Monday, May 08, 2006
TAC Newsletter 5/6/06
ENEWS - TREATMENT ADVOCACY CENTER
TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
May 6, 2006
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1. TREATMENT ADVOCACY CENTER WINS 2006 APA PRESIDENTIAL COMMENDATION FOR 'EXTRAORDINARY ADVOCACY' - U.S. Newswire, May 1, 2006
2. LIVING WITH MENTAL ILLNESS - USA Today, May 4, 2006
3. USING OUT-PATIENT COMMITMENT FOR HELPING THE MENTALLY ILL - NoSpeedBumps.Com, April 17, 2006
4. MENTALLY ILL JAM JAILS - Lakeland Ledger, April 30, 2006
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1. U.S. NEWSWIRE, May 1, 2006
[Editor's Note: We are pleased to announce that the Treatment Advocacy Center has received a presidential commendation from the American Psychiatric Association. Mary Zdanowicz, our Executive Director, will accept the award later this month at the APA's Annual Meeting.]
TREATMENT ADVOCACY CENTER WINS 2006 APA PRESIDENTIAL COMMENDATION FOR 'EXTRAORDINARY ADVOCACY'
To: National Desk, Health Reporter
Contact: Alicia Aebersold of the Treatment Advocacy Center
ARLINGTON, Va., May 1 /U.S. Newswire/ -- The Treatment Advocacy Center has won the American Psychiatric Association's Presidential Commendation for "sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment."
The Treatment Advocacy Center (TAC) is a national nonprofit organization dedicated to eliminating legal and clinical barriers to timely and humane treatment for people with severe brain disorders who are not receiving appropriate medical care. TAC educates legislators and the media on the benefits of assisted outpatient treatment (AOT) to improve outdated treatment laws that keep people from getting the help they need. Since TAC opened its doors in 1998, this small organization has been involved in changes in treatment laws in 17 states.
"One of the great tragedies of modern psychiatry is the large number of individuals with mental illnesses who are incarcerated or homeless," said APA President Steve Sharfstein, M.D. "This is the inevitable consequence of our reluctance to use caring, coercive approaches, such as assisted outpatient treatment. The Treatment Advocacy Center has been the catalyst for many positive changes in our laws and a shift in our perception of the importance of intervention. Their unique advocacy is restoring the important balance between individual freedom and caring coercion."
Assisted outpatient treatment allows courts to order people who meet specific criteria to receive outpatient mental health treatment. AOT helps those who are the most ill and often unable to make informed treatment decisions for themselves. Results from states that use AOT show marked reductions in the incidents and duration of hospitalization, homelessness, arrests and incarcerations, victimization, and violent episodes. AOT also increases treatment compliance, promotes long-term voluntary compliance, and improves quality of life.
"Until we find the causes and definitive treatments for schizophrenia and bipolar disorder, we have an obligation to those who are suffering to try to improve their lives," said TAC president E. Fuller Torrey, M.D. "Except for biological chance, any one of us might today be there, living on the streets or in jail. TAC is the only organization willing to take on this fight, and I am very proud to be part of it."
TAC Executive Director Mary T. Zdanowicz will accept the award at the 2006 APA Annual Meeting in Toronto later this month. Past winners include Rosalyn Carter and U.S. Senator Pete Domenici and Nancy Domenici.
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The Treatment Advocacy Center ( http://tacenews.c.topica.com/maaeL5ZabqmPEbfGwZEb/ is a national nonprofit organization dedicated to eliminating barriers to timely and humane treatment for millions of Americans with severe mental illnesses. TAC is funded by individual donations and does not accept funding from pharmaceutical companies.
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2. USA TODAY, May 4, 2006
[Editor's Note: Pete Earley has been bringing a lot of attention to people with severe mental illnesses who are incarcerated and the difficulty of getting treatment for and preventing such people from entering the criminal justice system. Pete and his riveting new book, Crazy: A Father's Search Through America's Mental Health Madness, have been featured in magazines and radio programs throughout the country. This week Mr. Earley brought his message to the more than 2,000,000 readers of our nation's largest newspaper.
Crazy: A Father's Search Through America's Mental Health Madness, it is available on Amazon.com. If you buy Mr. Earley's work, or any other, from Amazon, TAC gets a percentage of the money you spend if you enter the Amazon website through this special link:
www.amazon.com/exec/obidos/tg/browse/-/283155/102-4614779-2864968 ]
LIVING WITH MENTAL ILLNESS
By Pete Earley
"Dad, how would you feel if someone you loved killed himself?"
My college-age son, Mike, has stopped taking medication for the mental illness that was diagnosed a year ago, and he is having a relapse. He and I are speeding to an emergency room. Hang on son, I think. The doctors will help you.
But after waiting four hours, a doctor appears and tells me it's illegal to treat Mike. He is not sick enough. He is not in "imminent danger," and because Mike now thinks "pills are poison," the doctor cannot forcibly medicate him under Virginia law. I'm told to bring him back if he tries to kill himself or someone else.
No parent should watch what I see next. Mike sinks further into a mental abyss. Forty-eight hours later, he breaks into a stranger's house to take a bubble bath. The homeowners are away, but Mike is arrested and charged with two felonies. I've been a journalist 30 years and thought I knew a lot about jails, courtrooms and mental illness. But I was always on the outside looking in.
I was so outraged about what happened to my son that I spent the next three years investigating America's mental health system.
I went to Florida, to separate myself from Mike's case, and spent time in the Miami-Dade County jail. I followed psychotic prisoners through the courts, rode with cops, interviewed judges, attorneys, psychiatrists, mental health advocates, parents and persons like my son.
System In Disarray
I discovered our system is in a shambles. Jails and prisons have become our new asylums.
Deinstitutionalization - the haphazard closing of state mental hospitals and dumping of patients into the streets during the '70s and '80s - began the migration from hospital wards to jail cells.
In 1955, about 559,000 Americans were patients in state hospitals. If you took the patient-per-capita ratio then and extrapolated it out to today, you'd expect to find 930,000 patients in those facilities. But there are fewer than 60,000.
Where are the others? About 300,000 are in jails and prisons. An additional 500,000 are on probation. According to the Department of Justice, 16% of inmates in state correctional facilities say they have a mental condition or have spent a night in treatment. The largest public mental facility in the USA is the Los Angeles County jail.
Lawsuits filed to protect patients from abuse in horrific state hospitals created legal barriers that are now preventing parents and other loved ones from intervening until it is too late, just as they did in Mike's case. A shameful lack of community services, including treatment programs and housing, also are to blame.
In Miami, I saw homeless men with chronic schizophrenia arrested for trespassing, jailed, released Untreated And Arrested Again Days Later. They Are Stuck In A Vicious Revolving Door.
No One Is Immune
Mental illnesses are chemical imbalances that affect how nerve cells in the brain send and receive messages. They can strike anyone. Nothing in our family's history hinted that a debilitating disorder loomed ahead. And Mike did nothing to bring this sickness on himself.
Sadly, we are making jails a core part of our mental health care network. Jail officials are building separate facilities for psychotic prisoners. In effect, we are reconstructing the dreaded "warehouse" asylums from our past inside our jails.
Jails are not safe places for a person with a mental illness, and the sick shouldn't have to become criminals to get help. Most can get better. Treatment works in 80% of cases - if it is available.
Incredibly, we are continuing to shut down psychiatric wards in favor of jails. My state, Virginia, has lost 84% of its psychiatric hospital beds since 1955. Why are we choosing cells over beds? The cost of a psychiatric bed exceeds $500 per day. The cost of a Virginia jail is $89 per day.
My son is back on his medication. But now he faces the stigma of having a mental illness and a criminal record. That's wrong. Few of us worry we'll wake up with a mental illness. But what if the phone rings and it's someone telling you about your sister, your daughter, your mother - your son?
I've been on the inside looking out now. It is frightening.
Pete Earley's book, Crazy: A Father's Search Through America's Mental Health Madness, was published this month.
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3. NOSPEEDBUMPS.COM, April 17, 2006
[Editor's Notes: The internet gives a public voice to just about anyone who wants one. One no longer has to be a reporter, broadcaster, national figure or renowned expert to make your opinion available to the populace. And the advent of blogging has made reaching out even easier.
NoSpeedBumps.com is Dan Morgan's blog, his voice to the world. On his blog, you can learn that Dan is a married computer systems engineer with two daughters who plays the guitar (although not well) and likes lobster and beer. In the April 17 entry on his blog, Dan also shows that he has compassion as well as common sense.]
USING OUT-PATIENT COMMITMENT FOR HELPING THE MENTALLY ILL
By Dan Morgan
When I was in New York City a couple of weeks ago, there was a lady dressed only in plastic trash bags begging for money on a street corner. The bags were very torn up. The upper part of body exposed a lot of skin, it seemed that the bags would fall away at any moment. She stayed leaned forward at about 45 degrees for some reason.
She was obviously mentally ill. It made me wonder if the right thing was done when in the 1960s and 1970s state mental institutions were closed down. You think of the movie One Flew Over the Cuckoos Nest, and you think: We don't want to give mental health officials the right to institutionalize people or force treatments on them. Remember Jack Nicholson's forced lobotomy?
But the real world of today is far, far from the fictional world of One Flew Over the Cuckoos Nest.
Tonight on NPR's show Fresh Air, there was an interview with Pete Earley, a former Washington Post reporter whose son is mentally ill. To hear how messed up our mental health system is, listen to his story of trying to get treatment for his son. (This is incredible, you really should listen to it.)
If you have a schizophrenic family member, who refuses their medicine, it is extremely hard to get any help from the state.
Incredibly, often the best way for families to get treatment for someone that is mentally ill, and refuses their medicine, is for the ill person to end up in prison for committing some crime. Otherwise, you are powerless in trying to get them to take their medicine.
Later on the show, psychiatric Dr. E. Fuller Torrey advocates turning back the clock just a bit and forcing people, who are obviously very mentally ill, to take medication. This requires using the "out-patient commitment statutes" that most states have. Unfortunately, these are very hard to use because of excessive legal safeguards.
But why force them to take their medicine? Dr. Torrey s explained that schizophrenia and bipolar disorder effect the mind so that most sick people have no awareness that they are ill. He said it is similar to Alzheimer's in that regard. He said that they will really believe things like they have regular conversations with the president and that the CIA beams messages to them.
Dr. Torrey said the positive thing is that now we know that the vast majority of these people do not need institutionalization. They can be treated on an out-patient basis, typically needing an injection just every two weeks. He says that they are far better off than in being in state institutions. Modern medicines to treat schizophrenia and bipolar disorder have come a long way.
But unfortunately, when the commitment order expires, often patients will think that they are better. They will stop taking there medicine for awhile and then, without them realizing it, they are back in a delusional state but unaware it.
Have we done the mentally ill any favors letting them go untreated in the name of civil rights? Dr. Torrey said that 28% of the mentally ill homeless in LA get most of their food out of garbage cans. About 20% of people in prison are mentally ill. (Deranged people eventually get in some kind of trouble.)
But when they take their medicine, most do just fine. But you have to force many of them to take it. Dr. Torrey says you don't have to hold them down or anything. Most will come for treatments just knowing that the alternative is jail. Also, most people getting the treatments are much happier. They become rational again. And they are less victimized by crime since they can watch out for themselves better.
It seems pretty clear to me that Dr. Torrey and Pete Earley are right. The pendulum has swung way too far in the direction of just letting deranged people roam the streets in a pathetic state. It is not right to let people, in the name of freedom, be utterly neglected. And it is not fair to burden families with this by taking away channels to force treatment if a family member refuses it because they have gone insane.
And it is not healthy for society to have mentally ill citizens neglected, filthy, vulnerable to crime, and living on the streets eating out of garbage cans.
The bottom line is that we need to start committing people again and forcing them to get treatment. Between a judge, a panel of experts, and family members - the courts should be able to have a mechanism to quickly get an out-patient commitment for someone in a delusional state. And the laws need to be changed to allow this process to work quickly, like over a weekend.
If you think otherwise, listen to Pete Earley's story above on how the hospital refused to treat his son because his son believed that the medicine was poison. Just take him home the doctor at the hospital told him, there was nothing that he could do.
Of course lots of safeguards are needed. But the system and procedures for dealing with the mentally ill needs a major overhaul. I imagine that the ACLU will fight reforms every step of the way. But good reforms are never easy, there are always the defenders of the status quo.
It is time to end the fantasy that severely mentally ill people will somehow find a way to get better, or be happier, simply because we ignore them.
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4. LAKELAND LEDGER (FL), April 30, 2006
[Editor's Note: The headline of this piece is an apt summary of the deplorable situation in Polk County, Florida: "Mentally Ill Jam Jails." If you investigate, chances are that you will find out that it's not too different in your county.]
MENTALLY ILL JAM JAILS
Hospitals Full
Inmates Locked in Place
By Robin Williams Adams, The Ledger
BARTOW
Which Polk County institution houses the most people with mental illnesses? Look no further than the Polk County Jail, where nearly 1 in 5 inmates gets psychotropic drugs.
The number of inmates taking those drugs generally ranges from 17 percent to 19 percent of the total jail population.
In March, the average daily number of inmates in Polk's jails was 2,610, which means 444 to 496 inmates were medicated for illnesses such as schizophrenia or bipolar disorder.
And don't think those are all the inmates who have mental illnesses. Others are undiagnosed or refuse medication.
"Our jail is the biggest mental-health facility in Polk County," Polk Sheriff Grady Judd said. "Our jails and prisons collectively are the biggest mental-health facilities in the state." That's a crisis, in Florida and nationwide. Jails have become asylums for thousands of inmates with mental illnesses whose problems and needs far exceed what jails can provide.
Among the problems in Polk County:
. Although inmates are screened for mental illnesses when they're booked into the jail, the evaluation falls far short of what they would get in a true mental-health facility.
. Most mentally ill inmates are put in regular jail populations, exacerbating problems caused by overcrowding. The Special Needs Unit at the Central County Jail, for inmates whose mental illnesses are seen as putting them at greater-than-average risk, has fewer than 50 beds for men and women. More are needed.
. Detention deputies, except those in special units, typically don't get advanced training in handling people who have mental illnesses.
. Little money is available to improve the jail or set up alternative treatments, and Florida lawmakers have shown little inclination to pay for reforms.
"Many of the problems (of people with mental illnesses) have been dumped on a criminal justice system that is ill equipped to deal with it and, frankly, should not be dealing with it," said Risdon Slate, chairman of the Florida Southern College criminology department.
Judd and other sheriffs say it's a role they don't want, didn't expect and would gladly assign elsewhere if they could.
But other resources are scarce. Interviews with Slate, Judd and others identified changes that need to be made:
. More law enforcement officers who have crisis intervention team training to better equip them to deal with people who have mental illness.
. A broader range of housing, including additional facilities more secure than the assisted-living facilities now used for many who have mental illnesses.
. More beds at state psychiatric hospitals where inmates go for evaluation or if they are incompetent to stand trial. A bottleneck now keeps some waiting for months in the local jail.
. More programs to divert people with mental illness away from jail and more money to let community mental health centers expand those alternatives.
What Can Result
James Lee Griffin, who died March 19 after altercations at Polk County's Central County Jail, is a worst-case scenario.
Griffin was arrested in Lake Wales on March 18, a Saturday, after a disturbance at a restaurant.
He said he had bipolar disorder, a mental illness, but that he wasn't receiving medication for it. That's on the arresting officer's information sheet, which a detention deputy signed when Griffin arrived at 7:20 that morning.
The information sheet said Griffin wasn't displaying unusual, bizarre or violent behavior and didn't appear suicidal.
Griffin, 21, never made it to the Special Needs Unit, although he was scheduled for a mental-health evaluation the following Monday, March 20.
Griffin was put into an isolation cell after he became disruptive. He kicked the window of the cell on March 19, shattering it, Judd said, and had to be subdued.
That included being shocked with an electronic riot shield. Investigations of his death continue, the Sheriff's Office said.
In a best-case scenario, Griffin would have been taken to a mental health center, rather than to jail, and received a full evaluation from mental health experts. They would have made a determination as to whether he posed a danger to himself or others.
Without more comprehensive community care and other alternatives to imprisonment, jails will continue having an excess number of inmates with mental illnesses, law enforcement and mental health advocates agree.
Fallout From Hospital Closings
Burgeoning jail populations aren't what mental-health advocates had in mind when "deinstitutionalization" began removing mentally ill patients from state hospitals in the late 1950s.
But jails and courts nationwide soon saw the fallout. Communities were ill prepared for the influx of released patients and the extent of services they needed.
Many people with mental illness end up recycling through the justice system. While some belong behind bars, Judd said, he agrees with mental-health advocates that the number is too high.
"I can show you a percentage in the Polk County Jail who are not intentional criminals," Judd said. "They are just really, really mentally ill."
He described a patient who paced his cell almost constantly, sleeping for 15 minutes at a time, then getting up to pace again.
Another time, he said, he saw one of his detention deputies pulling off a rubber glove and saying about a new prisoner: "I finally got him to urinate in the toilet instead of in the bed or on the floor." There are patients who aren't faking their illness, Judd said, but there are others "who are mean as snakes or crooks and they use mental-health issues as a shield."
The National Alliance for the Mentally Ill recently gave Florida a C-minus grade on health care for the seriously mentally ill. The state has a crisis, NAMI said, with 23 percent of inmates in county and city jails thought to have a mental condition.
"By necessity, the criminal justice community has become one of the most visible mental health advocacy communities in Florida," NAMI said.
NAMI and Partners in Crisis, a statewide group of law enforcement and mental health advocates, urge legislators to allocate more money for mental-health care, including help with housing and job skills, and to streamline the process of getting treatment.
"We've been grossly underfunded since the 1950s," said Circuit Judge Charles Curry, who helped form the local Partners in Crisis chapter.
He said it's crucial that mentally ill inmates be dealt with in a separate setting.
"Mentally ill people don't belong in jails and jails are poorly equipped to deal with mentally ill people," Curry said.
Judd, who works with Partners in Crisis, also wants alternatives.
"We need an environment where they're housed so we can ensure they take their medicines, where we can protect them from society and society from them," he said.
Begging For Beds
In the Polk County Jail, no one describes the general population, where most mentally ill inmates go, as therapeutic.
"We do our best to treat them humanely, but when you're in a dorm of 130 people it's survival of the fittest," Judd said.
Although patients can get medicine, the jail isn't set up for other mental-health therapy.
"Our job is to get them on medication and stabilize them," said Derek Zimmerman, mental health liaison at the jail.
The Special Needs Unit has an extra level of protection for up to 30 men and 16 women. But safety carries a price -- spending most of each day in a cell rather than mingling with others.
Jimmy, 35, said he doesn't say he is bipolar when he is in jail because he doesn't want to go in that unit. The Lakeland man, who asked that his last name not be used, was at his mother's home when he was interviewed.
Others, however, said they feel safer in the Special Needs Unit.
When jail expansion is completed, it won't be a problem to add more Special Needs Unit beds, Judd said. Two pods adjoining that unit could be used for inmates with mental illness.
But expansion won't be complete for about three years, he said, and space isn't there now.
Another factor contributing to limited SNU space is insufficient beds in the state's psychiatric hospitals. Inmates in the SNU include some in limbo as they wait for hospital beds. Two who were interviewed had waited more than three months.
Under state law, inmates referred for commitment to a state hospital should be transferred within 15 days, said Michele Saunders, executive director of Florida Partners in Crisis.
Reality is different.
In early April, men waited an average of eight weeks and women waited nine weeks statewide.
Gov. Jeb Bush's proposed 2006-2007 budget included $6.8 million for 84 new state hospital beds and $5.4 million for increased hospital drug costs.
But mental health advocates were disappointed Bush didn't seek money to boost community alternatives. His proposal didn't earmark extra money for community mental health.
Hunt For Housing
Affordable housing is a major concern for many whose mental illnesses aren't controlled enough to let them work. The problem becomes worse for those on disability who end up in jail.
Their government disability benefits stop when they're in jail, said John Ruffin, program manager for Peace River Center's forensic (criminal justice) program.
It takes six weeks to six months to get benefits started again for people in jail more than 30 days but less than a year. For those in jail more than a year, he said, reinstatement can take up to a year.
But keeping them in the county jail for one day short of a year, which makes getting back on disability easier, conflicts with one of Judd's strategies to reduce jail overcrowding.
Judd said he encourages judges to sentence inmates for longer than a year so they serve time with the Department of Corrections' state prisons rather than in Polk County's overcrowded jail.
Peace River Center and Winter Haven Hospital Behavioral Health -- the two community mental health programs -- can help with medicine during the time released inmates wait for disability payments to resume.
But the supply of housing is limited, causing mental health caseworkers to search desperately for places to put people.
"That's a dream for a lot of us, to have forensic housing exclusively for these people," Ruffin said. "So often they have special needs."
Zimmerman, the jail mental health liaison, said Polk County needs more locked facilities such as step-down programs and Peace River's short-term residential unit.
Pete Earley, author of "Crazy: A Father's Search Through America's Mental Health Madness," advocates reinstituting or expanding state hospital systems, along with other alternatives, to provide somewhere outside the jails for some people who have severe mental illnesses.
Earley, whose son is diagnosed with and treated for bipolar disorder, includes in his book an account of the psychiatric ward of the Miami-Dade County Jail.
That jail has "by default become the largest psychiatric institution in Florida," according to the 11th Judicial Criminal Mental Health Project Jail Diversion Project, but "it cannot provide the necessary and appropriate treatment that is required for successful rehabilitation and recovery."
Some Changes Are Coming
There are bright spots:
. Crisis intervention team training in some counties, including Polk, improves relationships between CIT-trained officers and people with mental illnesses.
. Some counties, although Polk isn't among them, have mental health courts. Judges, prosecutors and defense lawyers collaborate to find the best solutions for people with mental illnesses who commit crimes.
But much more is needed.
"Crisis intervention training is a piece in the puzzle, but it's not a panacea in and of itself," said Slate, the FSC criminology professor. "You can have all the diversion you want, but, if the person is out causing trouble in 22 hours, what have you gained?"
Crisis intervention team training, which came to Polk County recently, makes officers more aware of how mental illnesses can affect behavior.
Changes in how law enforcement approaches someone with a mental illness can make a difference in how the encounter ends.
The person may go to a crisis unit rather than jail after an altercation, for example. A simple charge of trespassing can stay at that level instead of escalating to a more serious charge of battering a law enforcement official.
Mental health experts and law enforcement officers agree a jail will always be a poor setting to address the needs of the mentally ill.
"Wouldn't it be nice if they didn't come to jail in the first place?" Judd asked.
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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:
Treatment Advocacy Center
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Arlington, VA 22203
703-294-6001 (main no.)
703-294-6010 (fax)
TREATMENT ADVOCACY CENTER
Visit our web site www.psychlaws.org
May 6, 2006
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1. TREATMENT ADVOCACY CENTER WINS 2006 APA PRESIDENTIAL COMMENDATION FOR 'EXTRAORDINARY ADVOCACY' - U.S. Newswire, May 1, 2006
2. LIVING WITH MENTAL ILLNESS - USA Today, May 4, 2006
3. USING OUT-PATIENT COMMITMENT FOR HELPING THE MENTALLY ILL - NoSpeedBumps.Com, April 17, 2006
4. MENTALLY ILL JAM JAILS - Lakeland Ledger, April 30, 2006
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1. U.S. NEWSWIRE, May 1, 2006
[Editor's Note: We are pleased to announce that the Treatment Advocacy Center has received a presidential commendation from the American Psychiatric Association. Mary Zdanowicz, our Executive Director, will accept the award later this month at the APA's Annual Meeting.]
TREATMENT ADVOCACY CENTER WINS 2006 APA PRESIDENTIAL COMMENDATION FOR 'EXTRAORDINARY ADVOCACY'
To: National Desk, Health Reporter
Contact: Alicia Aebersold of the Treatment Advocacy Center
ARLINGTON, Va., May 1 /U.S. Newswire/ -- The Treatment Advocacy Center has won the American Psychiatric Association's Presidential Commendation for "sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment."
The Treatment Advocacy Center (TAC) is a national nonprofit organization dedicated to eliminating legal and clinical barriers to timely and humane treatment for people with severe brain disorders who are not receiving appropriate medical care. TAC educates legislators and the media on the benefits of assisted outpatient treatment (AOT) to improve outdated treatment laws that keep people from getting the help they need. Since TAC opened its doors in 1998, this small organization has been involved in changes in treatment laws in 17 states.
"One of the great tragedies of modern psychiatry is the large number of individuals with mental illnesses who are incarcerated or homeless," said APA President Steve Sharfstein, M.D. "This is the inevitable consequence of our reluctance to use caring, coercive approaches, such as assisted outpatient treatment. The Treatment Advocacy Center has been the catalyst for many positive changes in our laws and a shift in our perception of the importance of intervention. Their unique advocacy is restoring the important balance between individual freedom and caring coercion."
Assisted outpatient treatment allows courts to order people who meet specific criteria to receive outpatient mental health treatment. AOT helps those who are the most ill and often unable to make informed treatment decisions for themselves. Results from states that use AOT show marked reductions in the incidents and duration of hospitalization, homelessness, arrests and incarcerations, victimization, and violent episodes. AOT also increases treatment compliance, promotes long-term voluntary compliance, and improves quality of life.
"Until we find the causes and definitive treatments for schizophrenia and bipolar disorder, we have an obligation to those who are suffering to try to improve their lives," said TAC president E. Fuller Torrey, M.D. "Except for biological chance, any one of us might today be there, living on the streets or in jail. TAC is the only organization willing to take on this fight, and I am very proud to be part of it."
TAC Executive Director Mary T. Zdanowicz will accept the award at the 2006 APA Annual Meeting in Toronto later this month. Past winners include Rosalyn Carter and U.S. Senator Pete Domenici and Nancy Domenici.
------
The Treatment Advocacy Center ( http://tacenews.c.topica.com/maaeL5ZabqmPEbfGwZEb/ is a national nonprofit organization dedicated to eliminating barriers to timely and humane treatment for millions of Americans with severe mental illnesses. TAC is funded by individual donations and does not accept funding from pharmaceutical companies.
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2. USA TODAY, May 4, 2006
[Editor's Note: Pete Earley has been bringing a lot of attention to people with severe mental illnesses who are incarcerated and the difficulty of getting treatment for and preventing such people from entering the criminal justice system. Pete and his riveting new book, Crazy: A Father's Search Through America's Mental Health Madness, have been featured in magazines and radio programs throughout the country. This week Mr. Earley brought his message to the more than 2,000,000 readers of our nation's largest newspaper.
Crazy: A Father's Search Through America's Mental Health Madness, it is available on Amazon.com. If you buy Mr. Earley's work, or any other, from Amazon, TAC gets a percentage of the money you spend if you enter the Amazon website through this special link:
www.amazon.com/exec/obidos/tg/browse/-/283155/102-4614779-2864968 ]
LIVING WITH MENTAL ILLNESS
By Pete Earley
"Dad, how would you feel if someone you loved killed himself?"
My college-age son, Mike, has stopped taking medication for the mental illness that was diagnosed a year ago, and he is having a relapse. He and I are speeding to an emergency room. Hang on son, I think. The doctors will help you.
But after waiting four hours, a doctor appears and tells me it's illegal to treat Mike. He is not sick enough. He is not in "imminent danger," and because Mike now thinks "pills are poison," the doctor cannot forcibly medicate him under Virginia law. I'm told to bring him back if he tries to kill himself or someone else.
No parent should watch what I see next. Mike sinks further into a mental abyss. Forty-eight hours later, he breaks into a stranger's house to take a bubble bath. The homeowners are away, but Mike is arrested and charged with two felonies. I've been a journalist 30 years and thought I knew a lot about jails, courtrooms and mental illness. But I was always on the outside looking in.
I was so outraged about what happened to my son that I spent the next three years investigating America's mental health system.
I went to Florida, to separate myself from Mike's case, and spent time in the Miami-Dade County jail. I followed psychotic prisoners through the courts, rode with cops, interviewed judges, attorneys, psychiatrists, mental health advocates, parents and persons like my son.
System In Disarray
I discovered our system is in a shambles. Jails and prisons have become our new asylums.
Deinstitutionalization - the haphazard closing of state mental hospitals and dumping of patients into the streets during the '70s and '80s - began the migration from hospital wards to jail cells.
In 1955, about 559,000 Americans were patients in state hospitals. If you took the patient-per-capita ratio then and extrapolated it out to today, you'd expect to find 930,000 patients in those facilities. But there are fewer than 60,000.
Where are the others? About 300,000 are in jails and prisons. An additional 500,000 are on probation. According to the Department of Justice, 16% of inmates in state correctional facilities say they have a mental condition or have spent a night in treatment. The largest public mental facility in the USA is the Los Angeles County jail.
Lawsuits filed to protect patients from abuse in horrific state hospitals created legal barriers that are now preventing parents and other loved ones from intervening until it is too late, just as they did in Mike's case. A shameful lack of community services, including treatment programs and housing, also are to blame.
In Miami, I saw homeless men with chronic schizophrenia arrested for trespassing, jailed, released Untreated And Arrested Again Days Later. They Are Stuck In A Vicious Revolving Door.
No One Is Immune
Mental illnesses are chemical imbalances that affect how nerve cells in the brain send and receive messages. They can strike anyone. Nothing in our family's history hinted that a debilitating disorder loomed ahead. And Mike did nothing to bring this sickness on himself.
Sadly, we are making jails a core part of our mental health care network. Jail officials are building separate facilities for psychotic prisoners. In effect, we are reconstructing the dreaded "warehouse" asylums from our past inside our jails.
Jails are not safe places for a person with a mental illness, and the sick shouldn't have to become criminals to get help. Most can get better. Treatment works in 80% of cases - if it is available.
Incredibly, we are continuing to shut down psychiatric wards in favor of jails. My state, Virginia, has lost 84% of its psychiatric hospital beds since 1955. Why are we choosing cells over beds? The cost of a psychiatric bed exceeds $500 per day. The cost of a Virginia jail is $89 per day.
My son is back on his medication. But now he faces the stigma of having a mental illness and a criminal record. That's wrong. Few of us worry we'll wake up with a mental illness. But what if the phone rings and it's someone telling you about your sister, your daughter, your mother - your son?
I've been on the inside looking out now. It is frightening.
Pete Earley's book, Crazy: A Father's Search Through America's Mental Health Madness, was published this month.
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3. NOSPEEDBUMPS.COM, April 17, 2006
[Editor's Notes: The internet gives a public voice to just about anyone who wants one. One no longer has to be a reporter, broadcaster, national figure or renowned expert to make your opinion available to the populace. And the advent of blogging has made reaching out even easier.
NoSpeedBumps.com is Dan Morgan's blog, his voice to the world. On his blog, you can learn that Dan is a married computer systems engineer with two daughters who plays the guitar (although not well) and likes lobster and beer. In the April 17 entry on his blog, Dan also shows that he has compassion as well as common sense.]
USING OUT-PATIENT COMMITMENT FOR HELPING THE MENTALLY ILL
By Dan Morgan
When I was in New York City a couple of weeks ago, there was a lady dressed only in plastic trash bags begging for money on a street corner. The bags were very torn up. The upper part of body exposed a lot of skin, it seemed that the bags would fall away at any moment. She stayed leaned forward at about 45 degrees for some reason.
She was obviously mentally ill. It made me wonder if the right thing was done when in the 1960s and 1970s state mental institutions were closed down. You think of the movie One Flew Over the Cuckoos Nest, and you think: We don't want to give mental health officials the right to institutionalize people or force treatments on them. Remember Jack Nicholson's forced lobotomy?
But the real world of today is far, far from the fictional world of One Flew Over the Cuckoos Nest.
Tonight on NPR's show Fresh Air, there was an interview with Pete Earley, a former Washington Post reporter whose son is mentally ill. To hear how messed up our mental health system is, listen to his story of trying to get treatment for his son. (This is incredible, you really should listen to it.)
If you have a schizophrenic family member, who refuses their medicine, it is extremely hard to get any help from the state.
Incredibly, often the best way for families to get treatment for someone that is mentally ill, and refuses their medicine, is for the ill person to end up in prison for committing some crime. Otherwise, you are powerless in trying to get them to take their medicine.
Later on the show, psychiatric Dr. E. Fuller Torrey advocates turning back the clock just a bit and forcing people, who are obviously very mentally ill, to take medication. This requires using the "out-patient commitment statutes" that most states have. Unfortunately, these are very hard to use because of excessive legal safeguards.
But why force them to take their medicine? Dr. Torrey s explained that schizophrenia and bipolar disorder effect the mind so that most sick people have no awareness that they are ill. He said it is similar to Alzheimer's in that regard. He said that they will really believe things like they have regular conversations with the president and that the CIA beams messages to them.
Dr. Torrey said the positive thing is that now we know that the vast majority of these people do not need institutionalization. They can be treated on an out-patient basis, typically needing an injection just every two weeks. He says that they are far better off than in being in state institutions. Modern medicines to treat schizophrenia and bipolar disorder have come a long way.
But unfortunately, when the commitment order expires, often patients will think that they are better. They will stop taking there medicine for awhile and then, without them realizing it, they are back in a delusional state but unaware it.
Have we done the mentally ill any favors letting them go untreated in the name of civil rights? Dr. Torrey said that 28% of the mentally ill homeless in LA get most of their food out of garbage cans. About 20% of people in prison are mentally ill. (Deranged people eventually get in some kind of trouble.)
But when they take their medicine, most do just fine. But you have to force many of them to take it. Dr. Torrey says you don't have to hold them down or anything. Most will come for treatments just knowing that the alternative is jail. Also, most people getting the treatments are much happier. They become rational again. And they are less victimized by crime since they can watch out for themselves better.
It seems pretty clear to me that Dr. Torrey and Pete Earley are right. The pendulum has swung way too far in the direction of just letting deranged people roam the streets in a pathetic state. It is not right to let people, in the name of freedom, be utterly neglected. And it is not fair to burden families with this by taking away channels to force treatment if a family member refuses it because they have gone insane.
And it is not healthy for society to have mentally ill citizens neglected, filthy, vulnerable to crime, and living on the streets eating out of garbage cans.
The bottom line is that we need to start committing people again and forcing them to get treatment. Between a judge, a panel of experts, and family members - the courts should be able to have a mechanism to quickly get an out-patient commitment for someone in a delusional state. And the laws need to be changed to allow this process to work quickly, like over a weekend.
If you think otherwise, listen to Pete Earley's story above on how the hospital refused to treat his son because his son believed that the medicine was poison. Just take him home the doctor at the hospital told him, there was nothing that he could do.
Of course lots of safeguards are needed. But the system and procedures for dealing with the mentally ill needs a major overhaul. I imagine that the ACLU will fight reforms every step of the way. But good reforms are never easy, there are always the defenders of the status quo.
It is time to end the fantasy that severely mentally ill people will somehow find a way to get better, or be happier, simply because we ignore them.
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4. LAKELAND LEDGER (FL), April 30, 2006
[Editor's Note: The headline of this piece is an apt summary of the deplorable situation in Polk County, Florida: "Mentally Ill Jam Jails." If you investigate, chances are that you will find out that it's not too different in your county.]
MENTALLY ILL JAM JAILS
Hospitals Full
Inmates Locked in Place
By Robin Williams Adams, The Ledger
BARTOW
Which Polk County institution houses the most people with mental illnesses? Look no further than the Polk County Jail, where nearly 1 in 5 inmates gets psychotropic drugs.
The number of inmates taking those drugs generally ranges from 17 percent to 19 percent of the total jail population.
In March, the average daily number of inmates in Polk's jails was 2,610, which means 444 to 496 inmates were medicated for illnesses such as schizophrenia or bipolar disorder.
And don't think those are all the inmates who have mental illnesses. Others are undiagnosed or refuse medication.
"Our jail is the biggest mental-health facility in Polk County," Polk Sheriff Grady Judd said. "Our jails and prisons collectively are the biggest mental-health facilities in the state." That's a crisis, in Florida and nationwide. Jails have become asylums for thousands of inmates with mental illnesses whose problems and needs far exceed what jails can provide.
Among the problems in Polk County:
. Although inmates are screened for mental illnesses when they're booked into the jail, the evaluation falls far short of what they would get in a true mental-health facility.
. Most mentally ill inmates are put in regular jail populations, exacerbating problems caused by overcrowding. The Special Needs Unit at the Central County Jail, for inmates whose mental illnesses are seen as putting them at greater-than-average risk, has fewer than 50 beds for men and women. More are needed.
. Detention deputies, except those in special units, typically don't get advanced training in handling people who have mental illnesses.
. Little money is available to improve the jail or set up alternative treatments, and Florida lawmakers have shown little inclination to pay for reforms.
"Many of the problems (of people with mental illnesses) have been dumped on a criminal justice system that is ill equipped to deal with it and, frankly, should not be dealing with it," said Risdon Slate, chairman of the Florida Southern College criminology department.
Judd and other sheriffs say it's a role they don't want, didn't expect and would gladly assign elsewhere if they could.
But other resources are scarce. Interviews with Slate, Judd and others identified changes that need to be made:
. More law enforcement officers who have crisis intervention team training to better equip them to deal with people who have mental illness.
. A broader range of housing, including additional facilities more secure than the assisted-living facilities now used for many who have mental illnesses.
. More beds at state psychiatric hospitals where inmates go for evaluation or if they are incompetent to stand trial. A bottleneck now keeps some waiting for months in the local jail.
. More programs to divert people with mental illness away from jail and more money to let community mental health centers expand those alternatives.
What Can Result
James Lee Griffin, who died March 19 after altercations at Polk County's Central County Jail, is a worst-case scenario.
Griffin was arrested in Lake Wales on March 18, a Saturday, after a disturbance at a restaurant.
He said he had bipolar disorder, a mental illness, but that he wasn't receiving medication for it. That's on the arresting officer's information sheet, which a detention deputy signed when Griffin arrived at 7:20 that morning.
The information sheet said Griffin wasn't displaying unusual, bizarre or violent behavior and didn't appear suicidal.
Griffin, 21, never made it to the Special Needs Unit, although he was scheduled for a mental-health evaluation the following Monday, March 20.
Griffin was put into an isolation cell after he became disruptive. He kicked the window of the cell on March 19, shattering it, Judd said, and had to be subdued.
That included being shocked with an electronic riot shield. Investigations of his death continue, the Sheriff's Office said.
In a best-case scenario, Griffin would have been taken to a mental health center, rather than to jail, and received a full evaluation from mental health experts. They would have made a determination as to whether he posed a danger to himself or others.
Without more comprehensive community care and other alternatives to imprisonment, jails will continue having an excess number of inmates with mental illnesses, law enforcement and mental health advocates agree.
Fallout From Hospital Closings
Burgeoning jail populations aren't what mental-health advocates had in mind when "deinstitutionalization" began removing mentally ill patients from state hospitals in the late 1950s.
But jails and courts nationwide soon saw the fallout. Communities were ill prepared for the influx of released patients and the extent of services they needed.
Many people with mental illness end up recycling through the justice system. While some belong behind bars, Judd said, he agrees with mental-health advocates that the number is too high.
"I can show you a percentage in the Polk County Jail who are not intentional criminals," Judd said. "They are just really, really mentally ill."
He described a patient who paced his cell almost constantly, sleeping for 15 minutes at a time, then getting up to pace again.
Another time, he said, he saw one of his detention deputies pulling off a rubber glove and saying about a new prisoner: "I finally got him to urinate in the toilet instead of in the bed or on the floor." There are patients who aren't faking their illness, Judd said, but there are others "who are mean as snakes or crooks and they use mental-health issues as a shield."
The National Alliance for the Mentally Ill recently gave Florida a C-minus grade on health care for the seriously mentally ill. The state has a crisis, NAMI said, with 23 percent of inmates in county and city jails thought to have a mental condition.
"By necessity, the criminal justice community has become one of the most visible mental health advocacy communities in Florida," NAMI said.
NAMI and Partners in Crisis, a statewide group of law enforcement and mental health advocates, urge legislators to allocate more money for mental-health care, including help with housing and job skills, and to streamline the process of getting treatment.
"We've been grossly underfunded since the 1950s," said Circuit Judge Charles Curry, who helped form the local Partners in Crisis chapter.
He said it's crucial that mentally ill inmates be dealt with in a separate setting.
"Mentally ill people don't belong in jails and jails are poorly equipped to deal with mentally ill people," Curry said.
Judd, who works with Partners in Crisis, also wants alternatives.
"We need an environment where they're housed so we can ensure they take their medicines, where we can protect them from society and society from them," he said.
Begging For Beds
In the Polk County Jail, no one describes the general population, where most mentally ill inmates go, as therapeutic.
"We do our best to treat them humanely, but when you're in a dorm of 130 people it's survival of the fittest," Judd said.
Although patients can get medicine, the jail isn't set up for other mental-health therapy.
"Our job is to get them on medication and stabilize them," said Derek Zimmerman, mental health liaison at the jail.
The Special Needs Unit has an extra level of protection for up to 30 men and 16 women. But safety carries a price -- spending most of each day in a cell rather than mingling with others.
Jimmy, 35, said he doesn't say he is bipolar when he is in jail because he doesn't want to go in that unit. The Lakeland man, who asked that his last name not be used, was at his mother's home when he was interviewed.
Others, however, said they feel safer in the Special Needs Unit.
When jail expansion is completed, it won't be a problem to add more Special Needs Unit beds, Judd said. Two pods adjoining that unit could be used for inmates with mental illness.
But expansion won't be complete for about three years, he said, and space isn't there now.
Another factor contributing to limited SNU space is insufficient beds in the state's psychiatric hospitals. Inmates in the SNU include some in limbo as they wait for hospital beds. Two who were interviewed had waited more than three months.
Under state law, inmates referred for commitment to a state hospital should be transferred within 15 days, said Michele Saunders, executive director of Florida Partners in Crisis.
Reality is different.
In early April, men waited an average of eight weeks and women waited nine weeks statewide.
Gov. Jeb Bush's proposed 2006-2007 budget included $6.8 million for 84 new state hospital beds and $5.4 million for increased hospital drug costs.
But mental health advocates were disappointed Bush didn't seek money to boost community alternatives. His proposal didn't earmark extra money for community mental health.
Hunt For Housing
Affordable housing is a major concern for many whose mental illnesses aren't controlled enough to let them work. The problem becomes worse for those on disability who end up in jail.
Their government disability benefits stop when they're in jail, said John Ruffin, program manager for Peace River Center's forensic (criminal justice) program.
It takes six weeks to six months to get benefits started again for people in jail more than 30 days but less than a year. For those in jail more than a year, he said, reinstatement can take up to a year.
But keeping them in the county jail for one day short of a year, which makes getting back on disability easier, conflicts with one of Judd's strategies to reduce jail overcrowding.
Judd said he encourages judges to sentence inmates for longer than a year so they serve time with the Department of Corrections' state prisons rather than in Polk County's overcrowded jail.
Peace River Center and Winter Haven Hospital Behavioral Health -- the two community mental health programs -- can help with medicine during the time released inmates wait for disability payments to resume.
But the supply of housing is limited, causing mental health caseworkers to search desperately for places to put people.
"That's a dream for a lot of us, to have forensic housing exclusively for these people," Ruffin said. "So often they have special needs."
Zimmerman, the jail mental health liaison, said Polk County needs more locked facilities such as step-down programs and Peace River's short-term residential unit.
Pete Earley, author of "Crazy: A Father's Search Through America's Mental Health Madness," advocates reinstituting or expanding state hospital systems, along with other alternatives, to provide somewhere outside the jails for some people who have severe mental illnesses.
Earley, whose son is diagnosed with and treated for bipolar disorder, includes in his book an account of the psychiatric ward of the Miami-Dade County Jail.
That jail has "by default become the largest psychiatric institution in Florida," according to the 11th Judicial Criminal Mental Health Project Jail Diversion Project, but "it cannot provide the necessary and appropriate treatment that is required for successful rehabilitation and recovery."
Some Changes Are Coming
There are bright spots:
. Crisis intervention team training in some counties, including Polk, improves relationships between CIT-trained officers and people with mental illnesses.
. Some counties, although Polk isn't among them, have mental health courts. Judges, prosecutors and defense lawyers collaborate to find the best solutions for people with mental illnesses who commit crimes.
But much more is needed.
"Crisis intervention training is a piece in the puzzle, but it's not a panacea in and of itself," said Slate, the FSC criminology professor. "You can have all the diversion you want, but, if the person is out causing trouble in 22 hours, what have you gained?"
Crisis intervention team training, which came to Polk County recently, makes officers more aware of how mental illnesses can affect behavior.
Changes in how law enforcement approaches someone with a mental illness can make a difference in how the encounter ends.
The person may go to a crisis unit rather than jail after an altercation, for example. A simple charge of trespassing can stay at that level instead of escalating to a more serious charge of battering a law enforcement official.
Mental health experts and law enforcement officers agree a jail will always be a poor setting to address the needs of the mentally ill.
"Wouldn't it be nice if they didn't come to jail in the first place?" Judd asked.
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