tag:blogger.com,1999:blog-104174272024-03-07T05:58:40.402-08:00The PAIR Program The PAIR Mental Health Diversion Program of Indianapolis _____________________Blog of Bob CardwellUnknownnoreply@blogger.comBlogger100125tag:blogger.com,1999:blog-10417427.post-48487242229496670832013-11-29T13:40:00.001-08:002013-11-29T13:40:29.142-08:00Dave leaves college<div id="dE_H" style="font-family:Helvetica;font-size:18px;white-space:pre-wrap;-webkit-overflow-scrolling:touch;;width:100%; height:100%; ;"><br>Dave was there. He was in Bob Jones University, It was a strict and fundamentalist Bible college. Dave was going here because it was what his father and mother wanted. He had heard this almost weekly while growing up. BJU looked down on self ordained preachers and some of the faculty actually considered Brother Joe's brand of holy roller preaching to be downright heretical. But BJU consider the Pope a heretic too.<div><br></div><div>So being at BJU, under the shadow of Brother Joe's beliefs, Dave already had one strike against him. He would soon get two more strikes and be kicked out of school.</div><div><br></div><div>The first strike came from Dave hanging around an artist colony in the hills of North Carolina. There were many new thinkers with radical beliefs there. Dave started spending more and more time there has he was fascinated with the people and with talk of different religions and philosophies. He particularly like the discussion of eastern religions and learning about prior utopian communities of Emerson, Alcott, and Thoreau. They preached a simple living with high thinking. The general mood of the colony was libertine which was in direct contrast to BJU's legalistic view of Christianity. </div><div><br></div><div>The contrast of these community views affected people and their behavior. The religious school was angry and hostile toward the colony. In contrast, the colony would often say to say to the students and protestors, "let's sit down and talk about it."</div><div><br></div><div>There were a view who did sit down and talk. And occasionally the individual would end up joining the colony. Most opponents of the colony spread rumors and lies. A frequent complaint heard in nearby communities were that the colony were Satanists or homosexuals. Allegedly the satanist wanted to steal their babies and sacrifice them to the devil and that the homosexuals wanted to molest their boys and turn them into queers. </div><div><br></div><div>It was not long before there was a rumor going around that Dave was homosexual and was looking for a lover. Others used the fact that Dave had an effeminate study partner as proof that Dave was a pervert. The final straw was when the study partner was caught in a sexual act with his room mate. This was used as absolute proof of the evil of Dave and he was terminated from the school.<br><br><br /></div></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-60700548344241375562013-07-29T12:01:00.004-07:002013-07-29T12:01:47.266-07:00I have been thinking about this blog for the past week. I have made the decision to suspend my attention to this blog for an indeterminate time. I have not been involved directly in the PAIR Program for over 13 years. I only posted occasionally as this blog get tens of thousands of hits. I wanted to help if I could. <br />
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I have decided that the best way to continue this is to devote my energy to my commentary blog [here on blogger] or my web page www.bobcardwell.com. I am working on a book and I also hope to have an audio podcast up soon.<br />
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For information on the PAIR Program, call the Crisis Line of Marion County, Indiana.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-14827984544406755762013-07-26T08:58:00.001-07:002013-07-26T09:00:31.926-07:00Kindness<div>
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I have worked in the field of social work, mental health, and psychiatry for 38 years. I have worked with many doctors, nurses, and therapists of all kinds. Some are very smart. Some are very well trained. Most like the work they do. However, these qualities are not what makes a good therapist. Sometimes the best therapists are those with the least training and education.</div>
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Yesterday I was reading Facebook. I saw an old quote Dalal Lama. It said simply, "Kindness is my religion." I too would like to affirm this and if there is anything consistent I have seen in good therapists over the years, and I believe it is the most important trait, it is kindness.</div>
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We all need to meditate at the alter of kindness.</div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-59216274098627538062013-07-25T12:39:00.001-07:002013-07-25T12:39:45.773-07:00<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="mso-cellspacing: 0in; mso-padding-alt: 0in 0in 0in 0in; mso-yfti-tbllook: 1184; width: 100%px;">
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<b><span style="color: #000066; font-family: "Georgia","serif"; font-size: 14.0pt; mso-bidi-font-family: Arial;">Mental
Health & Criminal Justice Trainings</span></b><span style="color: #000066; font-family: "Georgia","serif"; font-size: 14.0pt; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 10pt;">Dear Friend of NAMI
Indiana:</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Now is the time to register
for our upcoming "Mental Illness #101" and "Mental Illness
#201". These trainings are geared to law enforcement, corrections,
judges, attorneys, social workers and others who work in the Criminal
Justice field. We hope to see you there.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Sincerely,<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;"><br />
Marianne Halbert, JD, Criminal Justice Director <o:p></o:p></span></div>
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</v:shape><![endif]--><!--[if !vml]--><a href="http://r20.rs6.net/tn.jsp?e=001utW7c46GQB6RWBXevWhajW3DueZI77JgZhAGjNS9kyrw9SVrth-sT44QQ8541W3F4TMPOr01nBV1OKm9DD7bVX7dcJ0twxkVyTpSmLVjhRoNt2HgDaIIxw==" target=""_blank""><img align="left" alt="Larue Carter" border="0" height="75" hspace="5" name="ACCOUNT.IMAGE.133" src="http://ih.constantcontact.com/fs173/1101905082100/img/133.jpg" v:shapes="_x0000_s1026" vspace="5" width="100" /></a><!--[endif]--><span style="font-family: Arial, sans-serif; font-size: 10pt;"><a href="http://r20.rs6.net/tn.jsp?e=001utW7c46GQB6RWBXevWhajW3DueZI77JgZhAGjNS9kyrw9SVrth-sT44QQ8541W3F4TMPOr01nBV1OKm9DD7bVX7dcJ0twxkVyTpSmLVjhRoNt2HgDaIIxw==" target="_blank"></a></span><b><span style="color: #000066; font-family: "Arial","sans-serif"; font-size: 10.0pt;">Course Description</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;"><br />
This educational day includes presentations on the topics of the
"Biological Basis of Mental Illness," "Categories of Mental
Illness", and "Active Listening & Tools for Crisis
Situations," as well as two Lived Experience presentations. <o:p></o:p></span></div>
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<b><span style="color: #000066; font-family: "Arial","sans-serif"; font-size: 10.0pt;">Course Details</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;"><br />
Offered <strong><span style="font-family: "Arial","sans-serif";">August 15</span></strong>
and again on <strong><span style="font-family: "Arial","sans-serif";">November
7</span></strong>, 2013<br />
The training will be held in the Small Auditorium at Larue Carter Hospital<br />
2601 Cold Spring Road<br />
Indianapolis, Indiana 46222<br />
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8:30 a.m. - 4:30 p.m.<o:p></o:p></span></div>
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parking, light breakfast and afternoon snack, coffee, juice and bottled
water, as well as course materials. 6 Hours of ILEA credit for law
enforcement and 6 Hours of CEU for social workers and family therapists.
5.5 Hours of Non-Legal Subject for attorneys is pending approval.<o:p></o:p></span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 10pt;">Our Price:</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;">
$80.00 per person<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;"><a href="http://r20.rs6.net/tn.jsp?e=001utW7c46GQB41GsmLBjf5WJ5jvyOZK33T1ohQFE25-8oJDhBRR_bPaqPpWRe0rHN_b4S_qPv3GpgZBy9Nrq0wqU_DNYep_T5kxKL8s_BIxjd4ti3z8AQ3hj3PsPU4EHRskrSjFjjBzix1M3i2zMGzhpXUmdxYDvhj-wJH8DFCuEyAu1eh6QdQZnQN3TjSCw5MlVSTxzPjHwuYAavmaBgoRrdgQFhm8qWnGKVDUtrARIU=" linktype="1" shape="rect" target="_blank" track="on">REGISTER NOW</a><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Questions? Contact <a href="mailto:mhalbert@namiindiana.org" linktype="2" shape="rect" target="_blank">Marianne Halbert</a><br />
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-14387666694100122592013-07-10T09:16:00.003-07:002013-07-10T09:16:45.795-07:00An email from a person with mental illness, which arrived on 7/10/13<br />
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I ran accros your ite looking for the Pair program. To begin if you'd
like to share my story i am ok with. I like to start off ny stating i
come from a abusive mentally ill family, been adopted 2 times through
family members as well. I am 45 yr age. 3 lovely childs. My illness has
become apart of their lives as well. it did not take anyone to know an
seek the help i knew i needed 16yrs ago and present.To seek help of a
chemical imbalance i have lived with most of my life.I got the help on
my own i realized 15 yrs ago on my own. Never been to jail or even seen a
jail cell a day in my life. Due to an situation i was put in using my
poor judgement , i did not recognize was a crime at the time. I was
cohoared into going into a walmart store by a trusted elder PIG to pick
up a ipad that was suppose to be paid for w/ creditcard.
Elder PIG ex-friend, told me He didnt have i.d. to pick up the ipad
package. So i used poor judgement went an retrieved the ipad for him an
walked out the store .I was told It was sitting in the buggy next to me
as i was waiting in customer service line on Dec 2012 . On March 7th ,
got a call from IMPD asked for me i answered the cell an arresting
officer spoke my name an stated if i di not be home or answer my door in
3 secs he was going to Kick my door in. i asked why? he stated Hell
tell me when he gets there. As i waited with my window blinds &
front door wide open as well as notified family members in fear If
something happens to me it will be visual being i live next door to a
public church thats always busy,based on the statement the officer made
to me before arrival. Finally they arrived an said wheres the IPAd your
goin to jail an your child is going to CPS. As they surrounded me an
blocked me in my hallway questioning me . My illness
of bi polar , schizo anxiety and depression had already flaired up.
They mentally attacked me, then eventually cuffed my hands so tight , i
asked the officers if i can take my psych & blood pressure meds that
were sitting there on the table he said YES! then said NO an called the
pharmacy who verified they were my meds Instead the officer still
decided No i could not have them then I had a Panic attack / my blood
pressure rising an fell to the floor I fainted with the cuffs on my
hands . It is sad that officers are not trained to deal with mentally
ill people, and they put themselves above the law. An mishandling
mentally human beings. I never was a threat i cooperated an still was
treated inhumane Ive no history of drug or alchohol issues or any
criminal backround history. Sides me loosing my Mom to death of cancer
In june 2012. I was told about PARE in March 11 2013 upon 1st court
hearing w/ a court social worker. An never heard from
her again she stopped talking to me. As well as the Public defender as
he removed himself from my case . Why i still dont know ? I had to hire
my own attorney to stay out of jail for a 1st time class D theft in
which i was incarcerated an requested a high amount of cash bail. Now
the attorney i have works for the same court is refering me to the pair
program . My private counceler of 4 yrs called my court attorney to ask
him about Pair program . Since he mentioned it to me but he has not
returned her or my calls. An i would like to know if this program will
train police officers on how to act toward people human beings who have
been diagnosede with mental illness? The courts an police should not
mistreat an strike negatively toward persons w/ illness they should be
trained an be able to recognize traits of human beings as myself. Not
mentally ill persont only that but they come to intimidate and put
metally ill persons undr pressure an that
can very well in the future cause a person to lash out in a way of
negative an cause harm to themselves or others. It is just not the way
anyone who has an duty & oath to the public to be mistreated
inhuman.It effects us allUnknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-26181062378273325322013-07-02T18:13:00.001-07:002013-07-02T18:13:06.526-07:00Advance Indiana: Federal Judge Accepts Former Chief Deputy Prosecutor's Plea Deal In Bribery Case<a href="http://advanceindiana.blogspot.com/2013/07/federal-judge-accepts-former-chief.html#links">Advance Indiana: Federal Judge Accepts Former Chief Deputy Prosecutor's Plea Deal In Bribery Case</a><br />
<br />
Wow Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-29366861399691104462013-06-27T08:04:00.001-07:002013-06-28T19:47:17.228-07:00I applaud Judge Pratt's decision and for keeping the pressure on. I have known of Judge Pratt for many years and her work at the county level. I would like to think I, and my co-workers, educated her on the dismal state of mentally ill in prison. Hopefully she will look at the private prisons as well.<br />
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The advocates of the mentally ill have warned the DOC about this for twenty years!<br />
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From the Indianapolis Star:<br />
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<h6>
<a href="http://www.indystar.com/comments/article/20130626/NEWS/306260051/Indiana-prison-agency-plans-centralize-seriously-mentally-ill-add-staff-programs" target="_blank" title="Go to comments">
<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_2"></b>
</a>
</h6>
The Indiana Department of Correction will add staff and increase
treatment programs for seriously mentally ill inmates at a new facility
that will be open by January, agency officials told a federal judge
Wednesday<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_3">.</b><br />
<br />
Details
about the DOC’s plans for dealing with mentally ill prisoners placed
in segregation for disciplinary or safety reasons came during a status
hearing called by U.S. District Judge Tanya Walton Pratt<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_4">.</b><br />
<br />
The
judge ruled in December that “mentally ill prisoners within the IDOC
segregation units are not receiving adequate mental health care in terms
of scope, intensity and duration,” and ordered the department to
devise a plan to correct the shortcomings<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_5">.</b><br />
<br />
The
judge’s ruling came after the American Civil Liberties Union of Indiana
filed a lawsuit on behalf of the Indiana Protection and Advocacy
Services Commission and a group of inmates<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_6">.</b>
Pratt found that conditions endured by seriously mentally ill prisoners
held in segregation units constituted “cruel and unusual punishment<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_7">.</b>”
She also found that the DOC was aware of concerns about its treatment
of mentally ill prisoners and “has been deliberately indifferent,”
contributing to the suicides of at least 11 mentally ill inmates held in
segregation units from 2007 through July 2011<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_8">.</b><br />
<br />
The
new plan will eliminate segregation units — where prisoners often spend
23 hours a day locked in isolation — at state prisons<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_9">.</b>
Instead, the roughly 400 seriously mentally ill inmates who require
segregation will be grouped in a remodeled section of the Pendleton
Correctional Facility<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_10">.</b><br />
In
addition to the consolidation, DOC will add custody and treatment
staff, said Craig Hanks, the agency’s executive director for mental
health and special populations<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_11">.</b> Prisoners also will spend less time in isolation, he said<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_12">.</b><br />
<br />
No cost estimate is available for the changes, said DOC Chief Financial Officer Andrew Pritchard<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_13">.</b><br />
“This
is a really ambitious plan, and it sounds like we’re making progress,”
Ken Falk, the ACLU of Indiana’s legal director, said after the hearing<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_14">.</b><br />
<br />
During
the hearing, however, Falk expressed concerns that conditions for
the majority of seriously mentally ill prisoners held in segregation
have not changed since Pratt’s ruling<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_15">.</b><br />
Hanks admitted that, for many mentally ill prisoners held in those units, conditions and treatment have not improved<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_16">.</b><br />
<br />
Pratt asked DOC officials to provide her an update on the project in 90 days<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_17">.</b> She also requested a tour of the facilities at Pendleton<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_18">.</b><br />
<br />
At
this time, the judge said, she sees no need to appoint a federal
overseer to monitor the department’s progress toward compliance with
her order<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_19">.</b><br />
“It does appear you are making progress,” Pratt said<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_20">.</b><br />
But, she warned, the department cannot continue to subject prisoners to cruel and unusual punishment<b class="speechFragmentSeparator" id="speechFragmentSeparator__1_21">.</b><br />
</div>
</div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-55371645141158956802013-02-06T13:10:00.004-08:002013-07-10T09:17:21.650-07:00<br />
<div class="MsoNormal">
Here is a open letter I would like to send to Gov.
Pence. </div>
<div class="MsoNormal">
R.C.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dear Governor Pence:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In my many years of working with the seriously mentally ill
[SMI], there have many periods of public outrage because of the actions of a
psychotic individual. John Lennon was shot. President Reagan was shot.
There were random and nonsensical murders all across the country. And of course
there is the recent massacre of children at the Sandy Hook school. All
committed by the mentally ill. With each tragedy there is a public outcry
to supervise the mentally ill better. To provide better treatment. To provide
better supervision. To do a better job of protecting the public. I
would like to help with this.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Most of my 35 plus years of working in social services has
been working with the dangerous and serious mentally ill. I have been
responsible for monitoring 600 [of a possible 1000 or so] mental patients who
live in the community [in Marion County] and who were under court orders and
civil commitment to comply with treatment. I worked with the mental health
court to try to bring recalcitrant patients in compliance with their court
orders.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
At any given time, while supervising these patients,
approximately 50% were non-compliant either by not taking their medications,
missing appointments, or by substance abuse. The court had very few tools to
force compliance.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It was very frequent that we would see the arrest of one of
our patients for a notorious crime and then it made headlines all over the
media. It was sad that we could not have prevented this. It was sad that
we could not share with the criminal court information about the patients civil
commitment nor his mental history. There is no sharing of this vital info with
any agency.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are many problems with the supervision of dangerously
mentally ill. I believe with my experience from working with the Marion County
Prosecutor’s Office, the Public Defenders’ Agency, the Marion County Court
System, the Marion County Jail, and the Marion County Community Corrections
that I have knowledge and experience which would be helpful. In the past
I have help develop the PAIR Mental Health Diversion Program. I served on Mayor
Goldsmith’s Task Force on the Dangerous Mentally Ill. I served on Prosecutor
Newman advisory panel on the Incarcerated Mentally Ill. And I served on
the advisory committee for DOC under Commissioner Cohen.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I believe with rational planning and action, we can prevent
many tragic crimes committed by the dangerous and serious mentally ill. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I would like to again work on this problem. I am
willing to be part of a advisory committee to explore these issues. I am also
willing to serve on the Governor’s Commission on Mental Health.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Please advise me if I can be of service. I can be reached at
ph. 317-354-6668.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sincerely,</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Robert Cardwell, LSW </div>
<div class="MsoNormal">
January 31, 2013</div>
<div class="MsoNormal">
<br /></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-32969778487583918182013-01-31T08:41:00.003-08:002013-01-31T08:41:21.798-08:00<br />
<div class="MsoNormal">
Reasons for the Governor
to form a Interagency DOC/DMH Advisory Board</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Up to 20% of the inmates
at DOC [Dept of Corrections] have serious mental illness [SMI]. 95% of these
inmates will be eventually released into society. They frequentfully drop out of treatment,
violate their parole, commit a psychotic crime, or are arrested on nuisance
charges.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Up to 80% of the
in-patients in the DMH [Division of Mental Health] have court issues. This can
be relatively minor charges to very serious charges like murder and
cannibalism. A high percentage of this SMI patients are released to the
community for follow up in group homes. If the SMI patient refuses to
cooperate, he is either re-admitted to the hospital or is re-arrested on
another charge and is sent to jail, prison, or released to the streets.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Most civil commitments
for psychiatric treatment eventually end up treated in the community on an
out-patient commitment. Fifty percent to Two thirds of psych patients on
outpatient commitment are non-compliant. There is no regular supervision with
realistic consequences of patients on an out- patient commitment.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
SMI patients on
commitments are frequently arrested and the criminal court or police have no
knowledge of the person’s civil commitment of psychiatric treatment.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are no resources
to hospitalize all of these non-compliant persons on outpatient commitments. At
any given time there are about one thousand dangerous and SMI court committed
patients living in the community who are non-compliant with treatment and
supervision. Many of these SMI patients are arrested for a wide range of crimes
and the criminal court does not know that the civil court has placed this
individual on a civil commitment.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
SMI inmates at DOC tend
to stay longer and are much more expensive to manage. It is very common for SMI
inmates to go to jail or prison on minor charges and then get much more serious
charges while in custody and stretch out a sentence of a few months to
sometimes ten years.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Incompetent to Stand
Trial [ICST] laws are out of date and cause many problems and expense. For
example, a SMI is arrested. He is held in jail many months till a court date.
He is then found incompetent. He is sent
to Logansport State Hospital to be treated. Most of the time with treatment,
the SMI patient becomes competent and is returned to jail. He has to wait at jail several months for a
court date. He quits taking his
medications and by the time he goes to court he is psychotic and incompetent
again. He may be in this revolving door
for years.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The “Guilty But Mentally
Ill” laws are out of date and inefficient.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sex Offenders my benefit
from life long civil commitments.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are more injuries
from SMI patients. SMI inmates get injured more frequently. Staff are injured
more frequently by SMI.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There is no routine
monitoring or reporting of the dangerous and serious mentally ill. A SMI with a court commitment could buy a gun
legally and get a gun permit.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We have to do something.
We need change now.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-91429727540924890082012-07-01T19:13:00.000-07:002013-07-10T09:18:05.062-07:00Presentation of New Ideas for the PAIR Program 2012<br />
<div class="MsoNormal">
<span style="font-size: 12pt;">Greetings!
I am Bob Cardwell. I am one of the
founders of the PAIR Mental Health Diversion Program. Back in the beginning of
The Pair Program, I helped facilitate its start by doing the mental health
screenings in lock up and leading the group presentations to the PAIR
Roundtable.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
am here today to talk today about this program. It is a program dear to my
heart. I have worked in the mental health field since 1975. My involvement though goes back to my visits
to my mother who was a nurse at Central State Hospital. In the sixties it was
common for employees to bring their kids in to the picnics and festivities. It
is becoming rarer as I grow older, but it still , once in a while, I run into a
old resident, or hear something about an old Central State Hospital resident I
met as a child.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">So
for good or bad, being involved in the mental health field is a big part of my
life. In spite of all the work I have done and goals I have accomplished, there
is only one thing I might be remembered for doing, and that is why I am here
today. The PAIR Mental Health Diversion Program is my legacy. It is perhaps my
sole chance at being recognized or to have my work remembered. I want to see
the PAIR Mental Health Program grow and continue to do good work.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Here
are my goals for this presentation: </span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">1.
I want to talk about some ideas to grow the program. </span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">2. I want to talk about ideas to make the
program safer and to increase the quality of care and </span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">3. I wish to talk about
ideas to fund the PAIR Program.<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 12pt;">***<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 12pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
met with a young lady recently. She was a MSW student making a mid-career
switch to social work and was writing a research paper on the PAIR Program. She
had already interviewed several past and present members of the PAIR
Program. She updated me on the current state of the PAIR mental health
diversion program. The round table meeting still happens every Thursday. It is
unclear if any of the players are the same as they were when I and my
associates started the PAIR Program. It seems that some of the representatives
of the original stakeholders still attend. The representative for the largest
mental health service provide is there. An assistant prosecutor is there. A
public defender is there as are some support clerical staff from the PD's
office. And finally, she said that someone from the MHA--The Marion County
Mental Health America association still advocates for the mentally ill as a
court monitor.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Sadly,
there seems to be missing the attendance of anyone who actively goes out and
searches for persons who could actually benefit from the program. In the
beginning of PAIR, there were several persons actively advocating for the
mentally ill as they entered custody and help coordinate any emergency or long
term treatment.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Roughly
60, 000 people are processed through the Arrestee Processing Center. Only 10%
or 6000 are held for more than a few days. A conservative estimate would be
that 10% of these longer term detainees are the seriously mentally ill, or
about 600 are held who need serious psychiatric treatment. That conservative
number would easily make the Marion Co. Jail the largest mental health
inpatient [or custody] treatment facility in the state. And who is actually
treating the largest group of mentally ill persons in custody? A private
contractor. A contractor whose main
goal is to make a profit. There is no concern for the long term welfare of the
patient or the county. There is no accountability to the patient, the court, or
the community. To my knowledge, there is no one at the PAIR round-table to
represent this private contractor nor to represent the welfare of the serious
mentally ill offender.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> I
believe this lack of over-site and accountability for the treatment of the SMIO
is wrong and should be corrected. It is possible that I don't have all the
facts, but several reports from the PAIR program suggests that there is
something wrong. The biggest indicator seems to be the lack of utilization of
the PAIR Program by those SMIO [serious mentally ill offender] in jail. I am
told that in spite of the program being in existence for 17 years, it is
roughly handling the same number of clients, about four dozen, as it did in the
beginning of the program. Why is there no growth? What happened to all the
in-kind services provided to the PAIR program? What happened to all the
significant investments of personnel time and expense? Has the PAIR program
evolved into a show boat of good intentions and good will publicity without
doing any real work? <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> In
the beginning, I believed that we in the PAIR program thought we could really
make a difference. It was the naiveté and the belief that caring people could
change the world, or at least our county. When I first started working on the
PAIR project I tired to pull in people who were not only knowledgeable and
powerful, but truly seemed to care about the work and for the ideal of doing
something good for the welfare of the community. This group ended up including
professors, judges, attorneys, doctors, social workers, nurses, prosecutors,
advocates, and the public defenders. Interestingly, many of the early PAIR
workers had family members or love ones with mentally illness and had first
hand experience with the deficits in the current social network or so called
safety net for those with psychiatric problems. All of the early participants
in PAIR seemed to understand that the criminal/justice system's treatment of
the SMIO is/was a microcosm of how the mentally ill are treated in the real
world. Early on we tried to promote the notion that a rationale and humane
manner of treating the mentally ill in the criminal/justice system could
actually save money. We didn't want money. We wanted to save money and the
dignity of the ill. We wanted to save all of us money and be more caring to the
mentally ill too. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">We
benefited from Prosecutor Scott Newman's crusade to cut costs and his posting
of the "top ten frequent arrestees". He asserted that these few
persons accounted for over a million dollars in processing costs, which
included: man hours, court costs, and the cost of incarceration. Often times
when the subject was released by the court to the community, he would then be
re-arrested before his release papers were even finished being processed. All
of the persons on this list were frequently treated at the local mental health
centers. And the final comment on the list was that all of the arrests were for
trivial charges like public intoxication, trespass, disturbing the peace, etc;
or what are generally known as misdemeanor nuisance charges. Most of the
people on this list would be dead before the end of the decade.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Who
advocates for a sane system now? Who actually enters into the pit and tries to
rescue people? I would like to see the PAIR Program grow and do some good. I
would like to shake the program out of it complacency and see it actually do
something more than just being happy with the status quo. It seems at present,
the program is little more than window dressing, or a dog and pony show. This
PAIR program gives elected officials some plausible deniability of the state of
the care of the mentally ill in the county facilities. They can say, "We
are working on it". "Look what the PAIR Program does." ETC.
Meanwhile, sick people are suffering in jail cells and nothing is being done
about nudging them toward treatment nor helping them improve their lives.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">The
PAIR Program is in reality advocating for the same number of people we did 20
years ago and there is no supervision of care on the front lines in the
jail. <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 12pt;">***<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> I
would like to offer the following suggestions on re-invigorating the PAIR
program and improving it:<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
would like to see a build up the esprit de corp and an increase of knowledge of
the PAIR Roundtable participants. In the beginning of the PAIR program, we went
on frequent field trips to treatment facilities and service providers. We went
to Carter State Hospital, a Day Reporting program, Richmond State Hospital,
Madison State Hospital, and Logansport State Hospital. I did not get the time
to do more on the criminal/justice side. I would advocate the PAIR Roundtable start
taking tours of the courts, the jail, the arrestee processing center, and
community corrections center. The group needs to understand what truly happens
on the front lines. These field trips, educate and informs all who are involved in the work with the
mentally ill. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe there needs to be more advocacy in the PAIR program. The Protection and
Advocacy service needs to be more involved in the needs of the mentally ill in
custody. They have federal and state mandated powers to this. Also, the ACLU
needs to get involved and advocate for a rational consent decree to insure that
the rights of the SMIO [serious mentally ill offender] are being protected in
jail. Finally, the MHA [Mental Health America] needs to arrange for its
staff or volunteers either to respond to the requests of the incarcerated SMIO
or to periodically visit to insure the quality of supervision is being
maintained. In my day, the local federal court has several supervision
projects.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe there needs to be a designated staff person from the PAIR program, to screen
for the mentally ill in the group of daily new arrestees. That is what I use to
do. I would screen the records of
perhaps a hundred new arrestees and interview ten, everyday. Now, this could be
a two part screening with the first part being done by trained medical staff
and the bail commissioners. If the inmate is grossly psychotic and dangerous,
or at risk; he should be sent for
immediate emergency care. The second part of the screening should be done by a
representative of PAIR who has acecss
to the county or public mental health records. At any given time, there are
dangerous persons entering the jail whom are already under care for mental
illness or addiction and under the
supervision of a court order, be it a civil commitment, probation, parole, bail
conditions, community corrections, or some other pending criminal case. All of
these public and private records need to be available in one database for the
use of the PAIR screener. The PAIR screener refers the appropriate case to the
respective appropriate entity, while determining those who meet the guidelines
for an intervention by the PAIR program. The PAIR Screener will bring
those cases who meet the guidelines to the PAIR roundtable meeting on
Thursdays.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe that the Prosecutor's screening committee either needs to have a
representative of PAIR in attendance or a member of the screening committee
needs to attend the weekly PAIR Roundtable. The screening determines the
severity and whether charges should even be officially brought against an
individual. This process may present the opportunity for the prosecutor to make
a informal offer of diversion rather than simply dropping a charge which may be
of benefit to the arrestee and the community. The PAIR program could follow up
and report whether the agreement was followed or not and if so, the charges
could be dismissed. I believe many new cases for the PAIR Mental Health
Diversion could be found during this screening process.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe here should be periodic public workshops to train and inform the public
about the PAIR program. I believe one of the best things we use to do as a
group was to participate in public and professional workshops. I traveled all
over the state and also gave presentations in Chicago to the National NAMI
meeting and to Washington DC, to give a workshop at the National Public Health
Convention. The PAIR Program needs to participate more in this process and
contribute to the body of knowledge about the incarcerated mentally ill.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe that the providers of psychiatric treatment in the Marion Co. Jail
System and Community Corrections need to send a representative to the PAIR
Roundtable and provide a record of those receiving treatment in custody. This
would insure some continuity of care and provide some reasonable
oversight. Some of these same inmates may cycle through our different
systems many times and the more we know about their history and treatment, the
more effective and humane we can be.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;"> The
CIT officer's program seems to be working well. I believe there should be a CIT officer in attendance at the
weekly PAIR roundtable to discuss problems and issues of mutual interest. This
could aid in the enforcement of the diversion agreements and increase the
effective use of the Immediate Detention law. This cooperation could aid
the ideal of community policing and increase the likelihood that the CIT
officer and SMIO have an opportunity to have an informal diversion agreement. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">There
are multiple types of diversion programs and agreements. There is a domestic
violence court, a drug court, a protective order court, and perhaps others who
have a diversion agreement. I believe there should be some coordination and
database of those on diversion and what the conditions of the agreement are.
This sharing of knowledge will cut down on duplication of resources. There
should be a public record of a diversion agreement.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe there should be a representative of the Marion Co. Probation Department
in attendance at the PAIR Roundtable. Many of the mentally ill offenders won't
qualify for diversion, but will have their treatment supervised by probation.
Another benefit to the probation department is that many of their clients are
mentally ill and will need services long after the probation is over. There is
a strong possibility that many of them will be re-arrested for nuisance crimes.
This cooperation would benefit the community. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe the courts, and specifically the Circuit Court and the Probate Court
should be more involved in the PAIR program. Many of those arrested are already
on a civil commitment out of the Probate Court which is suppose to supervise
the person's mental health treatment. At present, it is possible for a mentally
ill person to be on a civil commitment, on several types of diversion, and to
be on probation: <b><u>ALL AT THE SAME TIME</u></b>!
The Circuit Court needs to determine a way to coordinate this better. It would
be especially beneficial for the Probate Court to send someone with knowledge
of the civil commitments to the PAIR Roundtable as it is the responsibility of
this court to supervise committees' treatment. A more long term goal could be
that there would be designated court for civil commitments and for minor
criminal charges. This court could follow persons on commitment and diversion. This
new court could issue new commitments and diversion. It could offer
supervision. This new mental health court could also screen and coordinate the
petitions for ICST and its mandated provisions. A court with specialized
knowledge in ICST would save the system much in time and expense. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
believe that the PAIR Roundtable needs to be more formalized. There should be
formalized roles. There should be an up or down vote on accepting someone for
the PAIR program. This would necessitate that there be some formal bylaws and a
formal administrative body or advisory board. The advisory board should be
appointed by the mayor, the City-County Council, and/or the governor. The PAIR
Roundtable would work under the supervision of the PAIR Mental Health Diversion
program. The PAIR Advisory board would need a similar body as the community
corrections board. There should be a representative of the Mayor, the
City-County Council, the IDOC, the Marion Co. Courts, The Marion Co. Sheriff,
The Marion Co. Prosecutor, The Community Corrections Director, Mental Health
Advocates, Members of the Public, and Mental Health Service Providers. The PAIR
Roundtable and interested parties should nominate official members of the
roundtable and they shall be affirmed by the advisory board. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">The
purpose of the PAIR Roundtable is to hear case presentations and to vote on
whether that individual is appropriate for the diversion program and may
possibly benefit from its supervision. The cases will be presented by the PAIR
screener or other interested parties after being placed on the agenda by the
PAIR coordinator. The number of participants to the roundtable should be
reasonable to facilitate discussion and to keep information as confidential as
possible. Members should include the screener, the coordinator, a public
defense attorney, assistant prosecutor, advocate, patient program monitor, and
formalized representatives of major public mental health providers. Other
interested parties could attend the PAIR roundtable meeting but should have the
power to vote.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">The
court supervision and monitor portion of the diversion program should continue
to be in the Mental Health Diversion Court. As usual, there will be a hearing
where the court monitor reports on the progress report under supervision of the
assistant prosecutor. The client will give testimony under the supervision of
the public defender. The judge will ask questions of comments at will. The
diversion agreement is either extended, terminated as failure, terminated as a
success. If the agreement is a failure, the prosecutor will decide on whether
to send this matter back to criminal court for prosecution.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">I
recommend that the PAIR Program find new ways to fund the program. I suggest to follow the money. Do a cost
benefit analysis. Many of the agencies and government entities which benefit
from the PAIR Program have their own revenue streams. Some of these streams are
taxes, grants, and fees. Some of these fees are collected from individuals and
some from other agencies. Often times this cache of money is not supervised by
any oversight and are used at the discretion of a department head or an elected
official. Sometimes these individual funds are a repository of millions of
dollars collected per year and are sometimes used for the most trivial of
projects and to promote the PR of the agency. Two examples are the diversion
fund of the prosecutor's office and the sheriff's commissary fund. Most of what
the public knows about these funds come from the shadows. There needs to be
known more about these funds and how they can be utilized for the public good
like funding the PAIR program. If the prosecutor or sheriff has millions of
dollars floating around for their discretionary use, the PAIR Program should be
advocating for some funding as their services save money for the respective
agencies.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Finally,
another initiative I have thought about is the <b>Make, Sake, Bake, Take, or Shake Program</b>. PAIR can <b>make</b> money by collecting fees from
either the individuals or from the participating agencies. The <b>sake</b> part of the initiative is getting
donations because this a good program and people should fund it for goodness'
sakes. The <b>bake</b> part is where the
members of the PAIR program do different fund raisers to get enough money to
fund part of the PAIR program. The <b>take</b>
portion is to take funds from agencies which benefit but who may not want to
give it to you like the sheriff or prosecutor. The <b>shake</b> idea is to seek funding through taxes or funding through the
City-County Council. The PAIR program logically saves money and the time of many
agencies. These agencies should contribute funds to help PAIR help them reach
their performance goals more efficiently.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">These
are just a few of my thoughts, here at the beginning of the Summer in 2012.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Are
there any questions or comments?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span style="font-size: 12pt;">DISCUSSION<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Respectfully
Submitted,<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Robert
Cardwell, LSW, QMHP<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: 12pt;">Original
PAIR Program Founding Member.</span></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-23114671813566091922009-07-25T15:20:00.000-07:002009-07-25T15:34:02.496-07:00What a Mental Health Court should be.Mental Health America<br /><br />Position Statement 53: Mental Health Courts<br /><br /><br /><span style="font-weight:bold;">Policy</span><br /><br />Mental health courts have been created in numerous jurisdictions across the United States, largely as a response to the increasing number of defendants with serious mental illnesses who are caught up in the criminal justice system. Mental Health America and other mental health advocacy organizations need to work to ensure that mental health courts do not lead to greater criminalization and stigma for persons living with mental illness and greater fragmentation of the mental health system.<br />The presence of defendants with mental illnesses in the criminal justice system imposes substantial costs on that system and substantial harm on defendants. It is difficult, if not impossible, to provide humane and just treatment to persons with mental illnesses in prisons and jails. Thus, Mental Health America strongly supports thoughtful efforts to reduce the number of defendants with mental illnesses in the criminal justice system and in prisons and jails. Mental Health America's diversion policy states that case.[1] <br /><br />To the extent that mental health courts are an effective mechanism for reducing the number of persons with mental illnesses in prisons and jails and subject to the concerns expressed in this policy, Mental Health America supports the creation of mental health courts. Mental Health America enthusiastically supports efforts to use new or existing criminal justice funding-federal, state or local--to provide community mental health services to persons with mental illnesses being diverted from prisons and jails through well-designed mental health court programs. <br />However, mental health courts can also be used to criminalize persons with mental illness, for "lifestyle" offenses. Mental health courts are a highly inappropriate way to treat homeless people and people with mental illness whose offenses flow from their troubled life on the street, and Mental Health America strongly opposes the use of mental health courts for this purpose or with this effect.<br /> <br />There are many other successful and innovative ways to divert persons with mental illnesses from the criminal justice system, including the creation of law enforcement-mental health liaison programs, increased training of law enforcement personnel and a general improvement in the funding and effectiveness of community mental health services. In order to prevent the misuse of mental health courts, such courts should be but one part of a coordinated community effort to reduce the number of persons with mental illnesses in the criminal justice system. The filing of actual criminal charges against persons with mental illnesses which would result in their assignment to a mental health court should be the last resort after all reasonable efforts at diversion have been exhausted.<br /><br />It is critical that Mental Health America, Mental Health Associations and other advocates work to promote diversion from the criminal justice system as the central mission of mental health courts, wherever they exist and by whatever name they are called. Advocates need to insist on mental health court standards that assure a non-coercive and de-stigmatizing approach and leave civil commitment as the central standard for the authorization of coercion, when it is needed and justified, not the criminal courts. A criminal record should not be a cost of getting mental health treatment.<br /><br /><span style="font-weight:bold;">Discussion</span><br />Where they exist, Mental Health America advocates that mental health courts play a role in convening criminal justice, mental health, substance abuse and other relevant social service agencies to facilitate diversion from the criminal justice system. Mental health courts should not act as mandators of treatment, using criminal sanctions to coerce compliance, imposing the stigma of criminalization as a condition of access to treatment resources. They should focus instead on diversion. <br />It must be conceded that when diversion is not possible, mental health courts may serve to assure treatment for persons with serious mental illness convicted of crimes and divert them from incarceration, if not from conviction. This too is a valuable role. Anything that keeps people with serious mental illness out of prisons and jails should be encouraged. With good will, mental health courts can broker diversion and protect the vulnerable from being crushed in the gears of the criminal justice system. However, the risk that remains is that mental health courts actually defeat diversion in favor of a kind of endless, boundary-less criminal probation, and that more and more people with mental illness will be swept into the criminal justice system, which would be an extremely unjust outcome. <br /><br />Above all, mental health courts must avoid becoming a preferential point of entry for persons who have been unable to obtain community-based treatment, thus draining resources from an already underfunded community mental health treatment system. Treatment preference should not be given to persons accused of crimes over others who have not committed a crime, but who are still unable to access services. Mental health courts should never become a way to "jump the line" and get preferential access to existing resources.<br /><br />The ultimate danger is that in the hope of improving access to treatment resources, and even providing some, mental health courts will, in the end, increase coercion and stigma. There is also the risk that they will fail to effectively triage available treatment resources to achieve the best overall public health outcomes. The basic problem is that the courts cannot run the mental health system from their limited vantage point and cannot provide the resources needed to fill the gaps. <br />Mental health courts risk inappropriate intervention of the criminal justice system, with no real improvement in treatment outcomes. At best, they may effectively determine individual needs and advocate for good individual treatment. At worst, they risk further criminalizing people with mental illness and fragmenting the mental health and criminal justice systems. Mental health courts are functioning all over the country now, and their implementation concerns all mental health advocates. It is a time for advocacy.<br /><br />Mental Health America believes that advocates must remain skeptical of mental health courts and attentive to their evolution. Mental health courts inherently risk further criminalization of persons with mental illness and may compete with diversion programs unless they embrace diversion as their own focus. Mental Health America believes that eventually, all mental health courts should satisfy the guidelines established in this policy.<br /><br /><span style="font-weight:bold;">Background</span><br />Mental Health Courts - While there is no accepted definition, mental health courts have been created by local initiatives, often adapting the model of drug courts, and focusing initially on dually diagnosed substance abuse and mental illness, to obtain mental health treatment for persons with mental illness accused of crimes. Currently, some mental health courts involve using the authority of the court to impose treatment compliance as a condition of release from jail or bail. Failure to comply may result in sanctions being imposed, up to and including incarceration.<br />Diversion - There are two basic models of diversion. Under the predominate model, a person is assigned to a treatment program and criminal charges are suspended or dropped. Any program that provides for dismissal of charges or deferred prosecution, even after arraignment, is considered to be "meaningful diversion." Programs under which persons are assigned to probation after a plea of guilty are sometimes referred to as diversion. However, these programs are only a diversion from incarceration and not diversion from the criminal justice system.<br /><br />The concept of mental health courts has been promoted in order to respond to the increasing number of people with mental illness caught up in the criminal justice system. The failure of American society to make good on the promise of community-based care is one of the reasons for this increase. America has never committed the resources necessary to provide adequate community mental health services for people who are at risk of commitment to or being discharged from institutions (including hospitals, prisons and jails). Additionally, lack of education contributes to the prejudice, stigma and discrimination against persons with psychiatric disabilities. Increased enforcement, especially of misdemeanor "lifestyle" offenses, has criminalized symptoms of mental illness and co-occurring substance abuse disorders. <br /><br />One of the primary concerns which Mental Health America has about mental health courts is that they may be used inappropriately as tools to coerce treatment. Since mental health courts are relatively new, there is not a great deal of research about the level of coercion involved in such courts. The research which has been conducted, however, is encouraging. A recent study of the Broward County Mental Health Court found that "the mean score on a self-report perceived coercion measure (0.69) was low in an absolute sense and...lower than almost any score on a comparable measure of perceived coercion previously reported in the literature."[2] This study emphasized that a key element affecting the perceived lack of coercion was the fact that participants could opt out and be returned to the courts which heard cases involving defendants who were not identified as having a mental illness. Additionally, the study emphasized the importance of insuring that defendants were aware of this option. <br /><br />Similarly, mental health courts were much less apt to use jails as a sanction for failure to comply with court-ordered treatment than were the drug courts after which they are modeled.[3] <br /><br />Given the wide variation among the designs of mental health courts, these studies do not demonstrate that mental health courts are non-coercive. But they do demonstrate that it is possible to design a mental health court with minimal coercion. Mental Health America urges jurisdictions which chose to create a mental health court to follow those models which use minimal coercion. <br /><br />In 2000, the United States Congress authorized a mental health court demonstration program (P.L. 106-515). In doing so, Congress identified mental health courts as having the potential to address the criminalization of people with mental illness. Mental health courts are here to stay. Mental Health America is concerned that communities may rush to implementation without considering all of the components of an effective system to respond to the needs of persons with mental illness involved in the criminal justice system. In the absence of a framework of values to guide the development of mental health courts, the needs and rights of people with mental illness may be ignored and threatened. This policy seeks to provide such a framework<br /><br /><span style="font-weight:bold;">Principles</span><br />Minimizing the use of coercion is fundamental to effective mental healthcare and treatment and recovery from mental illness, and the most coercive entry point for mental health treatment is the criminal justice system. The United States already incarcerates people at the highest rate in the western world, and we have effectively institutionalized many persons with mental illness in correctional facilities.<br /><br />Criminal courts rarely address mental health issues in sentencing decisions. Corrections systems are assigned the classification/diagnosis as well as the treatment responsibility, once there has been a criminal conviction, with deferred sentences and probation after a plea as a gray area of court involvement. However, probation and other forms of post-conviction court involvement, including deferred sentences contingent on mental health treatment, are really only alternatives to incarceration, not alternatives to the use of criminal sanctions. <br /> <br />Communities must develop services that meet the comprehensive needs of mental health consumers. It is essential that any mental health court program bring additional treatment resources to the community, rather than depleting already limited existing resources. In addition to significant increases in public investment, services must be integrated across public and private agencies to address the full range of consumer needs. Individual treatment plans should be focused on consumer recovery and choice and should include: mental and physical healthcare, case management, housing, supportive education, substance abuse treatment, and psychosocial services in the least restrictive environment possible.<br /><br />Mental health courts may act as a catalyst in developing this comprehensive, community-based mental health system because state and local corrections are often only minimally involved and unable to pay more attention. As a convener, mental health courts may be able to get the attention of other agencies that they do not control, to promote real and enduring systems change. In this capacity, the court convenes criminal justice, mental health, substance abuse and other social service agencies and community resources to respond to the needs of those persons before the court. However, that convening role requires real commitment from the judiciary and entails substantial risks.<br /><span style="font-weight:bold;"><br />Concerns</span><br />The greatest danger is that mental health courts will assume a coercive role, both in allocating scarce treatment resources and in further criminalizing and stigmatizing persons with mental illness who get caught up in the criminal justice system. Secondarily, there is a risk of fragmentation, both of the struggling community-based mental health treatment system, and of the already-fragmented criminal justice system. <br /><br />At the extreme, mental health courts may become a preferred means of access, with mental health judges granting treatment preference to persons accused of crimes over others. In addition, unless citizens are vigilant in monitoring the development and implementation of mental health courts, court processes may lead to even greater criminalization, stigma and fragmentation. Already, people with mental illness stay in jail two to three times longer than others charged with the same offenses.<br /><br /><span style="font-weight:bold;">Guidelines</span><br />State and local Mental Health Associations are in a strategic position in their communities to influence and guide the development and implementation of mental health courts in ways that safeguard the needs and rights of consumers. In order to avoid potential risks in establishing mental health courts, Mental Health America advocates that state and local Mental Health Associations be involved in the development and implementation of mental health courts from very early on. To assist in this effort, the following guidelines have been developed to support mental health advocates and justice systems in shaping new mental health court initiatives and holding mental health courts accountable where they currently exist.<br /><br />1. <span style="font-weight:bold;">Comprehensive mental health outreach</span> - Access to community-based mental health treatment services for all people needs to be improved, and should not depend on the existence of mental health courts. Equally effective services should be assured for the treatment needs of persons not accused of crimes. This requires an investment in outreach services to promote voluntary treatment as an essential complement to any mental health court program.<br />2. <span style="font-weight:bold;">Maximum diversion</span> - Pre-booking diversion should be assured for all persons accused of crimes for whom a voluntary mental health treatment plan is a reasonable alternative to the use of criminal sanctions. Timely and accurate mental health screening and evaluation is the single most critical element in a successful diversion program. Mental health courts may be helpful in assuring such diversion, but should never be the only way, or even the primary way, that it can occur.<br />3. <span style="font-weight:bold;">Meaningful diversion</span> - Meaningful diversion would require that when appropriate, no charges would be filed, and the individual is diverted directly to treatment without entering the criminal justice system. In the alternative, when charges must be filed, criminal proceedings should be deferred for a set period, usually not exceeding a year. Dismissal of criminal charges would then be guaranteed after a set period of successful treatment participation. <br />4. <span style="font-weight:bold;">No requirement for a guilty plea</span> - A guilty plea should not be required to enter a mental health court program. This requirement precludes diversion from the criminal justice system at the earliest possible point in time and further criminalizes a person because of his or her mental illness. As indicated above, the preferred method is to hold charges in abeyance until the successful completion of the treatment program. <br />5. <span style="font-weight:bold;">Voluntary/Non-coercive</span> - While the threat of criminal charges influences any decision, participation in any mental health diversion program should involve the same level of voluntary choice required of a criminal plea. No one should have to decide whether or not to accept diversion until the terms and the nature of the proposed treatment plan have been fully discussed and documented.<br />6. <span style="font-weight:bold;">Least restrictive alternative</span>. - All persons participating in diversion programs should be treated in the least restrictive alternative manner available, and all unnecessary institutionalization should be avoided. Jails are generally an inappropriate place for persons waiting for diversion as jail experiences tend to exacerbate underlying symptoms of mental illness. Long jail stays should be avoided in all diversion cases. <br />7. <span style="font-weight:bold;">Right to refuse treatment</span> - The qualified[4] right of a person with mental illness accused of a crime to refuse a particular treatment, including a particular medication, should be protected in a manner at least as protective of the consumer as the civil commitment process. A process should be established to review treatment refusals of persons diverted from the criminal justice system so that any decision to reinstate charges is made in an informed manner after all reasonable alternatives have been exhausted. <br />8. <span style="font-weight:bold;">Advocate/Counselor</span> - In addition to competent legal counsel in any criminal case, an experienced counselor, who may be a peer or other non-lawyer counselor, independent of any treatment facility, should be available to help the accused person to reach an informed decision. This person should also serve as an advocate to ensure that necessary services that have been mandated as part of a treatment plan are provided in a timely and appropriate manner. Mental Health Associations and other consumer advocacy groups may take on this important role.<br />9. <span style="font-weight:bold;">Confidentiality</span> - Networking to find an appropriate treatment setting, without safeguards, could compromise client confidentiality. Systems must be put in place to ensure confidentiality from the time that a person enters a mental health program.<br />10. <span style="font-weight:bold;">Cultural competence</span> - Cultural competence is essential to treatment success. Mental Health America believes that services must be tailored to the specific needs of communities and individuals in order to effectively address public health problems.<br />11. <span style="font-weight:bold;">Community coalitions</span> - The development of community coalitions, including partnerships between criminal justice, mental health and substance abuse treatment agencies, is essential to successful diversion programs. Such coalitions also should be involved in the creation and oversight of mental health courts. Consumers of mental health services and family members affected by mental illness need to be included in all such coalitions to assure that they address the real barriers to effective mental health treatment in that community. <br />12. <span style="font-weight:bold;">Comprehensive outreach and training</span> - Community coalitions need to reach out to all criminal justice system personnel and ensure that training is provided at all levels to deal with issues of mental illness, wherever and whenever they occur. <br />13. <span style="font-weight:bold;">Co-occurring disorders</span> - In addition, persons with co-occurring disorders, and especially substance abuse, must be treated in an integrated way, so that substance abuse is not an impediment to diversion.<br />14. <span style="font-weight:bold;">Convening role</span> - The focus of mental health courts should be on convening prosecution, probation, treatment and social services agencies to promote interagency collaboration in the interest of the individual. The focus should not be on the use of criminal sanctions to compel treatment. <br />15. <span style="font-weight:bold;">Consolidation and coordination of cases</span> - Cases should be consolidated to assure that the individual is the focus rather than the case. Centralized, coordinated case management and a single treatment plan are needed to avoid fragmentation, with or without a mental health court.<br />16. <span style="font-weight:bold;">Handling relapses in the court setting</span> - Relapses are inevitable during the recovery process. As such, an individual's time under jurisdiction of the mental health court should not be extended as a result of these relapses.<br />17. <span style="font-weight:bold;">Evaluation</span> - Timely monitoring of court processes, waiting lists, and consumer outcomes are essential to ensure that mental health courts are responding appropriately to persons with mental illness, that waiting lists are kept to a minimum, and that treatment providers are held accountable for consumer outcomes.<br />Effective Period<br /><br />The Mental Health America Board of Directors on November 17, 2001 and revised by the Mental Health America Board of Directors on November 13, 2004, adopted this policy. It will remain in effect for a period of five years. <br />Expiration: November 13, 2009 <br /> <br /><br /><br /> <br /> <br />[1]Mental Health America Policy Number 50 (Issued 2002), "In Support of Maximum Diversion of Persons with Serious Mental Illness from the Criminal Justice System."<br />[2] (The score was compared to the scores of both voluntary and involuntary inpatients and involuntary outpatients.) Poythress, N. et al, "Perceived Coercion and Procedural Justice in the Broward County Mental Health Court," 25 Int. J. of L. & Psych. 517 (2002) <br />[3] Griffin, et al, "The Use of Criminal Charges as Sanctions in Mental Health Courts," 53 Psych. Services 1285 (Oct. 2002)<br />[4] Washington v. Harper, 494 U.S. 210<br /> <br /> <br /> <br />HELP<br />In Crisis? 1-800-273-TALK If you, a friend or a loved is going through a tough time <br /><br /><br /> Policy from:<br /><br />Mental Health America<br />2000 N. Beauregard Street, 6th Floor Alexandria, VA 22311<br />Phone (703) 684-7722<br />Toll free (800) 969-6642<br />TTY 800/433-5959<br />Fax (703) 684-5968Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-19367615651537867162008-08-20T19:31:00.000-07:002008-08-20T19:32:31.187-07:00Judge Barb Collins of PAIR to Lead DiscussionJudge Barb Collins will be a presenter at the NAMI State Conference in OCt.<br /><br />http://www.nami.org/MSTemplate.cfm?Section=2008_NAMI_Indiana_State_Conference&Site=NAMI_Indiana&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=65464<br /><br />Read more <a href="http://www.nami.org/MSTemplate.cfm?Section=2008_NAMI_Indiana_State_Conference&Site=NAMI_Indiana&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=65464">here.</a><br /><br /><br />Image<br />2008 NAMI INDIANA STATE CONFERENCE<br />New Hope for Better Living: Treating the Whole Person<br /><br />OCTOBER 18, 2008 Marten House/ Lilly Auditorium<br /><br />CURRENT AGENDA<br /><br />Click Here to Register Now<br /><br />8:00 – 9:00am Registration and Gathering<br /><br />9:00 – 9:15am Welcome<br /><br /> Marciniak Scholarship Award Recipient<br /><br />9:15 – 10:15 Keynote Speaker: Fred Frese Click Here for Speaker Bio<br /><br />10:15 – 10:30 Break<br /><br />10:30 – 11:15 Workshops #1<br /><br /> Ask the Judge – Judge Barbara Collins<br /><br /> Peer Specialist – Bruce Van Dusen<br /><br /> Keeping SSDI while working part-time – Rebecca Deetz<br /><br /> Social Security Administration<br /><br /> Electronic Medical Records Panel Discussion - TBA<br /><br />11:30 – 12:15 Workshops #2<br /><br /> Clubhouse Coalition – Paul Curry<br /><br /> Sunshine Clubhouse, South Bend Indiana<br /><br /> Spirit – Greg Denniston<br /><br /> Author, The Meaning of Faith and Mental Illness<br /><br /> Parents & Teachers as Allies – Teresa Hatten<br /><br /> NAMI Fort Wayne, President of NAMI Indiana Board<br /><br /> Breaking the Silence – Bill Lefurgy<br /><br /> President NAMI West Central<br /><br /> Electronic Medical Records Panel Discussion - TBA<br /><br />12:15 – 1:30 Lunch and Exhibitors<br /><br />1:30 – 1:45 Awards Presentation<br /><br />1:45 – 2:15 Plenary Speaker - Ted Colburn Click Here for Speaker Bio<br /><br /> NAMI Fort Wayne<br /><br />2:15 – 2:30 Break<br /><br />2:30 – 3:30 Ask the Doctor <br /><br /> Schizophrenia - Dr. Andrew Chambers <br /><br /> Mood Disorders / Children’s Disorders - TBA<br /><br /> Borderline Personality Disorder – Dr. Joan Farrell<br /><br /> Larue Carter Hospital, Indianapolis<br /><br /> Treating the Whole Person – Dr. Thom Liffick, Evansville<br /><br /> Electro-Convulsive Therapy – Dr. Alan Schmetzer<br /><br /> Professor/Director, Indiana University Dept. of Psychiatry<br /><br /> Consumer Council Meeting<br /><br />3:30 – 4:00 Wrap-up/Grand Prize DrawingUnknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-55346958836128518472008-08-20T19:22:00.000-07:002008-08-20T19:26:31.999-07:00Judy Spray has resigned from the PAIR ProgramJudy Spray has resigned from the PAIR Program. She will be sorely missed. Judy has done a great job for the past 10 years. The PAIR Program could not have been started without her work and surely would not have stayed together all these years. <br /><br />Good luck Judy!!!1Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-88858330693047939912008-02-22T19:56:00.000-08:002008-02-22T19:58:30.803-08:00Getting Help for the Mentally Ill<a href="http://bobcardwell.com/mihelp.htm">Click here</a> to read info on getting help for a loved one in Indianapolis, Indiana.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-23782349002873004722008-02-21T13:27:00.000-08:002008-02-21T13:28:54.245-08:00Updated 2/21/08<br /> <br />Getting Help for Loved Ones Who are Mentally Ill<br />An Action Plan for Helping those with Mental Illness<br />An Opinionated Guide by Bob Cardwell<br /><br /> <br />Sad, but true....<br /><br />For most families, when they think about getting help for a mentally ill love ones, they think of the state hospitals. This is understandable. The state hospitals get a lot of attention. They get a lot of money. Historically, and in the community’s collective memory, the state hospitals are where loved ones went when they were mentally ill. Most families can recall family histories where a grandparent, a cousin, a sister, parent, or other loved one went to a state hospital for help. This is not true in today’s treatment scheme. <br /><br />The state hospitals are the treatment choice of last resort. They are not truly for the families. The state hospitals are an option [albeit the last choice] of community treatment providers. The community treatment providers only put a sick person in a state hospital when they can find no other option available. An admission to a state hospital is not based on the seriousness of the illness. The admission is based on many other factors such as: legal issues, political issues, need of subjects for research, criminal charges, and public outcry. The new system has pretty much eliminated problems with patient abuse and clear neglect, but the state hospitals offer little treatment for mentally illness other than forcing medications.<br />A mentally ill individual is much more likely to receive involuntary “treatment” in the local jail than in a state hospital. Sadly, there are many more mentally ill persons in jail being treated than in the state hospitals. <br /><br />This is a plan for family members helping those with mental illness in Marion County, Indiana, or the Greater Indianapolis area. Please go here to read about some suggestions from a general standpoint or to find some ideas for your area.<br /><br />My basic belief is that whenever possible, those with mental illness should take the responsibility for their own care. However, mental illness often robs individuals of their judgment and it becomes necessary for family and the community to intercede for the safety of the individual and the community.<br /><br />I would like to start off with two names of the most knowledgeable and caring persons I know on matters of mental health. These persons are: Mike Trent, of Midtown Mental Health Center [ph 317- 630-7791] and Judy Spray, of the PAIR Mental Health Diversion Program [317- 327-6869]. I would certainly start with these two for ideas and guidance on helping a loved one into treatment.<br /><br />If he is dangerous to himself or others, the family can seek an Emergency Detention to a mental health center. After a period of 72hrs, the hospital has to determine if he is dangerous as a result of mental illness. If so, the hospital can have him court ordered for long-term inpatient or outpatient treatment. This procedure must be initiated in cooperation with a mental health center as the petition for an emergency detention must have a doctor's statement, as well as a factual witness, and the agreement of the mental health center that they will hospitalize the person for a period of observation. There may be a fee charged by the mental health center for this service. Some mental health centers serving Indianapolis are:<br /><br />Midtown MHC<br /><br />Gallahue MHC/Community Hospital <br /><br />BehaviorCorp.<br /><br />Adult and Child MHC<br /><br />Assorted Mental Health Providers<br /><br />If the mentally ill person presents an immediate danger, one can always call 911 and explain that there is a mentally ill person in need who may harm themselves or others. The mentally ill person can be picked up by the responsible law enforcement officer and taken to the nearest appropriate treatment facility under provisions of the Immediate Detention Law. Another strategy is to avoid calling 911, if time and circumstances permit, and call the shift commander of the appropriate law enforcement district. This may permit the commander the time to exercise more judgment and discretion on what officers to send out and at what time. Working with caring law enforcement officers may lessen the trauma to the mentally ill person and facilitate the person gaining appropriate access to the right services. A mission of the Indianapolis law enforcement agencies are to encourage the notion of "community policing" and the problem of the mentally ill falls under this plan. To find the appropriate officer in Indianapolis, go to IMPD here. <br /><br />If he is gravely disabled, the family can go to Probate Court and seek Guardianship over him. The court or his guardian can then sign him in for treatment. You will need to start with an attorney first.<br /><br />If he has any pending criminal charges [probation, parole, court case], the court, parole officer, or probation officer can order him into treatment. IF he is in custody, email or call [317-231-8263], the jail and request that he be evaluated for treatment while in custody. It would also be advisable to notify the PAIR Mental Health Diversion Program, at 317-327-6869, and request an evaluation. To check if your loved one is in jail, go to MCSD here. <br /><br /><br />If he is a nuisance, the family, or any responsible party, can go to court and ask for a protective order. The court can order him to quit being a nuisance to the petitioner and order him into treatment. To get a protective order one has to go through the Marion Co. Prosecutor's Office and be a resident of the county. This person also has to be the offended party. There may be a charge for filing the petition. A person may qualify for free assistance in getting a protective order.<br /><br />If the family has the means, they can hire an attorney for help. Check with the local bar association or with the local chapter of NAMI to find attorneys versed in this area of the law.<br />The Indiana Civil Liberties Union [ICLU] often investigates systematic problems with the delivery of mental health services to jail and prison inmates. <br /> <br />Finally, if all of the above doesn't work out, get an advocate. All of the mental health centers and courts are political entities who depend on funding and the good will of the public. You would be surprised how much a phone call from an advocate will help with your cause. Just look up the phone numbers, web addresses, or location; then write or call, but follow up and expect a response. Here are some possible advocates in no particular order:<br /><br />Protection and Advocacy Agency of Indiana<br />or specifically with mental health treatment issues, go here.<br /><br />Marion Co. Mental Health Association<br /><br />Adult Protective Services<br /><br />NAMI- National Alliance of the Mentally Ill<br /><br />TAC- Treatment Advocacy Center<br /><br />State Representatives<br /><br />Federal Representatives<br /><br /><br />Judge Barb Collins, Marion County Superior Court<br />[Mental Health Expert and Advocate]<br />Court 8 <br />City-County Bldg Room E-643<br />6th Floor, East Wing<br />(317) 327-3202<br /><br />Mayor Greg Ballard<br /><br />Governor Mitch Daniels<br /><br />Misc. Helpful Indiana Resources<br /><br />Read about The PAIR Mental Health Diversion Program here.<br /><br />Read about mental health laws across the country here.<br /><br />Good Luck and God Bless!<br /> Bob Cardwell [email bob@bobcardwell.com]<br /><br />Updated 2/21/08Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-82523292316678349572007-11-02T11:34:00.000-07:002007-11-02T11:39:15.655-07:00How to help loved ones with mental disabilitiesHow to help loved ones with mental disabilities.....<br /><br /><br />10 Tips: Mental illness can be emotionally — and financially — draining<br /> <br /><br />10 Tips<br /><br /><br />By Laura T. Coffey<br />MSNBC contributor<br />updated 7:30 p.m. ET, Tues., Sept. 18, 2007<br /><br /><br />It can happen to anyone, from any walk of life, when you least expect it. A child can be diagnosed with autism. An aging parent can be diagnosed with Alzheimer’s disease. A middle-aged spouse can be diagnosed with any number of incapacitating mental disorders.<br /><br />While such illnesses take an obvious emotional toll, they can hurt families financially as well. <br /><br />The rigors of lining up the right kind of care can be draining, and planning for the future can become much more complicated than it otherwise might have been.<br /><br />If someone you love is affected by a mental illness, consider these tips for getting a handle on the situation.<br /><br />1. Assess decision-making abilities. Does your family member need help making major – or even extremely basic – financial decisions? Be sensitive to just how much help your relative actually needs right now, or is likely to need over time. Allow the person to be as independent as possible for as long as possible.<br /><br />2. Line up supervision at the right time. When serious decision-making help is needed, consult with a lawyer to determine whether someone trustworthy should be given durable powers of attorney, trustee status or guardianship over your loved one. While different in scope, each of these approaches allows someone else to handle your relative’s affairs.<br /><br />3. Find the right kind of legal help. You can find lawyers who specialize in issues affecting the disabled through the National Academy of Elder Law Attorneys.<br /><br />4. Determine eligibility for government help. If the illness is so debilitating that your loved one can’t earn enough money to live on, he or she may qualify for Medicaid or Supplemental Security Income (SSI). Basic rules for eligibility can be found through the Social Security Administration and through your state’s department of health, human services, social services, or children and families. (The department names vary from state to state.)<br /><br />5. “Spend down” wisely. In most cases, your aging relatives would have to impoverish themselves in order to qualify for Medicaid. Be sure to help them pay off bills and debts first before they apply. Such obligations are not factored into the government’s formula for determining eligibility.<br /><br />6. Understand the system. Your loved ones would stand a much better chance of getting into a nursing home or assisted living facility they – and you – prefer if they go in as private-pay patients as opposed to Medicaid patients. You can help them apply for Medicaid after they’ve lived there for several months or more.<br /><br />7. Look into Special Needs Trusts. You can use such trusts, also known as Supplemental Needs Trusts, to set aside money for specific needs for relatives who qualify for Medicaid or SSI without disqualifying them from receiving those benefits. Have a lawyer draft such a trust for you.<br /><br />Have you ever thought about legally changing your name? No matter what motivates you to take this step — a marriage, a divorce or just a deep-seated desire to do so — you’ll have to deal with a barrage of paperwork after the fact. Do you have advice to share with people who are about to take this step? <br /><br />8. Plan ahead. To get a handle on how much money you might need over time to cover a family member’s expenses, use Merrill Lynch’s Special Needs Calculator.<br /><br />9. Tap into local support. You can find contact information for local experts through the National Alliance on Mental Illness (1-800-950-6264). The national Eldercare Locator (1-800-677-1116) can connect you with your local Area Agency on Aging office if you’re lining up care for an aging relative.<br /><br />10. Make sure your child’s care is covered. If you die before doing any advance planning for your disabled child, the courts could appoint a guardian without direction from you. Your child also may not be equipped to handle money inherited from you. The book “Planning for the Future: Providing a Meaningful Life for a Child with a Disability After Your Death” contains helpful advice in this arena.<br /><br />Sources:<br /><br /> * Consumer Reports Money Adviser<br /> * Kiplinger’s Personal Finance magazine<br /> * MSN Money<br /><br />© 2007 MSNBC InteractiveUnknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-8359208450732614252007-10-24T18:55:00.000-07:002007-10-24T18:57:13.581-07:00PAIR Like Program Begins in TexasMental health care expanded for county workers, offenders <br /><br />Officials see the initiatives as wise investments. <br /><br />Web Posted: 10/23/2007 10:41 PM CDT<br /><br />Tracy Idell Hamilton<br />Express-News <br /><br />Bexar County has ramped up its commitment to mental health with initiatives that will help both county employees and mentally ill offenders. <br />For employees, the county is increasing its health insurance coverage for mental health treatment in an effort to reduce two barriers to getting help — cost and stigma — Commissioner Paul Elizondo announced Tuesday. <br /> <br />"We need to be treating mental illness with the same fervor as cancer or anything else," he said. <br /><br />Currently, the county's 3,900 employees and their dependents must pay high out-of-pocket costs to see a counselor, psychologist or psychiatrist. Beginning in January, treatment for mental health problems will have the same co-pay as any other doctor's visit. <br /><br />Employees with untreated mental disorders incur medical expenses more than four times higher than for other employees, and mental health conditions are the second-leading cause of absenteeism, according to Mental Health America of Texas, a nationwide advocacy and educational organization whose chief executive officer praised Bexar County's efforts. <br /><br />Lynn Lasky Clark said covering employees' mental health care makes good business sense in addition to being "the fair, humane and responsible thing to do." <br /><br />Elizondo used the announcement to challenge other businesses and municipalities to follow suit. <br /><br />In a pair of related initiatives, the county unveiled a mental health court and a county-funded program that will help keep indigent, nonviolent misdemeanor offenders out of jail and get them into treatment. <br /><br />"The largest mental hospital in the county has long been the Bexar County Jail," Elizondo said, with anywhere from 400 to 600 inmates who need treatment at any given time. <br /><br />The mental health court, similar to a drug court that requires treatment and offers more intense supervision, will be launched with a $250,000 grant from the Bureau of Justice Assistance. <br /><br />Up to a third of the county's criminal docket is made up of mentally ill offenders, said Judge Tim Johnson, a longtime advocate for such a court. <br /><br />"Many of these people start out with mild mental illness" that is exacerbated by drug use and lack of treatment, Johnson said. Once someone lands in the criminal justice system, the person's situation almost always gets worse, and it becomes more expensive for taxpayers, he said. <br /><br />Commissioners authorized $1.5 million in their 2007-08 budget to expand programs to keep the mentally ill out of jail. <br /><br />Charlie Boone, chief operating officer for the Center for Health Care Services, which was nationally recognized last year for its jail diversion program, praised commissioners' actions. <br /><br />"There is a huge cost when there is not access to mental health care in the community," he said, but more important, "this is a humanity issue."Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-5526548072801369322007-09-26T15:19:00.000-07:002008-11-13T00:07:36.706-08:00Some Info from the Web on PAIR<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRNtDdnRsOfv3JZFeOTuqDGolrLryJ-0hOUfw1TRPa84uNREOUTSBUjdTBMy0UPmd7jshQd8cUUhzQewGZea1OgzQ70glJdun_ILxrzVK91KyT9lDsCP0k98-ru6Bkeh6ADhY/s1600-h/logo_2.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRNtDdnRsOfv3JZFeOTuqDGolrLryJ-0hOUfw1TRPa84uNREOUTSBUjdTBMy0UPmd7jshQd8cUUhzQewGZea1OgzQ70glJdun_ILxrzVK91KyT9lDsCP0k98-ru6Bkeh6ADhY/s400/logo_2.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5114641536964064130" /></a><br /><br /><br /><br />Marion County MHA<br />STATE: Indiana <br />PROJECT(S): Court-based jail diversion<br /><br />Overview<br /><br />The Marion County Mental Health Association (MHA) coordinated a process through which representatives of the courts, jails, and mental health service providers developed a court-based jail diversion program. <br /><br />History<br /><br />In 1994, after receiving calls from the courthouse and the jail asking for assistance with an increasing number of individuals with mental illness, staff of the Marion County MHA convened a group of local judges, prosecutors, jail staff, and service providers to talk about the scope of the problem and potential solutions. The diverse stakeholders all agreed: individuals with mental illness charged with minor infractions should be diverted into treatment.<br /><br />As plans for a diversion program took shape, two sticking points became apparent. First, legislative changes were necessary to allow for a diversion program. A lawyer on the MHA's board volunteered to draft appropriate legislation, which promptly passed. Second, local judges and prosecutors wanted assurance that participants would comply with treatment and receive follow-up care. To address this concern, the parties agreed that MHA would monitor participants' compliance and would report back monthly to the court and district attorney. The parties also agreed to a weekly roundtable in which all relevant parties could discuss cases. Based on these and other agreements, Marion County launched the Psychiatric Assertive Identification and Referral Project (PAIR), which allows defendants with mental illness facing misdemeanor charges to receive treatment in lieu of prosecution, with the charges dismissed upon the successful completion of treatment for a set period of time. <br /><br />Perhaps the greatest achievement of the MHA was establishing trust between different agencies. The cornerstone of the program is the weekly roundtable in which service providers, MHA staff, representatives from community corrections, the prosecutor, and public defenders review eligible cases. Open communication between all stakeholders is essential for the program to run smoothly. <br /><br />Funding <br /><br />PAIR was funded through a reallocation of resources. All participating parties the court, public defenders, prosecutors, treatment providers, and MHA volunteer staff time to make the program happen. As the program has expanded, it has grown from one judge to two. In addition, MHA has increased its staffing commitment and now provides a dedicated staff member. PAIR has received funding from the United Way in order to pay for the full-time program staff member. <br /><br />Obstacles<br /><br />At the start of the program, community mental health providers were not accustomed to providing updates to MHA and were slow to respond to information requests. In response to this problem, the court gave MHA subpoena power, which helped providers prioritize their reporting function. This has, in turn, increased judicial and prosecutorial confidence in the program. <br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdwl8ETnSqP7Fut1LaxnAZCbc1nA6nJcjNgvtpH9LG3D3K_8Kdlyn5N70vgJxgIaxSyA4FfrPPPrdL_GokTEPjQXfusqnNrNb8VIHEjU9Cay_m91EG8KV_0p7F3CRjkJ_iIuY/s1600-h/wakeup.jpeg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdwl8ETnSqP7Fut1LaxnAZCbc1nA6nJcjNgvtpH9LG3D3K_8Kdlyn5N70vgJxgIaxSyA4FfrPPPrdL_GokTEPjQXfusqnNrNb8VIHEjU9Cay_m91EG8KV_0p7F3CRjkJ_iIuY/s400/wakeup.jpeg" border="0" alt=""id="BLOGGER_PHOTO_ID_5114641850496676754" /></a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-27422563416505319502007-04-27T20:48:00.000-07:002007-04-27T20:51:07.299-07:00Dangerousness and Mental IllnessRead the study <a href="http://www.nimh.nih.gov/press/schizophreniaviolence.cfm">here:</a><br /><br /><br />July 18, 2006<br /><br /><strong>New Factors Identified for Predicting Violence in Schizophrenia</strong><br /><br />A study of adults with schizophrenia showed that symptoms of losing contact with reality, such as delusions and hallucinations, increased the odds of serious violence nearly threefold. The odds were only about one-fourth as high in patients with symptoms of reduced emotions and behaviors, such as flat facial expression, social withdrawal, and infrequent speaking. Results of the study, which was conducted in patients in real-world community settings as part of the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), were published in the May 2006 issue of the Archives of General Psychiatry. Jeffrey A. Lieberman, M.D., of Columbia University, was the principal investigator.<br />Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia. Of the 1,140 participants in this analysis, 80.9 percent reported no violence, while 3.6 percent reported engaging in serious violence in the past six months. Serious violence was defined as assault resulting in injury, use of a lethal weapon, or sexual assault. During the same period, 15.5 percent of participants reported engaging in minor violence, such as simple assault without injury or weapon. By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period, according to the NIMH-funded Epidemiologic Catchment Area Study.<br />The researchers found that the odds of violence also varied with factors other than psychotic symptoms. For example, serious violence was associated with depressive symptoms, conduct problems in childhood, and having been victimized, physically or sexually; minor violence was associated with co-occurring substance abuse. Participants who lived alone had lower rates of violence than those living with families. However, participants living with families they felt "listened to them most of the time" had half the rate of violence of those living with less supportive families.<br />Serious violent behavior, while generally uncommon in people with schizophrenia, can have serious consequences. Knowledge about symptoms and characteristics that increase risk for violent behavior in individual patients is crucial for developing effective ways to manage schizophrenia and allow people with the illness to successfully engage in daily living.<br />Data from the CATIE project have been analyzed in a number of studies funded by NIMH. This analysis of CATIE-generated data was funded by the Foundation of Hope and an NIMH grant.<br />Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA, Stroup TS, McEvoy JP, Lieberman JA. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16651506&query_hl=5&itool=pubmed_docsum">A National Study of Violent Behavior in Persons With Schizophrenia</a>. Archives of General Psychiatry 63:490-499. May 2006.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-64930967427029272402007-04-26T16:40:00.000-07:002007-04-26T16:43:20.100-07:00Listen to Radio Show on Mental IllnessGo here to listen to program:<br /><br /><br /><a href="http://wamu.org/programs/dr/07/04/25.php#15344">http://wamu.org/programs/dr/07/04/25.php#15344</a><br /><br />or try this:<br /><br /><a href="mms://wamu.wmod.llnwd.net/a202/e1/dr/07/04/r1070425.wma">mms://wamu.wmod.llnwd.net/a202/e1/dr/07/04/r1070425.wma</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-60231369746354796982007-04-07T10:14:00.000-07:002007-04-07T10:15:27.966-07:00ENEWS - TREATMENT ADVOCACY CENTERTREATMENT ADVOCACY CENTERVisit our web site <a href="http://www.treatmentadvocacycenter.org/">www.treatmentadvocacycenter.org</a>Blog TAC - <a href="http://tacenews.c.topica.com/maagbFzabxHtBbfGwZEb/">http://tacenews.c.topica.com/maagbFzabxHtBbfGwZEb/</a>April 6, 2007******************************1. LEGISLATION NEEDED TO HELP MENTALLY ILL - Daily News, April 4, 20072. MENTALLY ILL NEED MORE THAN PRISON OR THE STREETS, ETHICIST SAYS - Catholic Register, March 13, 20073. HOMELESS MYTHS DIMINISH THEM, AND US - St. Petersburg Times, March 28, 2007 4. WHY MOST OF THE HOMELESS ARE INTRACTABLE IN FACE OF ATTEMPTS TO HELP THEM - Wall Street Journal, January 31, 20075. SHELTERS FOR DICKENS, SHAKESPEARE AND THE HOMELESS - Los Angeles Times, April 1, 20076. MENTAL ILLNESS LINKED TO DISAPPEARANCE, STUDENT SAYS - The California Aggie, March 12, 2007******************************1. DAILY NEWS (Los Angeles), April 4, 2007[Editor's Note: A supervisor of our nation's largest county, an ethicist, an outreach specialist, an economics professor, and a librarian - in this E-news each of this disparate group offers his perspective of homelessness and, more particularly, of those who are so because of untreated and severe psychiatric disorders.First is Los Angeles County Supervisor Michael Antonovich, who clearly understands that helping the 35,000 people in his county who are both chronically homeless and suffer from a severe mental illness or substance addiction requires more than just an ample supply of room keys.]LEGISLATION NEEDED TO HELP MENTALLY ILLOp-ed By Michael Antonovich The solution to the homeless problem in Los Angeles County is not to spread it to other communities but to reduce the number of people who are homeless.Skid Row, near Los Angeles City's downtown, has the highest concentration of homeless individuals. The Los Angeles Homeless Services Authority census revealed that a majority of the nearly 35,000 chronically homeless in Los Angeles County suffer from mental illness and/or addiction to drugs and alcohol. To solve the homelessness problem, fundamental reform of our mental health laws must be accomplished including mandatory psychological, alcohol and drug-abuse treatment. However, these necessary reforms continue to be opposed by groups aligned with the American Civil Liberties Union and like-minded legislators. The solution is not forcing them into neighboring cities and communities, as suggested by the downtown special interests looking to profit on the area's new high property values as evidenced by the ill-advised taxpayer subsidy of the Grand Avenue Project. While community-based treatment facilities, stabilization centers, family access centers, and transitional housing are valuable temporary tools to treat symptoms of homelessness, they must provide proactive access to medical treatment that addresses mental illness and rehabilitation for alcohol/drug addiction. As we roll out new services throughout the county of Los Angeles, facilities need to be established and operated with the support and participation of the community. Long-term success for shelters and treatment centers depends on cooperative working relationships with local government, business, service organizations, faith-based groups and community volunteers.An example of a successful public/private partnership is Pasadena's Union Station Foundation. Since 1973, it has provided emergency and transitional housing for individuals and families, hot meals, job development, health care, case management services, and vital mental health care and substance abuse rehabilitation. The Antelope Valley's Lancaster Homeless Shelter, operated by Catholic Charities, recently added 52 more transitional housing units for adults with the $1 million grant we secured for this project. The proposed St. Joseph's Manor in the Antelope Valley will use county and private contributions to house, support and inspire homeless clients in the Antelope Valley. Penny Lane's new Lancaster center is another superb example of the community working together in a united effort to provide housing and services to emancipated youths at risk of becoming homeless. We initiated the Los Angeles County Emergency Outreach Call Center and hotline at (800) 854-7771 and launched the Network of Care Web site at <a href="http://www.losangeles.networkofcare.org/">www.losangeles.networkofcare.org</a>. All of these programs and housing projects fall short of our goal of long-term solutions for ending the homeless problem. The long-term solution requires state legislation to reform the dysfunctional mental health laws. Local experience continues to demonstrate that those suffering from mental illness and/or alcohol or substance abuse require mandatory treatment. ---Michael D. Antonovich is a Los Angeles County supervisor. ******************************2. CATHOLIC REGISTER, March 13, 2007[Editor's Note: It has many names, but our society holds no ideal more sacrosanct - self-determination, autonomy, liberty. Indeed, protecting the right to choose one's own course is indelibly ingrained in our nation's character. Restrictions of individual freedom of action must overcome a rightly intense prejudice against them - doing so solely to help an individual is rarely enough.Take someone who is homeless. If the person, while fully aware of and able to assess the alternatives, chooses to be homeless, few would argue that anyone should be able to dictate otherwise. The scenario shifts, however, when the affects of an acute psychiatric disorder severely impair that person's ability to rationally make that decision. The choice is no longer between whether or not to override the person's right to choose what his best for him; he is no longer able to do so. Instead, the alternatives change to either aid the person or to leave him to the symptoms of his illness.Philosopher and bioethicist Barry Brown's take on the interplay between mental illness and autonomy is described in the article below.]MENTALLY ILL NEED MORE THAN PRISON OR THE STREETS, ETHICIST SAYS By Michael Swan TORONTO, Canada (The Catholic Register) - Putting a person in jail for being sick might sound extreme, barbarous and unreasonable, but 40 percent of the inmates in Canada's prison systems suffer mental illness and approximately 35 percent of the homeless suffer serious forms of mental illness. Philosopher and bioethicist Barry Brown argues that society should do more for the mentally ill than tossing them in jail or out on the street. The problem, according to Brown, is how personal autonomy rules as almost the sole value in the ethics of health care. In the annual Cardinal Ambrozic Lecture presented by the Canadian Catholic Bioethics Institute March 2, Brown argued that doctors and health care administrators have to find ways to continue treating mentally ill patients who refuse treatment or deny their illness. Laws that allow any adult to refuse treatment so long as they do not present a danger to themselves or others, and they show some understanding of the consequences of refusing treatment, have resulted in the social tragedy of vulnerable people sleeping on subway grates and being arrested for nuisance crimes, Brown said. Extreme deference to personal autonomy has meant patients who are only marginally competent routinely refuse treatment for manic depression, schizophrenia and dissociative disorders. So long as patients are violent or delusional, the law says they may be treated against their wishes. As soon as the treatment begins to work, patients may refuse treatment and are routinely returned to the street, Brown said. "The right to refuse treatment when one is marginally competent takes autonomy to an extreme," said the retired University of Toronto professor of philosophy. Brown argues patients should be pressured to continue treatment if non-treatment is likely to result in homelessness, run-ins with police or readmission to hospital in the medium- to long-term future. The health care system has granted mental health patients "an autonomy the exercise of which will lead to the eventual loss of autonomy," he said. Brown said he is not advocating the steamrolling of patient rights or return to the mid-20th-century asylum system. And the health-care system could avoid a constant crisis of having to determine who really is competent to refuse treatment with earlier intervention and by reducing the stigma which prevents two-thirds of mentally ill people from seeking treatment, he said. In a Catholic health care setting the legitimate right of personal autonomy should be balanced against the duty to care for one's own health, said Brown. ******************************3. ST. PETERSBURG TIMES (FL), March 28, 2007 [Editor's Note: Key to assessing how, and even whether, to help those who are homeless is to determine who among that population rationally prefer that lifestyle. No matter how bizarre or foolish choosing a life on the streets might appear, the fully-informed and competent selection of it should be respected. Richard Shireman, an outreach worker, spends his days among this population; he has found few who have chosen to be part of it.]HOMELESS MYTHS DIMINISH THEM, AND US Guest Column By Richard T Shireman Countless times since I began doing outreach work with the homeless, I've heard people say something like, "We should help the truly homeless, but we shouldn't help those who choose to be homeless." The speaker has said or implied that a significant percentage of the people who live on our streets do so by choice. These people are often referred to as vagrants, bums or transients. Regardless of the appellation applied to them, apparently many people believe that this population does not deserve any, or any more, help. In a recent letter to the editor, the writer divided our homeless population into three categories: 1. Those who are genuinely down on their luck and trying to get back on their feet. 2. Those who suffer from mental disorders but won't take their medication. 3. The majority, who have no intention of getting out of their homelessness. His third category, this "majority, who have no intention of getting out of their homelessness," is a fallacy. After working with this population for the past 14 months, I must conclude that the idea of a significant percentage of our homeless population being homeless by choice is a myth. A destructive, denigrating and cruel myth. My partner and I have worked with hundreds of homeless individuals. We have been privileged to hear their stories, hopes, fears, frustrations and pleas for assistance. We have met only one individual we thought might be homeless by choice. If we were to include with him the few people who would not speak with us or said that they didn't want our help, the sum would be less than 2 percent of our total contacts. Of course, that is assuming that not wanting to talk with the Outreach Team equates with being homeless by choice. The reality is that many people who appear to be lazy and irresponsible are suffering from serious, life-threatening addictions, have a mental illness, have been scarred by trauma or abuse in their past, or have some combination of these conditions. Oftentimes the "vagrants" or "bums" that are being decried as people unworthy of our compassion are the homeless alcoholics that populate our streets. Many people believe that these people live and behave the way they do because they freely choose this lifestyle. There is nothing free about their "choice" to live this way. In fact, many of the seriously ill alcoholics (who generate most of the complaints and police calls related to homelessness in our community) are aware of the fact that they are dying on our streets. They are profoundly ashamed of their behavior. They're depressed. They hate going to jail repeatedly. They hate being verbally abused, beat up and robbed. They hate being looked upon as subhuman. They hate being too cold, too hot, wet, and regularly feasted upon by fire ants, spiders and mosquitoes. Most have sought help many times for their addictions. They have had periods of sobriety. Of those who haunt the environs of downtown St. Petersburg, many have responded to the offers of the Outreach Team to go to detox or some other treatment facility. Unfortunately, it is the nature of addiction that the vast majority of people relapse. The homeless addict, with little or no resources and virtually no support network, relapses back to the street, back to "vagrancy." Even those who do not suffer from a life-threatening addiction or serious mental illness often are handicapped in ways that make it hard to describe their decisions as "free." Because of things that have happened to them, things that have been done to them, they lack the emotional and/or rational wherewithal to make free, informed decisions. Abuse, neglect, dysfunctional families and insufficient education are just some of the factors that account for many lacking the life skills that are required in order to make truly free, healthy decisions. When you consider that homelessness is a condition that robs one of self-esteem, motivation, hope and trust, it is not at all surprising that these people have difficulty making the choices that we think are appropriate for them. I am not suggesting that we should ignore or condone illegal, destructive or unhealthy behavior. I am saying that we should not embrace this myth simply because it allows us to ease our moral burden by relegating a significant portion of our homeless population to the "Deserves No Help" category. These sufferers need our help and compassion. Surely, this community has the compassion, resources, patience and integrity to continue reaching out to all of our homeless people. I believe that after a little thought and discussion, we will conclude that we must reject this convenient and destructive myth. Richard T. Shireman is an outreach specialist with Operation PAR Inc. and a member of the St. Petersburg Homeless Outreach Team.******************************4. WALL STREET JOURNAL, January 31, 2007[Editor's Note: Dave O'Neill, an economist, points the readers of the Wall Street Journal to one of the chief reason why 200,000 Americans with a severe mental illness are homeless - deinstitutionalization.] WHY MOST OF THE HOMELESS ARE INTRACTABLE IN FACE OF ATTEMPTS TO HELP THEMLetter to the EditorHow could Julia Vitullo-Martin ("Homeless in America," editorial page, Jan. 18) write a 1,300 word article on homelessness in America and not once mention the term "deinstitutionalization"? Almost every psychiatrist, from those that still think it was a good idea to essentially shut down our mental hospital system once thorazine, haldol and other drugs that control somewhat the symptoms of psychosis became available, to those, like Fuller Torrey who think it was a dangerous and ill-conceived movement, agrees that half or more of the chronic street homeless are severely mentally ill.It is estimated that today there are well over a million people with schizophrenia, major depression and bipolar disorder who, using 1960 standards, would be inside mental hospitals, are outside today. Some, the lucky ones, find treatment in either small private psychiatric hospitals or in special programs usually located in rural or suburban areas with almost a one-to-one counselor patient ratio and where their taking of medication is strictly monitored. But the others have been living lives that make even those depicted in the famous anti-mental hospital movie "The Snake Pit" seem not so bad in comparison. Instead of being released into lives more humane and caring than could be provided in a mental hospital, which was the basic goal of the deinstitutionalists, their fate has been either living in shelters, living in special shabby "hotels" for the mentally ill funded by Medicaid, living in the streets, or in the worst cases, criminal behavior leading to terms in prison orsudden outbursts of psychotic frenzy that lead to deaths of bystanders or themselves either as suicides or at the hands of police trying to subduethem.If this is the character of the major part of the homeless population, what is one to make of the survey of approaches to the problem presented by Ms. Vitullo-Martin? The one actual program described in detail in her article would be ludicrous as an approach to the homeless mentally ill if the problem were not so serious. This is the "Housing First" program in New York City. Its approach is not to watch or be concerned with what the program participants do in private, just their public behavior has to be monitored and sanctions applied. But the central problem of the homeless mentally ill is to get them in a highly monitored situation that will ensure they are taking their medication. Mayor Bloomberg is quoted as promising to take on the problem by getting tough with advocates for the homeless -- whatever that is supposed to mean. Most "advocates" are parents and relatives of the deinstitutionalized mentally ill who try to get better care for them. One wonders if he realizesthat there are between 20,000 to 30,000 street homeless with psychotic mental disease in the city, and that to really provide them with facilities and programs that would ensure they stay on their medications and avoid getting into trouble on the city streets would probably cost $1 billion to $2 billion, a mere 20% to 40% increase in what the city now spends on providing all medical care. Go get 'em,Mike.If President Bush's $4 billion effort to end street homelessness is going to be used for funding many programs like "Housing First," then its chance of making a dent in the huge fraction of homelessness due to deinstitutionalization is nil.Dave M. O'Neill O'Neill is adjunct professor of economics, Baruch College, CUNY; he was formerly a resident economist at the Nathan Kline Institute for Psychiatric Research, 1994-1998.******************************5. LOS ANGELES TIMES, April 1, 2007[Editor's Note: Those who suggest that homelessness is a choice for many seem to suggest that the value of an unbridled existence may, for some, outweigh the appeal of a more comfortable, stable, and healthful lifestyle. Imagine if every day that it rained, snowed, or was too cold that your local library essentially became your prison.]SHELTERS FOR DICKENS, SHAKESPEARE AND THE HOMELESS While We Look Away, Public Libraries Become Warehouses For Those Living On The Streets.Op-Ed By Chip WardChip Ward was, until recently, assistant director of the Salt Lake City Public Library. OPHELIA SITS BY THE FIREPLACE and mumbles softly, smiling and gesturing at no one in particular. She gazes out the window through the two pairs of glasses she wears at once. When her muttering disturbs the woman seated beside her, Ophelia turns, chuckles and explains, "Don't mind me, I'm dead." Not at all reassured, the woman gathers her belongings and moves quickly away. Ophelia shrugs. Verbal communication is tricky. She prefers telepathy, she says. Mick is having a bad day too. He has not misbehaved but sits and stares, glassy-eyed. This is usually the prelude to a seizure. His seizures are easier to deal with than Bob's, for instance, because he usually has them while seated and so, unlike Bob, he rarely hits his head and bleeds, nor does he ever soil his pants. Franklin sits quietly by the fireplace and reads a magazine about celebrities. He is fastidiously dressed and might be mistaken for a businessman or a professional. His demeanor is confident and normal. If you watch him closely, though, you will see him slowly slip his hand into the pocket of his sport coat and furtively pull out a long, shiny carpenter's nail. With it, he carefully pokes out the eyes of the celebs in any photo. These may sound like scenes from a psych ward. But in fact, this is the Salt Lake City Public Library, which, like virtually all the urban libraries in the nation, is a de facto daytime shelter for the city's homeless. It's also the place where I was, until recently, the assistant director. In bad weather, most of the homeless have nowhere to go but public places. Local shelters push them out at 6 in the morning and, even when the weather is good, they are already lining up by the time the library opens at 9 because they want to sit down and recover from the chilly dawn or use the restrooms. Fast-food restaurants, hotel lobbies, office foyers and shopping malls do not tolerate them for long. Public libraries, on the other hand, are open and tolerant, even inviting and entertaining places for them to seek refuge from a world that will not abide their often disheveled and odorous presentation, their odd and sometimes obnoxious behaviors and the awkward challenges they present. "Homeless" may not be a precise enough term for the people we see in the library. These are not the people for whom homelessness is a temporary, once-in-a-lifetime experience. The people we find in the library are those for whom homelessness is a way of life. We see them sleeping in parks, huddled over grates on sidewalks, resting on subway cars, passed out in doorways or panhandling with crude cardboard signs. Social workers refer to them as the chronically homeless, and studies of shelter users indicate that they make up 10% to 20% of the total homeless population. The most salient characteristic of these people is that most of them are mentally ill. The data on how many homeless are estimated to be mentally ill vary widely, between 10% and 70% - depending on whether all the homeless or just the chronically homeless are included and depending on how illness or disability are defined. How, for example, do you categorize alcoholics and drug addicts? When Crash is sober, for instance, he reasons like you or me and converses normally. Unfortunately, he is rarely sober. In one of his better moments, he petitioned me to let him stay in the library even though he had recently been caught drinking - an automatic six-month suspension. "C'mon, give me another chance," he pleaded. Crash was sitting in his wheelchair in the foyer outside my office. It was always hard for me to address Crash without staring at the massive scar on his face - a deep crease that divides it from his scalp to his chin. Unfortunately, his nose is also divided and the sides do not match up, giving him an asymmetrical appearance like a Picasso painting on wheels. "Alcoholics pass out in the library's chairs," I explained. "If you piss your pants or puke, the custodians have to clean that up, and they hate that. You guys fall down and knock things over. You're unpredictable when you drink. You disrupt others. Public intoxication is against the law.. " "OK, OK," he interrupted me, "I get it. Hey, just thought I'd try to get back in is all - no hard feelings, man." No hard feelings, I assured him. We shook hands. I wished I could cut him some slack, but I couldn't afford to establish a precedent I couldn't keep. The rule is clear: No drinking in the library, and no exceptions. As he waited for the elevator, I asked, "I know it's none of my business, but how did you get that scar?" "Car accident," he replied. "Same one as put me in this wheelchair. That's why they call me Crash." "Were you drinking?" I ask. He shakes his head "yes" and sighs. "Drunk as a skunk . drunk as a skunk." THE STRONG odor of mouthwash on the breath of the transient alcoholics is often masked by the overwhelming odor of old sweat, urine-stained pants and the bad-dairy smell that unwashed bodies and clothes give off. It can take your breath away. The library wrestles with where to draw the line on odor. The law is unclear. An aggressive patron in New Jersey successfully sued a public library for banning him because of his body odor, and that has had a chilling effect on public libraries ever since. Library users frequently complain about the odor of transients, and librarians usually respond that there isn't much they can do about it. Lately, libraries are learning to write policies on odor that are more specific and so can be defended in court: The criteria for ejection must fit within a clear legal standard so that it won't be perceived by the court as a violation of the person's right to have access to the library. Even so, such rules are hard to enforce because odor is such a subjective thing - and humiliating someone by telling him he stinks is an awkward experience that librarians prefer to avoid. None of this was covered in library school. So where are we to turn for help? Social workers are too few, underfunded, overworked and overwhelmed. In the dead of winter, they struggle to get people who are sleeping in alleys or passed out on sidewalks indoors so they don't freeze to death. If a homeless guy is inside the library, then the view is, "Hey, mission accomplished." Local hospitals also are uncertain allies. They have little room for the indigent mentally ill and often can't get reimbursed for treating them. So they deal with the crisis at hand, fork over some pills and send them on their away. Paramedics are caught in the middle. In winter, we call them almost every day. Once, when I apologized for calling twice in one day, one emergency worker responded: "Hey, no need to explain." He swept his arm toward the other paramedics, who surrounded a disoriented old man. "Look at us," he said. "We're the mobile homeless clinic. This is what we do. All day long, day after day." The cost of this mad system is staggering. Cities that have tracked chronically homeless people estimate that a typical transient can cost taxpayers $20,000 to $150,000 a year. You could not design a more expensive, wasteful or ineffective way of providing healthcare to individuals who live on the street than by having librarians dispense it through paramedics and emergency rooms. Ultimately, the indigent mentally ill are criminalized, and we librarians are complicit. When we have no good choices, in the end, we just call the cops. Take, for example, the case of a young man who entered the library spouting racial and ethnic slurs. He loudly asked some Latino teenagers doing their homework when they had crossed the border, and they reported his rude behavior. When a security guard approached, the young man started yelling obscenities and then took a swing at him. The guard tried to calm him, but on the next lunge, the guard took him down, cuffed his hands behind his back and called the police. They recognized the man. He had been let out of jail just two days earlier. That man's behavior, of course, was not a measure of his character but of his psychosis. He was sick, not bad. If we accept that schizophrenia, for instance, is not the result of a character flaw or personal failing but of some chemical imbalance in the brain - an imbalance that can strike a person regardless of his or her values, beliefs, upbringing, social standing or intent, just like any other disease might strike one - then why do we apply to that mental illness a kind of moral judgment we wouldn't use in other medical situations? We do not, for example, jail a diabetic who is acting drunk because his body chemistry has become so unbalanced that he is going into insulin shock. BY WINTER'S end - our "homeless season" - those of us at the library often find ourselves hard put to cope with our own feelings of depression and frustration. As one library manager told me, "I struggle not to internalize what I experience here, but there are days I just go home and burst out in tears." She is considering leaving the profession. America is proud of its hyper-individualism. We glorify the accomplishments of inventors, entrepreneurs, pioneers and artists. Although some individuals thrive, the plight of the chronically homeless tells me that our communities are also fragmented and disintegrating. The Penan nomads of Sarawak, members of an indigenous and primal culture in Borneo, have no technology or material comforts that compare with our mighty achievements. But they have six words for "we." Sharing is an obligation and is expected. An American child is taught that homelessness is regrettable but inevitable because some people are bound to fail. A child of the Penan is taught that a poor man shames us all. Ophelia is not so far off after all - in a sense she is dead and has been so for some time. She is neglected, avoided, ignored, denied, overlooked, feared, detested, pitied and dismissed. She waits in the library, day after day, gazing at us through her multiple lenses and mumbling to her invisible friends. She is our shame. We pay lip service to her tragedy - then look away fast. As a library administrator, I hear the public express annoyance more often than not: "What are they doing in here?" "Can't you control them?" We hear you loud and clear, we answer. Please be patient; we are doing the best we can. Are you? Chip Ward was, until recently, assistant director of the Salt Lake City Public Library. A longer version of this article appears at Tomdispatch.com.******************************6. THE CALIFORNIA AGGIE (Davis, CA), March 12, 2007[Editor's Note: About one-third of those who are chronically homeless have a severe psychiatric disorder; a many times greater preponderance than in the general population. That, in of itself, should be enough to dispel that for these individuals homelessness is a lifestyle choice.It is also important to remember that the symptoms of the most common forms of schizophrenia and bipolar disorder arise suddenly in the late teens or twenties - at a point of life where many of those who will later become homeless have already established promising track records, ones that give no suggestion of what lies in the future. Many, like James Banks, are in college when their illness first strikes. Mr. Banks appears to have responded well to his medication and attained the mindset to maintain his treatment. Many do not.]MENTAL ILLNESS LINKED TO DISAPPEARANCE, STUDENT SAYS First-Year's Bipolar Disorder Diagnosis Prompts Awareness Of DiseaseBy: Talia Kennedy When first-year student James Banks, 19, left his residence at Thoreau Hall on the evening of Feb. 26, he thought the "world was coming to an end," he said. Banks couldn't sleep and he didn't feel tired, and he barely remembers leaving his Cuarto residence hall, the international agricultural development major said. When his parents didn't hear from Banks for a day -- and roommates noticed his cell phone, identification card and credit card had been left in his room -- they filed a missing person report with the UC Davis Police Department. Banks doesn't remember much of what happened between the time he left his residence hall and when Yolo County sheriff's officers located him walking on county roads 31 and 97D, but a diagnosis made at a hospital soon thereafter helped clarify the experience -- Banks has bipolar disorder, and he was experiencing his first episode of the mental illness. Though the police searched the UC Davis campus and surrounding area for Banks until Feb. 28, even soliciting media and public help in locating the student, sheriff's officers had already found Banks, he said, just west of Davis on Feb. 26 -- the same day he was last seen at Thoreau Hall. "They found me on the road without any clothes on," Banks said. "I don't remember anything. There were periods of consciousness and unconsciousness." The officers took Banks to Woodland Memorial Hospital and then to a Kaiser hospital in Sacramento, where he remained for about a week to recover. Campus police, friends and family didn't know Banks had been found because he did not give permission to have the news released until Wednesday, he said "They probably were asking me [to release the information]," Banks said. "I don't remember anything." Banks spent his time in the hospital taking medication, which he'll have to take for the rest of his life to treat the disorder, and attending group sessions, including arts and crafts workshops, he said. The experience has changed how some see him, Banks said. "My family realized how precious I was to them," he said. "My roommates were glad to see me back. People aren't as silly around me now -- it's helped people become more mature, including myself. "On the whole, I think the experience was good for me -- but it's also a dangerous thing," he said. Now back to his normal routine, Banks said he meets with a social worker and a psychiatrist on a regular basis. While he is not seeking attention because of his illness, Banks said his experience could help make other students aware of mental illnesses and their symptoms. "If I raise some awareness about bipolar disorder, that would be fine with me," he said. ****************************** 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 <a href="mailto:info@treatmentadvocacycenter.org">info@treatmentadvocacycenter.org</a>.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 Center200 North Glebe Road, Suite 730Arlington, VA 22203703-294-6001 (main no.)703-294-6010 (fax)Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-1163352420825424512006-11-12T09:25:00.000-08:002006-11-12T09:27:01.170-08:00Judge Eichholtz [former mental health judge] heads Night CourtNight Court Held in Marion County for First Time<br /><br />Aug 21, 2006 09:49 PM EDT <br /><br /> <br /> <br />Judge Steve Eichholtz<br /> <br />By Daniel Miller<br />News 8 @ 6:00<br /><br />Night court is being held in Indianapolis for the very first time. Officials hope the new court will speed up the criminal justice process by moving cases through the system more quickly and alleviating jail overcrowding.<br /><br />"It's critical that we move cases for a lot of reasons," said part-time commissioner, Judge Steve Eichholtz.<br /><br />Court cases will be held at night as part of an initiative signed by city leaders to help cut crime on the streets.<br /><br />"The events of this summer have kind of highlighted the crisis we've faced in the criminal justice system. It's something that's been building for a number of years," said Judge Eichholtz.<br /><br />Judge Eichholtz, an Indianapolis attorney, will preside over the new night court. He says his courtroom will run like regular court proceedings.<br /><br />"It will run like a regular misdemeanor-D felony court docket. We will hear all types of hearings, pre-trials, guilty pleas," Judge Eichholtz said.<br /><br />For the first time, full and part-time prosecutors will handle class D felonies and misdemeanor drug charges at night inside the court.<br /><br />"This is something I have hoped for for a long time," Mayor Bart Peterson said.<br /><br />Mayor Peterson called city leaders together to address the jail overcrowding problem. He says moving justice cases through the system is crucial. He also says he's confident this new night court will help keep the streets of Indianapolis safe. <br /><br />"To be able to utilize our court resources at night, I think, is a great way to stretch the resources better and it also sends a real clear message to the criminals in this community, which I think they've been getting in the last couple weeks, that we are deadly serious about stopping this crime wave," said Mayor Peterson.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-1163267241743011842006-11-11T09:46:00.000-08:002006-11-11T09:47:24.383-08:00Help for the Mentally Ill in Prisons in IndianaDeal on mental health services for ex-cons<br />By Ken Kusmer<br />Associated Press<br />November 11, 2006<br /> <br />Needy, mentally ill prison inmates who have faced the prospect of losing their medications and other treatment when they complete their sentences are getting help from a new pact between the state's corrections and social services agencies.<br />Under an agreement signed recently by the heads of the two agencies, prison staff and their counterparts at the Indiana Family and Social Services Administration will work together during inmates' final months in prison to make them eligible on the outside for mental health care. It includes prescription drugs, funded by Medicaid, the government health insurance program for the poor.<br />The agreement, which also covers enrollments for food stamps and other benefits, marks a step forward in mental health care in Indiana because nearly one in five Indiana Department of Correction inmates is treated behind bars for schizophrenia, bipolar disease, addictions and other disorders that in many cases contributed to them ending up in prison.<br />Many mentally ill prisoners lose treatments as they move from behind bars to community settings where they might have little support from families or other means, said Mike Kempf, who works with prisoners as a volunteer for the Indiana chapter of National Alliance on Mental Illness.<br />"I think it's a huge step forward. It looks like they're trying to link the two systems together, and that's important," Kempf said Friday.<br />Prison populations have multiplied in recent decades in part because psychiatric hospitals closed, leaving many who could benefit from treatment unable to receive it because they lack access to clinics, cannot afford it or choose not to. Once in prison, the state provides care.<br />Thirteen percent of inmates in Indiana prisons take medicine to treat mental illness. Eighteen percent receive mental health treatment ranging from counseling to more intensive therapy, Correction Commissioner J. David Donahue has said.<br />"They just relocated. They just moved into the correction system," Donahue said during a tour of the prison system's psychiatric hospital at New Castle earlier this year.<br />The new agreement encourages prison staff to contact FSSA about 90 days before a sentence ends to have eligible prisoners apply for Medicaid and other benefits such as food stamps and Temporary Assistance for Needy Families.<br />"That way we do not risk the gap in the treatment or the medication," FSSA spokesman Dennis Rosebrough said.<br />More help might be on the way. The Indiana Commission on Mental Health recently approved proposed legislation that calls for jails and prisons to forward inmates' mental health records to doctors and clinics that provide treatment after release. The General Assembly still must act on the proposal.<br />DOC's agreement with FSSA is another in a series that it has struck with other state agencies to help ease former prisoners' transition after release. Other deals have been with the Bureau of Motor Vehicles to quickly provide government-issued identification cards, the Department of Workforce Development to point ex-cons toward jobs on the outside, and the Indiana Housing and Community Development Authority to help inmates find homes.<br />The agreements are aimed at curbing a recidivism rate of about 40 percent of Indiana inmates returning behind bars within three years of release. This year, the DOC will release more than 16,000 offenders into society.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-1160363515365689482006-10-08T20:11:00.000-07:002006-10-08T20:11:56.073-07:00still hereUnknownnoreply@blogger.comtag:blogger.com,1999:blog-10417427.post-1154279343011452692006-07-30T10:08:00.000-07:002006-07-30T10:09:32.383-07:00The Recovery ModelMENTAL ILLNESS: NOT EVERYONE RECOVERS FROM IT <br /><br />Op-ed<br /><br />By Mary Zdanowicz <br /><br /><br />"Recovery from mental illness is possible," wrote the director of one Maine psychiatric hospital, painting a rosy picture of life with schizophrenia. A week after his piece was published, one of his recently released patients stood accused of bludgeoning his mother to death. <br /><br />William Bruce wasn't afforded that chance at recovery. After Bruce was accused of killing his mother, the hospital director explained why. "In Maine, a client can choose not to be engaged in treatment ... [t]he major issue is when someone does not appear eminently [sic] dangerous and cannot be committed." <br /><br />This attitude is emblematic of a bizarre tendency by some in the mental health community to bank on an illusion of recovery for everyone, ignoring issues like awareness of illness and violence in the hope that disregarding them will eliminate stigmata. <br /><br />The problem with that strategy is that it isn't true. And anyone who reads a newspaper knows it. <br /><br />The mantra is that schizophrenia is not disabling and people who have it are no more violent than the general public. That simple message is more damaging than the one it tries to correct -- that schizophrenia means a life of disability and violence. <br /><br />A small group of people with mental illnesses are more violent than the general public; those are the ones not taking medication. Failing to acknowledge this -- because of a misguided sense of political correctness or fear of stigmatizing everyone with a mental illness -- keeps everyone from acting to help that small group. <br /><br />A recent national study clarifies who is at the greatest risk of being dangerous. Schizophrenia patients with "positive symptoms" (paranoid delusions, hearing voices, having imagined superhuman powers) were at least three times more likely to be violent than other schizophrenia patients. <br /><br />Scientific data like this helps clarify who most needs treatment interventions, reducing stigma for others with mental illnesses -- and saving lives. <br /><br />The establishment also tends to ignore the science on insight into illness. They talk about "choice," disregarding studies showing some people are unable to choose. The most common cause of nonadherence to treatment is actually not side effects, stigma, or medication cost, but a lack of insight into illness. That can seriously interfere with a patient's ability to weigh meaningfully the consequences of various treatment options. <br /><br />How does that affect choice? We understand that William Bruce thought the CIA had implanted a device under his skin. How will seeing a psychiatrist help you if the CIA is after you? Building a trusting therapeutic relationship is impossible if a patient imagines his doctor is part of a CIA plot. Medication is needed to combat the delusions. <br /><br />Maine, like every other state, has a law allowing civil commitment for people who meet strict standards. Sadly, the law is misunderstood even by mental health professionals. <br /><br />In one news story, William Bruce's father, Robert Bruce, recounted what he said to his wife the night before she was killed: "I can't believe they allow these people out on the streets. ... What do we have to wait for? Do we have to wait for him to hurt somebody or kill somebody before they do something?'" <br /><br />Too late for the Bruce family, the correct answer is "no." Maine's law does allow intervention before someone is deemed "imminently dangerous," and it is within the scope of the law for the hospital director to make discharge from a psychiatric facility conditional on someone taking medication. <br /><br />But some mental health professionals assume it is harmful to mandate someone to accept treatment. This is a myth. In one study, individuals in court-mandated community treatment had low levels of perceived coercion, similar to individuals who had never experienced any form of leverage -- they didn't feel "forced," in other words. But those same people reported significantly higher treatment satisfaction than those whose treatment had been voluntary, probably because they didn't get to choose whether to take medication or not. <br /><br />Maine's laws are weak in that they only allow civil commitment on an inpatient basis -- and there are too few beds to go around. A small pilot program is bringing an outpatient version of civil commitment to Maine -- states with similar programs have seen phenomenal results, reducing arrests, homelessness, and violence for participants. Hopefully that program will soon be available statewide. <br /><br />Until then, the mental health community must retool its message based on science. Yes, most people with mental illnesses can and do live independent and violence-free lives. But denying the truth about those who remain strips them, and sometimes their caregivers, of the chance to live any kind of life at all. <br /><br /><br />Mary Zdanowicz is the executive director of the Treatment Advocacy Center (www.psychlaws.org <http://www.psychlaws.org>), a national nonprofit dedicated to removing barriers to treatment of severe mental illnesses.Unknownnoreply@blogger.com