No death could be more devastating to the people left behind, Linda said.
The people who kill themselves may think the world is better off without them,
"but they don't realize that what they're doing is leaving people with a life
sentence, especially the people that love them the most," she said.
Her son's death finally drove her to speak out.
"I thought, this is too much. People need to know," she said.
Experts estimate 1 million people attempt suicide every year, and 30,000 die by
it. Suicide is the third leading cause of death among teens and young adults,
and the second leading cause of death among college students.
"They really go through a lot of stuff. The pressures are huge," Linda said.
"Life is hard. … So many things happen in life. It is about learning how to deal
with things and how to cope."
Four years after her son died by suicide, Linda finally has begun to think of
other things.
Today, she will turn her growing strength toward helping others.
Linda and other grieving families and friends will walk five kilometers,
starting in Santa Monica, to raise support for suicide awareness and prevention.
The American Foundation for Suicide Prevention's "Out of the Darkness" walks
bring hope to anyone thinking of ending his or her life and to loved ones
suffering the aftershock of a suicide.
"It takes an enormous toll" on loved ones, foundation director Bob Gebbia said.
Linda first experienced that toll at age 15. Her mother, Betty Kelly ,struggled
with bipolar disorder and hanged herself when Linda was in high school. School
helped the young girl cope, but her mother's suicide hit her father pretty hard,
she said.
Linda tried to move on. She grew up, married and had three kids.
But her husband, Tony Webb, had a drinking problem. One night, after they
argued, he shot himself in the head.
Linda struggled quietly, immersing herself in the care of three children younger
than 3. Eventually she remarried and had three more children. She kept the pain
to herself.
"I never told people how they really died. I just said my mom died of cancer. I
didn't want them to know she hung herself," Linda said. "Then when my husband
did it… I just said he was in a car wreck."
When her son died, the front of stoicism and silence went with him.
"The first year … I had a problem just being able to breathe," she said.
Linda was vacationing in Florida with her husband and young daughters when she
heard that her son, Raymond Webb, hanged himself.
"I just could not believe it," Linda said. "I just remember thinking this can't
be happening again."
Raymond was 25 and had two children. His addiction to methamphetamine, or
"speed," had landed him in jail, but he got clean for a year.
The suicide note said he had started using again. The backsliding, and possibly
the drug itself, sent him deep into depression. "Speed" is known to turn the
mind to dark and desperate thoughts.
"He said, 'I can't stop doing this evil drug,' " she said. "He went out in the
back yard and hung himself in the middle of the night."
With her mother out of town, Raymond's sister had to call the others and make
arrangements for his body.
Linda rushed back from the East Coast, fighting her own grief while trying to
help her young daughters understand what had happened.
"It was just terrible. I can't even tell you," she said.
The 12-year-old wrote in a diary on the plane ride home, "Suicide is the worst
thing in the world."
Linda still struggles to grasp why her oldest son would take his life. He had
lived through car wrecks and major surgeries. He had fishing plans, and things
he wanted to do.
"He was always the happy one," she said. "He was such a survivor. He was just
tough and loved everything and loved life - I never in a million years thought
that he was gonna end it like that."
But he was also sensitive, she said. Failure and conflict seemed to hit him
harder than the other children.
"He felt like he was in a corner," she said, "but looking at it from my point of
view there are so many other things that we could have done, but he didn't come
to us."
Linda had spoken with quiet frankness, and sometimes even a smile. Now tears
filled her eyes.
"The first thing I thought of when I found out was, y'know, I wasn't done trying
to help him. There's so many other things we could have tried, but he gave up."
Losing a child this way surpasses any other pain - even other suicides, she
said.
Linda would know.
The deaths of her mother and husband probably contributed to Raymond's choice,
she said.
"It just puts the idea in your head and it makes you think that's a way out,"
she said. "I think he did it because he knew that they did it."
Raymond's way out shattered his mother's world. "You don't realize how close we
are to insanity. I was a normal person and - I just snapped," she said. "I
didn't think I was ever gonna get over that. Two years I cried. Quit working and
just cried for two years."
By Christmas time the year of Raymond's death, she had totally withdrawn. If not
for her youngest daughter, she might have missed the holidays entirely.
"I was so upset, every single minute of the day. I just didn't want to see happy
people at all," Linda said. "If he knew what he did to me by killing himself, I
can guarantee he would have never done it."
Yet Linda soon faced the same temptation.
"I knew my son 25 years. That's longer than I knew my mom or my husband. I felt
like (we) grew up together," she said. "After my son died I didn't want to be
here either. I was there for two years.
"You feel like you're all alone, like no one understands," she said. "It just
never went away, you just couldn't get away from it."
She said depression turns in upon itself, making light and hope feel like
distant memories.
"This just wouldn't go away and the grieving wears you down - I can't compare it
to anything else in my life," she said.
She was mother, nurturer, a problem solver, but she couldn't fix this. She
pulled further away from life and human contact.
"When I was really bad I didn't tell anyone, because I thought, 'They're gonna
put me away,' " she said. "and I really felt in the back of my mind that I was
gonna kill myself anyway."
Most of her friends faded away, exhausted by her grief.
"I really felt like everybody let me down, except for my husband and my kids,
but I think that's because they don't know what to say after a while," she said.
"Two years is a long time to listen to someone cry about the same thing, so you
lose most of your support."
Yet, somehow her own pain also kept Linda from giving in.
"The only reason I didn't (attempt suicide) is because I knew what it did to the
people that are left behind," she said.
Many people who commit suicide don't understand the pain they cause, she said.
"They think they're doing everyone a favor, but they don't understand that,
(when) you end your life, you end all the chances of it ever getting better. And
the problems in your family only begin. Whatever pain you were in -their pain is
gonna be magnified for a lifetime."
Linda had a husband and other children to think about.
"I kept thinking, 'God, if I do then the kids are gonna do it,' " she said. "I'm
like the main one. I'm the mom. All the kids, they look to me for everything … I
knew that I had to be the example. I knew that I had to keep going and to keep
living and to get to the other side."
After wandering aimlessly for two years, Linda started to recover.
"You fight it and fight it and fight it, and I think your brain gets used to the
idea," she said. "You can't win. So that's when you just say, OK, I have to pull
myself together. … Every single day, I thought 'one more day' and I did it and
it started getting easier after a couple of years."
Her family lived for two years without a mother, she said. The strain began to
show.
"I knew that it was a turning point for me," she said. "I knew that I had to
either jump off the bridge or really get going."
She chose to move forward, but that didn't make it easier.
"It's slow. You just have to say, I'm gonna get through today. People don't
realize it takes a long time," she said. "I just forced myself to go back to
work, force myself to go to the gym."
Still, Linda struggles. She smiles and laughs, but the sadness hovers behind her
eyes.
"I still literally have to make myself do the things that I do every day," she
said. "I just had to say, no, I'm not gonna cry right now … I still (have to
say) that, because what are you gonna do? I can't cry forever, because I have
other kids - and plus, every life is worth living, is worth saving. There's
always hope. There is always hope."
Her message to young people like Raymond, who face such powerful stressors in
their lives:
"If you get in trouble mentally where you start to feel like your depressed
every day, you need to go get help. Go to the doctor and don't use (suicide) as
a way out."
Through the walk, and plans for a local support group, Linda also wants to
comfort and uplift those left behind by the suicide of a loved one.
"I know that there are people in the Antelope Valley that have kids or family
members that have died by suicide," she said.
Few resources exist for them in the Valley. She hopes "Out of the Darkness" will
help fill that void.
"I really wanted to talk to other people" who had faced it, she said. "I don't
know anyone that this has happened to."
Seeing how others have coped and grown stronger will be an important part of
today's walk in Santa Monica.
"It makes you feel not so alone ... it helps," she said. "Maybe I can help some
other moms or dads or brothers, (but) it's gonna be hard. I'll probably cry
again."
Anyone interested in joining Marquez for today's "Out of the Darkness Walk," or
in starting a local support group, can contact her at (661) 547-1875. The
five-kilometer walk will start at 7:45 a.m. at the Third Street Promenade, in
Santa Monica.
Linda also recommended the Web site www.parentsofsuicide.com as a starting point
for anyone searching for hope, and connection to others who share their pain.
Mental health services may be found at Antelope Valley Hospital, and suicide
risk can be assessed through the emergency room. If a threat of suicide is
imminent, call 9-1-1.
For all those struggling with depression and suicide, Linda offers the lyrics of
"Hold On" by the band Good Charlotte.
Hold on if you feel like letting go
Hold on it gets better than you know
Don't stop looking, you're one step closer
Don't stop searching, it's not over
Hold on
"The biggest message here," she said, is "don't give up. Hold on. There is help
out there."
******************************
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February 3, 2006
******************************
1. MENTALLY ILL MAN ON LONG ROAD - Raleigh News & Observer, January 19, 2006
2. NURSE SEES JAIL AS 'DUMPING GROUND' FOR MANY OF THE MENTALLY ILL -
Hendersonville Times News, January 4, 2006
3. YATES TAKEN TO MENTAL HOSPITAL - ASSOCIATED PRESS, February 2, 2006
4. CARLSBAD MAN GETS 16 YEARS TO LIFE FOR ATTACK ON FAMILY - San Diego
Union-Tribune, January 30, 2006
5. SUICIDE A LIFE SENTENCE; LOVED ONES STRUGGLE WITH PAIN, DEPRESSION - Antelope
Valley Press, November 20, 2005
******************************
1. RALEIGH NEWS & OBSERVER (NC), January 19, 2006
[Editor’s Note: The latest on Phil Wiggins offers a ray of hope, but one that
comes only after many months and the application of extensive, concentrated and
coordinated mental health resources - a targeted effort in large brought on by
the dogged efforts of his sister, Louise Jordan, and more than likely the public
spotlight on his progress created by reporter Ruth Sheehan.]
MENTALLY ILL MAN ON LONG ROAD
By Ruth Sheehan, Staff Writer
Phil Wiggins' emergence from 44 years in a state psychiatric hospital has been a
series of highs and lows, mirroring the promise -- and challenges -- of the
mental health reform effort he personifies.
Over the last seven months, he has shown glimmers of great promise. Bursts of
humor. A renewed interest in reading science texts.
He has also churned through five community-based social workers, the folks who
stay with him all day. He has begun "cheeking" his medicine for schizophrenia
and impulse control, refusing to swallow it.
And then of course, last fall, his sister, Louise Jordan of Raleigh, received
notice that Wiggins was being evicted from his group home in Zebulon after
trying to start a fire in the back yard with baking soda and cologne.
For two months, Jordan visited a grim selection of other homes. But the new year
brought good news. With his sixth social worker, Wiggins seems to be making
progress again -- so he's being allowed to stay at the group home.
I've followed Wiggins for nearly two years now in his journey back into the
community. I've been struck by the beneficial effects of more freedom and
interaction with the outside world. And I've been stunned at how quickly those
advances can be lost when logistical obstacles arise -- a break between social
workers or a delay in testing to make sure he's still swallowing his meds.
Keeping a patient as profoundly mentally ill as Wiggins on the right track
requires a huge investment.
First of all, 56 hours per week of one-on-one care. Forty hours with one worker
and 16 hours on the weekend with another.
That does not include the day program his social worker will soon begin
attending with him, to help him learn to socialize.
Nor does it include the basic care he receives at the group home, from the
psychiatric nurse who is on duty during daylight hours, and from the additional
person the group-home owner has hired to be on hand overnight in case Wiggins
wanders. Which he does.
On top of all that is Anita High, his uber-social worker, and the team that
arranges for every necessity from clothing to psychiatric care.
But when things are going well, even a man as sick as Wiggins is capable of
tremendous progress.
On a recent Wednesday, I met Wiggins and his new social worker, along with
Jordan and High at a Ruby Tuesdays in North Raleigh.
The wait for our food seemed endless. Yet Wiggins sat quietly. He even commented
on the restaurant's lively decor.
It was such a contrast from 21 months ago, when we first met. Then, Wiggins
could not sit for five minutes in a meeting at a state psychiatric hospital in
Goldsboro about his future. The meetings would barely begin and he'd shout,
"Louise! How about we go to Hardees?"
He had no clue about his future, much less about the decor of any room he sat
in.
So at Ruby Tuesdays, as we fought over the bill at the end of the meal, we all
roared with laughter when Wiggins told his social worker to let Jordan pay.
"Save your money," he said, "and spend it on me."
A small victory? Yes. But in it lies some hope that mental health reform can
succeed.
******************************
2. HENDERSONVILLE TIMES NEWS (NC), January 4, 2006
[Editor’s Note: Their stories are not so well chronicled as that of Phil Wiggins
but those of others affected by North Carolina’s shearing of its capacity for
inpatient psychiatric treatment can also be found in the Henderson County Jail.]
NURSE SEES JAIL AS 'DUMPING GROUND' FOR MANY OF THE MENTALLY ILL
By Joel Burgess
It was a normal day in the classification pod of the Henderson County Jail. Of
the dozen or so inmates, one was schizophrenic, two were from group homes, which
often treat those with developmental disabilities, one was on suicide watch and
a handful were withdrawing from alcohol, heroin or other drug addictions.
Of the 151 inmates in the jail that day, head nurse Karen Styles estimated 90
had some degree of mental illness and more than 100 had "alcohol or drug
issues."
"I would say there are probably 24 that have major mental health medications
that they are on," said Styles, an eight-year veteran of correctional medicine.
Considering what it has been like for the past year, this was just another day
for Styles.
"I call it little Broughton, without the medications," she said, referring to
the state hospital in Morganton where the jail sends inmates with extreme mental
illnesses. Or at least that was where the jail used to send such cases, she
said, before sweeping state mental health changes effectively cut off that
avenue of treatment.
Now the jail has become the "dumping ground," she said, for many of the
community's seriously mentally ill.
'The Archangel'
One such person was jailed two months ago after being picked up with a stolen
car in Henderson County. Styles cannot give out names of mentally ill inmates
because of medical confidentiality rules, but said before being incarcerated the
man had been staying with his sister in Buncombe County.
"He disappeared into the cold one night, and she took out commitment papers,
because she knew about his mental illness," Styles said.
The man, "Inmate A," told jail officers he was "the archangel" and was going to
kill himself and that he could take his eyeballs out.
Using the small length of cord on an inmate telephone he tried to hang himself.
An officer intervened and stopped him.
Though there have been many attempts, the jail has never had a suicide, due
largely, Styles said, to officers' diligence.
Officers took Inmate A's clothes and put him into a safety gown, a loose garment
that cannot be tied, burned or torn. They placed him into a small padded cell
absent of any furniture or fixtures except a light and a hole in the center of
the floor with a grate over it.
Styles, realizing the man needed more treatment than she or local facilities
could offer, got on the phone to try to get him committed to Broughton.
She found out about the commitment papers the sister had taken out and got in
touch with her.
"I learned that in Georgia he literally did pull his eyeball out because he
thought it was the end times," she said. Intensive surgery was required to save
his eye.
While on the phone Styles said she heard a "pop."
Inmate A had smashed his head against the padded wall and blood was now running
from a wound.
Officers took him from the room and transported him to Pardee Hospital. At the
hospital a psychiatric social worker evaluated him and said he was commitable to
Broughton.
The hospital has its own psychiatric ward, but it is not set up to handle
inmates.
Broughton refused admission, saying the inmate could be kept safely in the jail.
"So we had a person that was truly psychotic, good and strong physically, that
had injured himself before, hanged himself in his cell, we moved him into the
rubber room and he bounced and hit the wall so hard that he lacerated his head,
and they won't take him," Styles said.
Inmate A's injury required further medical attention and he was transferred to
Mission Hospitals in Asheville, ending the jail's responsibility for him. Styles
has tried unsuccessfully to get in touch with his sister and has been unable to
find out what became of Inmate A.
Much Different
Before the overhaul of the mental health system, the situation would have played
out much differently, Styles said.
If an inmate was having a psychotic episode, Styles would call Trend Mental
Health, the public mental health care provider for Henderson and Transylvania
counties.
Officers would transport the inmate to Trend for an evaluation and if necessary
Trend would call Broughton. Broughton routinely accepted such patients.
That changed with the reforms.
With the stated goal of achieving parity in mental health services and providing
users with more choices, the state dismantled the existing system of small local
public providers.
County programs such as Trend no longer give direct care such as counseling or
drug prescriptions. Instead, private contractors are supposed to provide care
under the umbrella of a central administrative unit, or Local Management Entity.
For Henderson, Transylvania, Polk and five other counties, the LME is Western
Highlands, based in Asheville.
Meanwhile, state mental hospitals that in the past dealt with the most severe
cases are reducing the number of beds for mental patients and cutting the length
of stays. The idea is to force communities to play a greater role in caring for
mentally ill residents.
Broughton administrators question whether the problems experienced by the
Henderson County Jail are really part of the reform, saying they are more likely
due to the exploding population in the mountains.
Hospital Director Seth Hunt said at Broughton and the other three state
hospitals that specialize in mental illness the patient population has
"increased pretty dramatically."
"When you look at the 2000 census you see that the population has changed but
without any exponential increase in services," Hunt said. "That is not
necessarily a problem with reform."
Broughton serves 37 counties that contain 36.4 percent of the state's
population, he said.
The hospital does not have beds designated for mentally ill inmates, but takes
them on a case-by-case basis according to the degree of sickness and potential
danger they could present.
"I don't know that we're being any more strict, but we're having to make
adjustments," he said.
State cutbacks have taken Broughton from 500 beds to 339 with further reforms
set to reduce that number to between 278 and 290.
The situation has the potential to get better with the construction at Broughton
and at Butner in Eastern North Carolina of 50-bed forensics units designed to
handle inmates.
At Broughton the $6 million unit could be completed by the summer of 2007.
Broughton has about 20 to 30 inmate patients and after the completion of the
unit will likely take back 10 to 15 western inmates from Dorothea Dix Hospital
in Raleigh, leaving it with five to 10 beds "wiggle room," Hunt said.
Trickle-down
Though Hunt sees no direct link, mental health providers in Henderson County say
that the reforms happened shortly before the jail began having difficulty
getting higher-level care for inmates.
"It's the trickle-down effect," said Barry Beavers, director of adult services
at Mountain Laurel Community Services. "As the state hospitals get further along
in their attempts to downsize they are having to get firmer with directives of
how to deal with clients that we would historically refer to them."
Mountain Laurel is a private nonprofit mental health organization that handles
many of the services formerly provided by Trend.
Beavers said emergency rooms are not equipped to deal with these people and he
thinks the new forensics unit at Broughton will help.
"But my perspective on mental health reform and what we need to do as a
community at this point is to move away from the idea that our state hospital
system is the answer to a lot of our ills and concerns," he said. "It's a lot
about our partnerships and what we can do here in our community."
Already Beavers has been working with Styles and other jail nurses to help the
inmates, going to the jail for assessments rather than making officers bring
them to Mountain Laurel.
The biggest problem in this type of work is a prohibition against billing for
services to incarcerated individuals. For this reason many of the new private
programs will be reluctant to pick up this area of last resort.
Though this puts a strain on Mountain Laurel's budget, Beavers said the service
is an important link in the chain of overall care.
"There are certain things we are just going to have to reach out and take care
of," he said.
Styles, meanwhile, said she is hoping for a change.
The increased number of severe mentally ill people in the jail has stretched
staff to the limits, she said, and left her with no time to sit down and work
through a solution.
She points to one inmate who she said had a "long violent history," and was put
in jail without the medication he needed for mental illness.
"He was constantly threatening to kill the officers and the other inmates. He
kicked the door every day and was just really violent," she said.
Styles tried to get him committed to Broughton but was refused. The inmate only
had a $400 bond. He was soon back on the streets.
As far as she knows there have been no incidents where inmates who needed mental
health treatment have left the jail and injured someone, she said, "but it
will."
******************************
3. ASSOCIATED PRESS, February 2, 2006
[Editor’s Note: The saga of Andrea Yates continues. After being awarded a new
trial, mainly because of false statements by an expert witness for the
prosecution, she will now spend her time awaiting that trial in a psychiatric
facility, perhaps where she should have been all along.]
YATES TAKEN TO MENTAL HOSPITAL
By Pam Easton, Associated Press Writer
HOUSTON (AP) -- Andrea Yates left jail early Thursday for a state mental
hospital where she will await her second capital murder trial for the drowning
deaths of her young children.
Yates' attorney posted her $200,000 bond, releasing her from incarceration for
the first time since the five children were drowned in the family bathtub in
June 2001.
State District Judge Belinda Hill set the bond Wednesday.
Yates, 41, didn't speak as she left the jail. She carried a brown paper sack and
wore jeans and a blue-and-white striped shirt as she entered a car with her
attorney and a private investigator for the drive to the mental hospital.
The judge said she couldn't order Yates to commit herself to the East Texas
hospital, but said she set the bond based on Yates remaining at the hospital
until her March 20 trial.
Once the trial gets under way, Yates will return to the Harris County Jail for
the duration of the trial, expected to last four to six weeks.
Yates faces capital murder charges for drowning three of the children and has
pleaded innocent by reason of insanity.
A jury rejected her original insanity defense in 2002 and sentenced her to life
in prison for the drowning of 7-year-old Noah, 5-year-old John and 6-month-old
Mary. Prosecutors presented evidence about the drownings of Paul, 3, and Luke,
2, but Yates was not charged in their deaths.
An appeals court last year overturned the convictions based on testimony by the
state's expert witness about a nonexistent episode on television's "Law & Order"
series. The expert, Park Dietz, said a show about a woman with postpartum
depression who drowned her children aired shortly before Yates killed her five
children.
******************************
4. SAN DIEGO UNION-TRIBUNE, January 30, 2006
[Editor’s Note: And as Andrea Yates, at least for a while, enters an inpatient
psychiatric facility, Thomas Earl Johnson will enter prison, still maintaining
that “he is an alien, is currently 2,000 years old and expects to be recycled
into a younger body.”]
CARLSBAD MAN GETS 16 YEARS TO LIFE FOR ATTACK ON FAMILY
By Jose Luis Jimenez, Union-Tribune Staff Writer
VISTA - Thomas Earl Johnson, the mentally disturbed 57-year-old Carlsbad man
convicted of second-degree murder and attempted murder for attacking his family,
was sentenced Monday to 16 years to life in prison.
Although the Probation Department recommended the maximum possible sentence of
33 years to life in prison, Superior Court Judge Marguerite Wagner chose the
lowest sentence, citing Johnson's long, documented struggle with mental illness.
In an interview with probation officials, Johnson explained his family pushed
him “over the line” the day of the Feb 16, 2004 attack in the family's Woodridge
Circle home. He also maintains he is an alien, is currently 2,000 years old and
expects to be recycled into a younger body, which will free him from prison.
In November, the former Air Force flight engineer was convicted of second-degree
murder in the stabbing death of his frail father, Robert Johnson, 84, and two
counts of attempted murder for trying to kill his mother Rita Johnson, 80, and
his 5-year-old great nephew, Corey Lucas.
He stabbed his father in bed, beat and choked his mother, and stabbed and broke
the jaw of the little boy.
Johnson, who pleaded not guilty by reason of insanity, was found to be sane by a
Superior Court jury on Dec. 8.
He was arrested 12 days after the attack. He was found sleeping in his car in
Monterey with his father's blood still on his jeans, according to testimony
during the six-week trial.
******************************
5. ANTELOPE VALLEY PRESS (CA), November 20, 2005
[Editor’s Note: Three suicides, one family. Not surprisingly, also can be
found among the members of that family are two of the main conditions found in
those who take their own lives - substance abuse and severe mental illness.]
SUICIDE A LIFE SENTENCE; LOVED ONES STRUGGLE WITH PAIN, DEPRESSION
By Titus Gee, Valley Press Staff Writer
Suicide haunts Linda Marquez .
Three of her loved ones took their own lives - her mother, her husband, her son.
No death could be more devastating to the people left behind, Linda said.
The people who kill themselves may think the world is better off without them,
"but they don't realize that what they're doing is leaving people with a life
sentence, especially the people that love them the most," she said.
Her son's death finally drove her to speak out.
"I thought, this is too much. People need to know," she said.
Experts estimate 1 million people attempt suicide every year, and 30,000 die by
it. Suicide is the third leading cause of death among teens and young adults,
and the second leading cause of death among college students.
"They really go through a lot of stuff. The pressures are huge," Linda said.
"Life is hard. … So many things happen in life. It is about learning how to deal
with things and how to cope."
Four years after her son died by suicide, Linda finally has begun to think of
other things.
Today, she will turn her growing strength toward helping others.
Linda and other grieving families and friends will walk five kilometers,
starting in Santa Monica, to raise support for suicide awareness and prevention.
The American Foundation for Suicide Prevention's "Out of the Darkness" walks
bring hope to anyone thinking of ending his or her life and to loved ones
suffering the aftershock of a suicide.
"It takes an enormous toll" on loved ones, foundation director Bob Gebbia said.
Linda first experienced that toll at age 15. Her mother, Betty Kelly ,struggled
with bipolar disorder and hanged herself when Linda was in high school. School
helped the young girl cope, but her mother's suicide hit her father pretty hard,
she said.
Linda tried to move on. She grew up, married and had three kids.
But her husband, Tony Webb, had a drinking problem. One night, after they
argued, he shot himself in the head.
Linda struggled quietly, immersing herself in the care of three children younger
than 3. Eventually she remarried and had three more children. She kept the pain
to herself.
"I never told people how they really died. I just said my mom died of cancer. I
didn't want them to know she hung herself," Linda said. "Then when my husband
did it… I just said he was in a car wreck."
When her son died, the front of stoicism and silence went with him.
"The first year … I had a problem just being able to breathe," she said.
Linda was vacationing in Florida with her husband and young daughters when she
heard that her son, Raymond Webb, hanged himself.
"I just could not believe it," Linda said. "I just remember thinking this can't
be happening again."
Raymond was 25 and had two children. His addiction to methamphetamine, or
"speed," had landed him in jail, but he got clean for a year.
The suicide note said he had started using again. The backsliding, and possibly
the drug itself, sent him deep into depression. "Speed" is known to turn the
mind to dark and desperate thoughts.
"He said, 'I can't stop doing this evil drug,' " she said. "He went out in the
back yard and hung himself in the middle of the night."
With her mother out of town, Raymond's sister had to call the others and make
arrangements for his body.
Linda rushed back from the East Coast, fighting her own grief while trying to
help her young daughters understand what had happened.
"It was just terrible. I can't even tell you," she said.
The 12-year-old wrote in a diary on the plane ride home, "Suicide is the worst
thing in the world."
Linda still struggles to grasp why her oldest son would take his life. He had
lived through car wrecks and major surgeries. He had fishing plans, and things
he wanted to do.
"He was always the happy one," she said. "He was such a survivor. He was just
tough and loved everything and loved life - I never in a million years thought
that he was gonna end it like that."
But he was also sensitive, she said. Failure and conflict seemed to hit him
harder than the other children.
"He felt like he was in a corner," she said, "but looking at it from my point of
view there are so many other things that we could have done, but he didn't come
to us."
Linda had spoken with quiet frankness, and sometimes even a smile. Now tears
filled her eyes.
"The first thing I thought of when I found out was, y'know, I wasn't done trying
to help him. There's so many other things we could have tried, but he gave up."
Losing a child this way surpasses any other pain - even other suicides, she
said.
Linda would know.
The deaths of her mother and husband probably contributed to Raymond's choice,
she said.
"It just puts the idea in your head and it makes you think that's a way out,"
she said. "I think he did it because he knew that they did it."
Raymond's way out shattered his mother's world. "You don't realize how close we
are to insanity. I was a normal person and - I just snapped," she said. "I
didn't think I was ever gonna get over that. Two years I cried. Quit working and
just cried for two years."
By Christmas time the year of Raymond's death, she had totally withdrawn. If not
for her youngest daughter, she might have missed the holidays entirely.
"I was so upset, every single minute of the day. I just didn't want to see happy
people at all," Linda said. "If he knew what he did to me by killing himself, I
can guarantee he would have never done it."
Yet Linda soon faced the same temptation.
"I knew my son 25 years. That's longer than I knew my mom or my husband. I felt
like (we) grew up together," she said. "After my son died I didn't want to be
here either. I was there for two years.
"You feel like you're all alone, like no one understands," she said. "It just
never went away, you just couldn't get away from it."
She said depression turns in upon itself, making light and hope feel like
distant memories.
"This just wouldn't go away and the grieving wears you down - I can't compare it
to anything else in my life," she said.
She was mother, nurturer, a problem solver, but she couldn't fix this. She
pulled further away from life and human contact.
"When I was really bad I didn't tell anyone, because I thought, 'They're gonna
put me away,' " she said. "and I really felt in the back of my mind that I was
gonna kill myself anyway."
Most of her friends faded away, exhausted by her grief.
"I really felt like everybody let me down, except for my husband and my kids,
but I think that's because they don't know what to say after a while," she said.
"Two years is a long time to listen to someone cry about the same thing, so you
lose most of your support."
Yet, somehow her own pain also kept Linda from giving in.
"The only reason I didn't (attempt suicide) is because I knew what it did to the
people that are left behind," she said.
Many people who commit suicide don't understand the pain they cause, she said.
"They think they're doing everyone a favor, but they don't understand that,
(when) you end your life, you end all the chances of it ever getting better. And
the problems in your family only begin. Whatever pain you were in -their pain is
gonna be magnified for a lifetime."
Linda had a husband and other children to think about.
"I kept thinking, 'God, if I do then the kids are gonna do it,' " she said. "I'm
like the main one. I'm the mom. All the kids, they look to me for everything … I
knew that I had to be the example. I knew that I had to keep going and to keep
living and to get to the other side."
After wandering aimlessly for two years, Linda started to recover.
"You fight it and fight it and fight it, and I think your brain gets used to the
idea," she said. "You can't win. So that's when you just say, OK, I have to pull
myself together. … Every single day, I thought 'one more day' and I did it and
it started getting easier after a couple of years."
Her family lived for two years without a mother, she said. The strain began to
show.
"I knew that it was a turning point for me," she said. "I knew that I had to
either jump off the bridge or really get going."
She chose to move forward, but that didn't make it easier.
"It's slow. You just have to say, I'm gonna get through today. People don't
realize it takes a long time," she said. "I just forced myself to go back to
work, force myself to go to the gym."
Still, Linda struggles. She smiles and laughs, but the sadness hovers behind her
eyes.
"I still literally have to make myself do the things that I do every day," she
said. "I just had to say, no, I'm not gonna cry right now … I still (have to
say) that, because what are you gonna do? I can't cry forever, because I have
other kids - and plus, every life is worth living, is worth saving. There's
always hope. There is always hope."
Her message to young people like Raymond, who face such powerful stressors in
their lives:
"If you get in trouble mentally where you start to feel like your depressed
every day, you need to go get help. Go to the doctor and don't use (suicide) as
a way out."
Through the walk, and plans for a local support group, Linda also wants to
comfort and uplift those left behind by the suicide of a loved one.
"I know that there are people in the Antelope Valley that have kids or family
members that have died by suicide," she said.
Few resources exist for them in the Valley. She hopes "Out of the Darkness" will
help fill that void.
"I really wanted to talk to other people" who had faced it, she said. "I don't
know anyone that this has happened to."
Seeing how others have coped and grown stronger will be an important part of
today's walk in Santa Monica.
"It makes you feel not so alone ... it helps," she said. "Maybe I can help some
other moms or dads or brothers, (but) it's gonna be hard. I'll probably cry
again."
Anyone interested in joining Marquez for today's "Out of the Darkness Walk," or
in starting a local support group, can contact her at (661) 547-1875. The
five-kilometer walk will start at 7:45 a.m. at the Third Street Promenade, in
Santa Monica.
Linda also recommended the Web site www.parentsofsuicide.com as a starting point
for anyone searching for hope, and connection to others who share their pain.
Mental health services may be found at Antelope Valley Hospital, and suicide
risk can be assessed through the emergency room. If a threat of suicide is
imminent, call 9-1-1.
For all those struggling with depression and suicide, Linda offers the lyrics of
"Hold On" by the band Good Charlotte.
Hold on if you feel like letting go
Hold on it gets better than you know
Don't stop looking, you're one step closer
Don't stop searching, it's not over
Hold on
"The biggest message here," she said, is "don't give up. Hold on. There is help
out there."
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