Holiday Wishes For Those Suffering With SMI

This is why I advocate for better legislation and changes in the language of KY law to improve the lives for those suffering with serious mental illness. Click here to read a story by Michael Judge, a writer and freelance journalist. He lives and works in Iowa City, Iowa.

De-Criminalizing Mental Illness: Is Prison Downsizing a Solution?

Click here to read this powerful article by:

Ron Honberg, NAMI Director for Policy and Legal Affairs

Serious Disconnects ~ can we learn to speak the same language when it comes to serious mental illnesses?

Serious Disconnects
Kelly Gunning, M.A.
Operations Director, NAMI Lexington

I was baptized in the waters of severe mental illness (SMI) 16 years ago. It wasn’t a baptism in the first person, as I was not actually the person who had the signs and symptoms of the illness and I was not the one who directly suffered each terrifying nuance of the illness. I have suffered serious bouts of depression and had dysthymia for most of my life … there were some very dark days but nothing like what my son was experiencing. With my son’s illness I became submerged in a parallel universe much like a dark, murky underwater world – disoriented and drowning in fear, grief and concern, but only able to watch, helplessly, as my son repeatedly went under. Today, 16 lonnng years later, I still find myself paralyzed for the most part and unable to save my son from what seems to be one of the cruelest of fates, indeed, constant, untreated psychosis.

Don’t misunderstand, it is not as if I have literally just stood by and watched this nightmare unfold, in fact; quite the opposite. First, I tried to learn everything I could about my son’s “condition”, that was the first experience in a series of constant ‘disconnects’, since for the first 8 years no one could agree on what was wrong with my son. Was it drug-induced psychosis? Was it bipolar illness? Was it (gasp!) schizophrenia? (Yes, I actually had one physician tell me he didn’t want to label my son’s “condition” schizophrenia because that was “just too terrible” and “offered so little hope”). It was only after my son’s fourth involuntary hospitalization and by now, years of symptoms, that it was decided that he did have paranoid schizophrenia. Armed with a definitive diagnosis and determined to help my son I encountered what I call the “rest of the nightmare”; ‘disconnect’ number two…the maze of the public mental health system. Unlike most illnesses, mental illness doesn’t walk in the front door of the health care system, nope; it comes in the back door, down the dimly lit alley of the criminal justice system. What other medical illness do you know of that demands the person suffering must arrive in handcuffs, in the back of a policed car? I would think to myself, ‘So (hmmmm), if this is an illness, why is he being treated like a criminal?’ This was and is today the most startling ‘disconnect’ of all. To have a serious, life-threatening illness and to be treated like a criminal simply cannot be our best option in this day and age. I know there are times when very ill individuals must be involuntarily taken into treatment, either for their own safety (usually due to extreme behavior or self neglect), or because their behavior is threatening to others. Today, we know these behaviors are symptoms of a brain disease. We often see these same types of behaviors in Alzheimer’s patients and they don’t come to treatment in handcuffs escorted by the sheriff. Is it because we talk about Alzheimer’s being a disease and schizophrenia as a disorder? People would be outraged if individuals with Alzheimer’s or brain injuries were jailed at the rate of the seriously mentally ill.

I think I have developed some serious insight into what triggers many of the ‘disconnects’ encountered when dealing with the whole spectrum of mental illness. We do not all speak or understand the same language when it comes to mental illness. I recently attended a subcommittee hearing on abolishing the death penalty for persons who are determined to be mentally ill at the time of the crime. This hearing captured a microcosm of the ‘perfect storm of disconnects’. Presenters interspersed their ‘expert’ testimony with words like ‘disorder’ and ‘dysfunction’ and ‘mental illness’ and subcommittee members expressed frustration over what was a ‘disorder’ and how was that different from ‘illness’ and ‘was it the person’s fault?’ ‘or in their control?’ ‘Or what?’ People started quoting the DSM-IV and the various synonymous renderings that we grapple and struggle with to name these myriad human conditions. Wham!! It hits me like a ton of bricks…no wonder there is so much misunderstanding, so many seeds of discord and interruption…nobody can even decide how we are going to talk about “it”, let alone treat “it” or the individuals who have “it”.

After the hearing experience I couldn’t stop thinking about why it is that among all the players in this mental illness conundrum, we can’t seem to come up with a language to use in talking about it. Enter synchronicity; the next week Dr. E. Fuller Torrey publishes an article in the Catalyst newsletter about this very topic. In the article Dr. Torrey talks about why we don’t call people suffering from schizophrenia and bipolar illness “patients”. He talks about the various terminology used such as; “consumer”, “survivor” and most recently, “person with lived experience”. He talks about SAMHSA’s role in determining (and funding) politically correct, universal, person-first terminology.

It seems the current political correctness and funding cycle only wants to acknowledge the end of the mental illness spectrum known as recovery. I support and work for recovery everyday but I also know that within the entire spectrum/continuum of mental illness there are people like my son who lack insight into the fact that they have an illness and refuse the basis of recovery … treatment and support.

Wham!! Here come the bricks again and I realize that until we can all begin to accept and adopt some baseline beliefs, such as; “Schizophrenia, bipolar and depression are brain diseases, i.e. medical conditions - as evidenced by two decades of overwhelming scientific study and proof. These diseases are experienced in different levels of severity and life impact across a spectrum. There are, within this spectrum, cohorts of individuals who lack insight and do not believe they are ill – thus treatment is more difficult and often times impossible, without being forced. Many people engage in and benefit from treatment with medication, adjunct therapies and support. Individuals engaged in wellness, recovery and illness management could recover and thrive, much like people with any other medical condition such as; diabetes and cancer. Until all the stakeholders can agree on some basic information and vocabulary we will always endure a disconnected system because we will not have the common communication interface needed for understanding.

I see this disconnect happening in our NAMI organization locally and nationally. I believe we have experienced some organizational identity crisis among members as a result of it. NAMI initially was formed as a family support, education and advocacy entity which focused on family members in their struggle to understand what was happening to their loved one with serious mental illness. In 1980, National Institute of Mental Health (NIMH) received a billion dollars to study mental illness and The Decade of the Brain research initiative was born. This is where the next big ‘disconnect’ occurs, I believe. Two important things happened that have caused confusion and misunderstandings, which weigh on our ability to understand SMI across systems. Just as NIMH is actually confirming the biological, i.e. medical, basis of brain diseases; new atypical antipsychotic and anti-depressant medications roll out with (perceived) less debilitating side effects. People who had suffered the zombie-like states, tardive dyskinesia and other anti-cholinergic side effects inflicted on them by older anti-depressants and antipsychotic/neuroleptic drugs were now becoming much more functional and engaged in life - thus the recovery movement was born. The fact that many folks were now able to experience relief and improved symptom control opened up the possibility that there could be sustained periods of wellness and illness management was fast becoming the norm. The folks who were now managing their symptoms and doing well were establishing their identity and collectively decided to be called ‘consumers’. With consumer groups, came consumer rights and the call for inclusiveness rang out.

In groups like NAMI consumer councils were started, recovery research and education was coming out and consumer specific groups were emerging and thriving. The thriving consumer movement was and continues to be a huge growth sector for NAMI locally and nationally. Rightfully so, in my opinion, monumental effort and resources were and are poured into program development and opportunities for this ever- growing population of people in recovery. The disconnect comes when this new-found population of ‘person’s in recovery’ do not much care for the notion of being defined as “mental patients” and rail against medical terminology and approaches to manage what would now be labeled, by and large, “disorders” or “lived experiences”. This causes a disconnect because the family education program in NAMI, Family to Family, clearly teaches the medical model and all the parents (myself included) had adopted the ‘no blame,’ medical description of serious mental illness. We were taught to treat our loved ones as if they had cancer or any other life-threatening illness (there is still a disconnect there though because folks with cancer do not exhibit injurious behavior (symptoms) and are not treated like criminals when needing hospitalization or treatment). So, we had a situation where the social climate was at odds with the medical advances being made and it was simultaneously being decided that it was politically incorrect to refer to anyone with a mental illness as a “patient” AND to abandon a medical model of treatment in favor of a recovery model of treatment. It was decided that all treatment needed to be based on person-centered, self-directed, recovery models of care. This was and is all very confusing. What happens to those who are not able to self-direct due to lack of insight? To really be inclusive and fair, I believe we must acknowledge the entire spectrum of illness.

These disconnects occur because, clearly, not everyone fits into the category of being in recovery or even in treatment. Half of the people with schizophrenia have no insight that they have a brain disease, (Torrey 2010) they refuse treatment and because they refuse treatment, they do not experience recovery. This is the story for my son. It is my belief that as long as he refuses treatment he cannot experience recovery. I do know recovery is possible WITH treatment, self care, illness management and support because I see it every day in the peer operated center where I work and I experience it personally in managing my depression.

Dr. Torrey points out in his article that schizophrenia is a disease, clearly established in more than a hundred recent, scientific studies. He points out that most individuals living with schizophrenia and other serious mental illnesses are receiving medical disability benefits such as Supplemental Security Income and Social Security Disability Income. They are receiving these benefits because they have been medically diagnosed with a brain disease. He goes on to point out the recent pressure for parity under insurance laws – parity is based on being treated equally with other diseases, not ‘disorders’ or ‘lived experiences’. (Torrey, 2010) I don’t know many people who would doubt that Torrey is the expert when it comes to unbiased, pure research devoted specifically to serious mental illnesses. Jim Pavle, Executive Director of the Treatment Advocacy Center, writes in this same newsletter, “Schizophrenia and bipolar illness are symptoms of brain disease just as heart attack is a symptom of heart disease”.

It is no wonder we cannot come to agreement on how to create a system to best treat and accommodate people with serious mental illness, let alone keep them out of the criminal justice system. Is it an illness? Is it a disorder? Is it an illness with behavioral implications? Is it curable? Manageable? Is it in a person’s control? What about the seriously ill with no insight? How can some folks experience recovery and some cannot? To create an effective system we have to be able to communicate across systems. To this day, we can’t even seem to come up with basic agreement on the existence of a spectrum of illness or to develop an inclusive terminology within the mental health community, alone. How will we create a universal understanding of the basic facts when we can’t even come to agreement on what mental illness is and what it isn’t or what to call people who have it? We seem more immersed in being politically correct than we are in deciding we need a baseline understanding of serious mental illness and an agreeable language we can use across systems to communicate about it.

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To read Dr. E. Fuller Torrey's article in the Treatment Advocacy Center's Fall newsletter click here. Also read page 6 for TAC's views on mental health laws in Kentucky:
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Psychiatry vs. Antipsychiatry: Call to action

Jaffe, (Advocate for seriously mentally ill) reports in the Huffington Post that brain disorders need a new advocacy group! Is funding going in the wrong place?

Prison is no place for people with mental illness - McClatchy Network - Kentucky.com

If, as Dostoevsky wrote, "The degree of civilization in a society can be judged by entering its prisons," then we have a long way to go.

Prison is no place for people with mental illness - McClatchy Network - Kentucky.com

Prison and poverty an endless loop - Editorial - Kentucky.com

How long can legislature ignore need for change?
Click on this link to read the story in its entirely.

I wrote a letter to the Lexington Herald-Leader editor on November 28, but it was not published in the opinion section. My rebuttal was only 250 words, this is the long version.


Pay Now or Pay Later Kentucky: by GG Burns

Thanks for exposing the misuse of Kentucky state funds. However, your failure to mention one important reason Kentucky has the fastest growing prison population in the United States is frankly disingenuous! Why are Kentucky's prisons growing faster than all other states, yet it's crime rate falls below the rest of the country? Why, because our country's jails and prisons have become the defacto mental facilities!

In May 2010, Treatment Advocacy Center in Arlington, VA, (a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness) and the National Sheriffs' Association released a 50-state report, revealing that people with severe mental illness, (which are biological brain diseases) are three times more likely to be in correctional institutions than psychiatric hospitals.

According to a Treatment Advocacy Report in June 2005, there were over 30,000 Kentuckians in local and state prisons. 4,805 of them suffered with serious mental illness, (16%). One year prior to this report in 2004, the number of patients in psychiatric or general hospitals in Kentucky was only 1,638.

In 2006 and again in 2009, Kentucky’s mental health care system received an F grade from the National Alliance on Mental Illness, (NAMI). NAMI is a national, 30-year old grassroots organization dedicated to improving the lives of individuals and families affected by mental illness. Again, Kentucky's funding is pouring into the “reactive” pay-later department called corrections. Kentucky's department of Health and Family services have been flat funded for years while Kentucky's prisons grow like wildfire. When in fact, the lack of sufficient mental health services sets these individuals with serious illnesses up to fail! It takes years to obtain the smallest amounts of services, small wonder so many self-medicate with illegal substances.

On October 19, 2010, NAMI published: "Election 2010: People with Mental Illness Don't Belong Behind Bars” ... Are Candidates Addressing the Facts Report". NAMI’s report charged that when states cut mental health services, costs often are shifted to law enforcement and corrections systems, with almost 25 percent of inmates in prisons and 20 percent of youth in the juvenile justice system living with serious mental illnesses.

Facts:

• About two million people with serious mental illness are booked into local jails each year.
• Seventy percent of youth in the juvenile justice system also experience mental health disorders.
• In prisons, almost 25 percent of inmates live with serious mental illness, but their conditions are often under-treated or not treated at all. Harsh conditions, including isolation and noise, can "push them over the edge" into acute psychosis.
• Fifty percent of people with mental illness who have previously been in prison are rearrested and returned to prison not because they have committed new offenses, but because they are unable to comply with conditions of probation or parole often because of mental illness.
• In prison, people with mental illness often lose access to Medicare, Medicaid, and Social Security benefits. Even when benefits can be restored upon release, reapplying for can be time-consuming and complex. Without case management and community assistance, individuals with mental illness are at risk of requiring costly emergency medical services or ending up back in prison.

Ironically, Kentucky's state budget cuts occur during a time of economic crisis when mental heath services are needed now more urgently than ever. This is an inhumane vicious cycle, called the "revolving door" which will continue to drain the Kentucky state budget.

In historical perspective, we have returned to the early nineteenth century, when people with "brain diseases" filled our jails and prisons. At that time, a reform movement, sparked by Dorothea Dix, led to a more humane treatment. For over a hundred years, these individuals were treated in hospitals. We have now returned to the conditions of the 1840s by putting large numbers of individuals with a serious illness back into our jails and prisons.

Thank you Governor Steve Beshear and Justice Secretary J. Michael Brown for addressing this prison & budget crises. It is time to "change" mental health laws in Kentucky. MORE treatment, LESS JAILS!

GG Burns, Mom, Artist and Mental Health Advocate
Change Mental Health Laws in Kentucky
changementalhealthlawsinky@gmail.com

Brain Disorder vs. Heart Disorder

"Schizophrenia and bipolar disorder are symptoms of brain disease just as heart attack is a symptom of heart disease, and those who suffer from these illnesses deserve medical care and ongoing treatment as immediate and effective as I received."

Click here to read the entire story:
By Jim Pavle, Executive Director of the Treatment Advocacy Center

One Mother's Story ~ the "ultimate AOT story" of one mother’s struggle to get her child help!

What would you do if your child needed medical help and year after year nothing ever changed? This is the "ultimate story" of one mother’s struggle to get her child help! This story illustrates why Kentucky needs its Mental Health Law revised.

I want to personally thank this mother for sharing her heartbreaking story – and for her courage!

I invite you to imagine how much money could have been saved if Tim had been receiving assisted outpatient treatment (AOT), these past 35 years? Imagine your son being transported to the hospital 32 times in handcuffs, if he had re-occurring heart disease instead of a "brain" disease?

********************************

One Mother's Story

by: Faye Morton

November 16, 2010

In June of 1975, I was 38, a working mother and wife. Living in Kentucky, my husband and I were busy raising our three children. Our oldest, a son, was 20 and serving in the Army. Tim, our middle child, was nearly 18, had just graduated from high school and planned to attend the local community college in the fall to study architectural drafting. Our youngest, a daughter, had just finished 7^th grade. I was energetic and had a full client list in my own hair salon, a home-based business. My husband was also self-employed and owned a local barber shop.

Tim had moved into an apartment with a few of the neighbor boys that he had been friends with throughout his childhood. They had spent summers riding bikes, building forts and scouting together as children and as teenagers, gathered at each other’s homes playing cards, table tennis and basketball. Tim was above average in height, being 6’-3’’, and slim built. A nice looking young man, Tim had a sense of humor that reflected his sensitivity and respect of others.

Tim called late one night and asked us to come get him, saying that he was afraid and in trouble; it was unexpected and alarming. After bringing Tim home, the three of us sat at the kitchen table and talked into the early hours of the next day.

Tim was admitted to the hospital the next morning, for 6 weeks, followed shortly afterwards by another hospitalization of 4 weeks. He was given several prescriptions to alleviate his symptoms of paranoia and the voices he heard. He was released with instructions to attend school part time, and work part time, to keep active physically and take his medication. He was to see a therapist once a week.

Never having any exposure to brain disease and the effects of psychosis, my husband and I had to absorb many new concepts and develop new expectations for success for Tim. We learned early that the doctors were convinced medicine would correct the damage to his brain and prevent it in the future.

Since Tim did not think he had a disease that needed treatment, he rarely took his medications. He was able to communicate and get a job, but he could not hold one for long - his paranoia and the voices he heard would interfere. He could keep his behavior together for short periods of time, making it appear that he did not have any symptoms. He tried to live at home, but that did not work because of the conflicts that would come from his paranoia and delusions.

By the end of 1996, at age 39, Tim had been living with paranoid schizophrenia, basically untreated, for 21 years. He had never attended college or held a job for any length of time. I had reached the age of 60 and still worked full time; my husband and I had become grandparents (our daughter’s children) and we enjoyed time spent with our grandchildren. Our oldest son had been diagnosed with cerebral palsy and lived in a local boarding house for veterans. He also had a brain disease, showing symptoms of mania and impulsive/compulsive behavior with some delusional thoughts. But unlike Tim  he recognized the symptoms as a disease, and was willing to take medication.

Tim had been hospitalized multiple times, and no longer would take medicine unless he was in the hospital. He would accept treatment while in the hospital, because he was told that if he took the medicine, he would be released. Tim did not connect the reduction of his symptoms with compliance with treatment. He still was not aware that he had a disease. Tim spent a great deal of time walking the streets. He was a familiar sight on the downtown sidewalks, his long legs making short work of the city blocks. He had developed an addiction to cigarettes, and a taste for soft drinks. Tim did not drink alcohol, smoke pot or misuse any type of drug. He was very tan and slim and looked healthy and fit. However, a short conversation would dispel that notion because his delusions, now quite fixed, would enter into his speech quickly, and his thinness was not because of care for his diet, but because he ate very little due to his paranoia, and would not keep food in his apartment.

When not in the hospital, Tim was offered treatment at the local outpatient facility, but had to find his way there, on the appointed day and time. He would go to the office, but most of the time would not accept treatment. Many caring social workers, psychologists and psychiatrists tried to help Tim, but they were limited by what they were allowed to do by the mental health laws in Kentucky.

During this time, an administrative judge explained to me that he could clearly see that Tim was not stable enough to live unassisted. However, he had no choice but to discharge him from the hospital because the doctor had indicated that he was not a threat to himself or others and the law would not allow the judge to keep him hospitalized against his will. By this time he had been hospitalized by court order eleven times.

Now, in 2010, I am 74, retired and living with my husband in the same house we’ve lived in for the majority of our married life. Our oldest son, age 55, is now living in a veteran’s long-term care facility, his cerebral palsy having progressed to where he is confined to a wheelchair. We visit him weekly, laundering his clothes for him and staying informed of his treatment plan. I’ve always been struck by the fact that our oldest son recognized his symptoms as a disease, and was willing to take medication. Our grandchildren are in college and keep in touch through Facebook.

Tim, now 53, has been in a new program of mobile outreach services that began in 2007. His assigned social worker visits him at his apartment and helps him with his errands to keep him living independently. Up until this time, I had provided his safety net to make sure he had some food, clothes and shoes. Years ago he was homeless and walked/hitchhiked to Buffalo, New York during a harsh winter storm. Since then, I have worked to ensure that Jim would not be homeless again, helping him obtain assistance for housing and food. Many times, due to his paranoia and voices, he would be dropped from programs and I would follow up to get him reinstated, working through red tape and a bureaucracy that allowed the most vulnerable of our citizens to be treated as though they were a subclass and worthless.

The mobile outreach program helps to ease the burden of caring for Tim, but still has not changed the treatment he receives for the disease he has lived with for 35 years. Although he has been hospitalized by court order through mental health warrant or petition (MIW) 32 times, he has never received treatment for any extended period of time. The last time Tim was hospitalized and released I noticed that he was not any less psychotic and it shortly became apparent that he had refused the recommended treatment while in the hospital. Although Tim has never been violent or arrested for any crime, of the 32 times he was picked up by a court order to be taken to the hospital, only the last time was he allowed to ride in the officer’s car without being handcuffed.

This past summer Tim was assaulted by a gang of youths and urged by the police to press charges; Tim was concerned that he would not be a credible witness because of his many “arrests”. He mistakenly believes that he has a criminal record because he has been handcuffed and taken to the hospital on so many occasions.

After 35 years of psychosis, Tim’s brain has been damaged to the point that he cannot mask his illness, so he is ostracized and victimized in his community. If Tim could have Assisted Outpatient Treatment, ensuring a therapeutic time of treatment on the appropriate medications, it could be possible to reverse some of the damage that has occurred to his brain, and he could benefit by improved brain function. The years of malnourishment and neglect are taking their toll as he is rapidly losing weight; his jeans held up by a belt fastened in the tightest notch, but still hanging on him; his teeth broken off and decayed, his mouth ravaged by too many cigarettes and sodas. He no longer can walk the miles he used to. If he does try, his breathing is labored, and racked with coughing.

The way our laws are written in Kentucky, legally, Tim can continue in this state of decline until he dies. The law says he can refuse treatment, so we have to stand by and watch him die by starvation and self neglect.

Tim still does not know that he has an illness, and he does not understand the consequences of refusing treatment. With the current legal system, how many other mothers of children diagnosed today, will spend the next 35 years of their lives watching while their loved one slowly dies?

Please work with me to Change Mental Health Laws in Kentucky!

Click here:
to view Faye's updated story about her son called: 'Personally speaking' ... published in 2012
_________________________________________

Do we Triage those with Serious Mental Illness?

Mental Health Kills the Mentally Ill

Writer/Advocate DJ Jaffe writes:
Limited resources should go to the most seriously ill first. That is not what is happening. The opposite is. The less symptomatic you are, the easier it is to get care.
Click here to read DJ's entire article:

Woman out of prison after repeatedly threatening presidents - Fayette County - Kentucky.com

Another example of the how difficult it may be for a person to receive mental health treatment, if they are lacking insight. To read article click here:

Woman out of prison after repeatedly threatening presidents - Fayette County - Kentucky.com

Kentucky Advocate, Jim Dailey Supports AOT ...

... the humane thing to do to support those with serious mental illness.

To view article click here under "Solutions":

A 35 year old man, (diagnosed with paranoid schizophrenia) is accused of killing his parents in Hardin County, Kentucky.

September 2010

I have watched this case for several months. I wonder about the man accused of the murder of his elderly parents? I wonder if he was aware of what he did and I wonder if AOT could have prevented their death? Is this another preventable tragedy?

• Hardin County man charged with murdering parents will wait to return to Kentucky
• Son suspected of killing parents caught in Tenn., charged with murder
• Police release chilling 911 call of man who found parents dead, brother missing in Elizabethtown
• Elderly couple found dead in Hardin Co.; son wanted for questioning
• Man charged with murdering parents to be extradited to Ky. soon
• Man accused of murdering parents returns to Ky.
• Judge enters not guilty plea for Buggeland in stabbing death of parents

Grandmother To Be Sentenced For Duct-Taping Grandson | LEX18.com | Lexington, Kentucky

Grandmother To Be Sentenced For Duct-Taping Grandson | LEX18.com | Lexington, Kentucky

I read of sad cases like this of abuse, neglect, violence or even murder every day in Kentucky. I assume many of these cases are related to lack of mental health diagnoses or lack of services/treatment. I wonder if this "grandmother" had wrap around services for her grandson, if she would now be going to prison? I wonder "if" her grandson has any services?

Locking Down the Mentally Ill

click here to view Locking Down the Mentally Ill

By James Ridgeway and Jean Casella

5100 Adults with Mental Illness live in a Kentucky State Prison

Election 2010: People with Mental Illness Don't Belong Behind Bars; Are Candidates Addressing the Facts?

for more info click here:

Why change?

BY: GG Burns, KY Mental Health Advocate

Why change?

BY: GG Burns, KY Mental Health Advocate

Recently I have been asked exactly “what is” CHANGE MENTAL HEALTH LAWS IN KY? Please allow me to explain.

According to Webster’s dictionary "change" is to make different in some particular way, to give a different position, course, or direction; to ALTER or TRANSFORM. In many contents, "amend" and "change" are used interchangeably as far as context and meaning.

CHANGE MENTAL HEALTH LAWS IN KY is a Blog about my personal story. It is also my effort to educate others why we need to bring treatment for those with brain disorders to the level of those with cancer and other organic diseases. Stigma is one thing ~ ignorance is another. The only way citizens of Kentucky will ever change their perception is through open discussions, education, and awareness.

My goal is to encourage mental health providers, family members, consumers and law enforcement professionals to visit my Blog to learn of topics such as anosognosia, the need for more CIT training, better mental health screening, or even other options rather than "force treatment". In fact, I dislike the idea of “forced” anything. In a perfect world we would not need Assisted Outpatient Treatment (AOT), but yet … Kentucky does not have that luxury. Not yet. In a perfect world there would be a cure for mental illness or at least medication, which would give a person insight.

Please note that AOT is only needed for a very small percentage of those diagnosed with a mental illness. Some agencies state less that 2%. Yet, this small amount of people are the very ones who get "stuck" in the revolving door. They are the ones using up a large majority of KY's budget. For more information click here and here to view the breakdown of mental health services in Kentucky and the number of people with mental illnesses in Kentucky prisons.

CHANGE means many things to me ... not only amending the current law, but also we need to CHANGE regulations and policies regarding funding, employment, housing, the corrections system, the transition of our youth with mental illness, and accountability of those who serve the seriously mentally ill. Many advocates have lobbied for change, but we need more individuals to step up and allow their voices to be heard.

In addition, I hope my blog will eventually be a place families will share their stories and desires. In the past century, NAMI has released the voice of "recovery" by encouraging people with a mental health diagnoses, (consumers) to share their stories. This incredible program is called In Our Own Voice, (IOOV). Mental illness is not singular ... it impacts the entire family and for too long, family members have hidden their pain under the rug.

I have NO hidden agenda except "survival". I do not have the answers how Kentucky can fund a revision to the current law … this is why I have added a section called “solutions”. I am asking others to share their wish list and hope that over time, many will share their suggestions and ideas. I do know legislators will not care about amending this law, if no one complains or takes the time to explain how revisions could keep a person from constantly being a threat to themselves or others and reducing the monetary drain on an already fragile budget.

I also welcome collaboration with “any person or group” working on amending mental health policy in Kentucky. It is time to change.

As quoted from Treatment Advocacy Center's Model AOT law written by:
E. Fuller Torrey, M.D., Mary T. Zdanowicz, J.D. and Jonathan Stanley, J.D.

How can so much degradation and death – so much inhumanity – be justified in the name of civil liberties? It cannot. The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principal of civil liberties. Medication can free victims from their illness – free them from the Bastille of their psychoses – and restore their dignity, their free will and the meaningful exercise of their liberties.

Brian Stettin: Laura’s Law Might Have Saved Cliff Detty - Noozhawk.com

Brian Stettin: Laura’s Law Might Have Saved Cliff Detty - Noozhawk.com

Decriminalizing Mental Illness: Making the Case for Justice Reinvestment During Difficult Economic Times

People living with serious mental illness crowd jails and prisons where they stay longer than others who are being held on similar charges and require costly care and additional staff, which correctional facilities cannot afford. Worse, once released, people living with mental illness are unlikely to get the treatment and support they need and are likely to wind up right back in jail. Often, the charges they face are for crimes like disturbing the peace or minor property crimes. read more click here:

The "System" is Killing My Son!

The mental health system, formally referred to as the medical model, (now called the RECOVERY model) and the laws, which keep his civil liberties intact, are allowing my son, (who I will call Joe) to die a slow death!

Joe's right to say no to treatment for an illness he does not realize he has, is slowly destroying what "brain function" he has left. The revolving door of uncertainties has stripped Joe of his dignity one horrific and painful experience at a time. Yet, Joe doesn’t remember these consequences and continues making the same bad choices again and again. He doesn't have a rear view mirror. 

In order to keep our own health intact, we are forced to help Joe from a distance. Would I be forced to abandon support with my son if he were dying of cancer? If I abandoned a loved one with a serious physical challenge, I would be arrested. But in our case, we are counseled to set healthy boundaries and turn our back on a family member when they are at their worse! THIS IS WRONG!

Joe was diagnosed with a serious brain disorder when he was a small child. During these years, he had many supports in place under the medical model. His Father and I traveled to other cities, even out of state to see the best specialist we could locate. We searched everywhere for solutions, since Joe had trouble sleeping, regulating his moods, extreme hyperactivity and horrendous rage attacks that seemed more like seizures than a temper tantrum. We researched every alternative treatment and therapy available to find solutions to help our son settle down enough to stay 'in a classroom' much less "sit in a desk."

In Joe's early years, he was always moving ... he never stopped bouncing, jumping, running, skipping, rocking, etc. Joe appeared to be the energizer bunny. 

Slowly over the years, doctors did discover a combination of medications that helped. By the time Joe was 16, he was working on obtaining his pilot’s license and had earned special certifications that would “in our minds” no doubt help jump start his career. Joe was a gifted, a talented young man with great charm and good looks. 

 Now, all of that potential is being swept up in a psychotic hurricane! Just 4 years out of high school, Joe is defeated. His way of coping is to NOT take the medications that stop his mania and delusions. He is trying his best to be a productive citizen, working on goals that will give him stability; but his brain disease keeps getting in the way. Yet, there is no way to make Joe understand what is happening.

Joe's psychotic break coincided around the same time that I was diagnosed with debilitating autoimmune diseases. Finally desperate and exhausted, my husband and I were encouraged by our son’s doctor to file a "beyond control petition" in the court system. We were hoping to save Joe from his own dangerous behavior. Yet, instead of going to a hospital or treatment facility, he was ordered to jail, punished for behaviors that were direct symptoms of his untreated brain disease! During these hearings, we became traumatized of the inhumanity of the adult system! We watched in terror as our gifted young son was usurer into the court room in an orange jump suit, shackled and cuffed like a prisoner. THIS IS WRONG!

WHY WOULD A DOCTOR ADVISE PARENTS TO DO THIS? Because the behavioral health system fails to recognize individuals who lack capacity to have informed consent. It is designed to punish behaviors ... not treat them! 

Prior to Joe's 18th birthday, professionals encouraged us to forgive our son’s inappropriate behaviors, to embrace each day as new, because he was unable to learn from his consequences ... yet as an adult, we were told his only option was jail and that should force him to hit bottom. Would doctors recommend this if he had cancer?

After Joe become an adult, his illness escalated rapidly. During one extreme manic episode, Joe once traveled to another state to open a business that only existed in his mind. He acquire speeding tickets, wreck cars and lost his driver's licence. He opened up credit card accounts he couldn't pay, destroying his credit. He move into apartments he couldn't afford and was evicted to the streets. We allowed him to move back home, only to be forced to ask him to leave again, due to his refusal to accept treatment and his threats against us.

Another time, while I attempted to help Joe be admitted to a psychiatric hospital ‘voluntarily’ … he ran barefoot into the freezing night, fearing the FBI would track his steps. All my son wants then and now is to be a productive businessman … but his untreated brain disease and the horrific consequences get in the way.

Finally one evening, in an angry manic rage, Joe cornered my husband and I into our bedroom demanding we sign a $10,000 business loan. (In his mind, Joe believed he had created a computer operating system that would revolutionize the world.) During Joe's verbal attack, I called the local crises line. The trained operators were unable to reason with Joe, because he was too sick! So instead of dispatching an ambulance, they called the police!

Across the US, everyday, law enforcement officers are placed on the front lines as psychiatric medical providers! Police are not licensed to provide medical services. The police are NOT paid enough nor have the resources to help families like ours in crisis! Too often, these situations end up deadly and young individuals like my son who need medical care, end up tazed, shot or killed!

These officers said, “your son is delusional and needs to be hospitalized.” But since Joe has not actually threaten your life, he will not be admitted! They encouraged us to press criminal charges against Joe, hoping he would eventually gain treatment through the back door of the justice system. (Joe was recently released from the state psychiatric hospital too soon, just as psychotic as he’d been before he was hospitalized.) 

Later that night, our very sick son was dragged out of our home by 4 heavily armed officers … kicking, screaming and crying. He was removed like a criminal from the only home he knew, into the freezing rain, with only his guitar and a laptop hanging off his back! I sat for hours staring across the room, frozen in complete shock.

Even with the EPO in place, Joe refused to voluntarily go to a hospital or a homeless shelter. Joe immediately became homeless! Within days, his illness was much worse … he couldn't feed himself! He ended up seeking shelter with drug dealers, which led to more life-altering consequences. 

Six months later, desperate and defeated, Joe finally broke the DVO. During an angry rage, on a cold February morning, where I was too afraid to let Joe in, he threw a frozen yard ornament through a window in our front door. Joe's desperate cry for help occurred seconds after I had stepped away. A neighbor watched the entire event and called 911. Joe was quickly arrested. 

Now, years later due to his DVO record, Joe cannot find a job! Even if he could remain stable long enough for us to go to court to request for his DVO record expunged, the DVO records remain in national data banks forever. The current behavioral health system sets up the entire family to fail. These laws establish to protect the public and a person's civil rights, actually backfire on person with a serious brain disease, destroying their will, destroying relationships and destroying trust with law enforcement.

You cannot imagine the pain watching someone you love dismantled mentally and physically. It all began with not only Joe’s RIGHT TO SAY NO, but also the fact that Kentucky does not have transitional services governing adolescents with severe mental illness into the adult system. THIS IS WRONG!

If my son had diabetes and saw a doctor when he was twelve, would his medical treatment drastically change when he turned 18? In Kentucky, HIPPA mixed with civil liberties = deterioration.

At 22, Joe sits behind a computer in a small apartment communicating with the outside world in a way that no one would ever believe. He has become an angry, hostile and desperate young man.

Today was a mere example. Joe phoned a dozen times in a less than an hour. When I receive that many phones calls in a short time, I realize there is likely to be a crisis. I take a deep breath and dive in. The stress 'du jour' was that Joe had just had a visit from his community mental health provider. Apparently they had informed him that his SSI needed to be reevaluated. Since Joe was able to work quite a bit before he stopped taking his meds, he qualified for SSDI. Supplemental Disability Insurance, is similar to what a person receives after they retire. Neither of these checks are much, definitely not enough to live on. Yet, this small amount does help Joe to have his own apartment and to NOT live on the streets. In Joe’s mind his money was about to be stopped and he would indeed be homeless in the very near future. He brain was stuck in 'park mode.' In a panicked voice he screamed, “I cannot become homeless again! I would rather be dead.”

In Joe’s mission to reach me, he left voice mails and even text messages such as: “Homeless is for people that haven’t committed suicide yet. If I go homeless I’ll just go ahead and kill myself. You are a fucking bitch; you won’t even talk to your homeless son. I ought to kill you first before I kill myself. You are more of a virus to society than I am.”

Imagine receiving a text from your son or daughter from college like this? What would you do? Who would you call?

When I try to reason with Joe about taking his meds or taking control over the illness that is destroying his brain … I hear statements such as: “I do not need medications. They make me sleep and I am too busy to sleep. I have too much work to do”. Or … “I can’t go to college, I already know everything; what a waste of time that would be." Or ... “I can’t work for ____, I know more than everyone working there and they would all hate me” … and on it goes.

The only thing that will help Joe is long term Assisted Outpatient Treatment or AOT. Some will argue that psychotropic medications are also dangerous and can bring on horrible irreversible side effects. However, Joe will die young without help!

Bottom line, if Joe were under a doctor’s care and he was able to accept treatment, his future has hope. As it is now, we are all dying a slow death from the dysfunctional mental health system.

Would Assisted Outpatient Treatment Impact the Death Penalty Exemption?

On August 11, dozens of mental health advocates attended the KY Senate and House Judiciary Committee hearing regarding the exemption of the death penalty for the mentally ill. NAMI Lexington was well represented, as was representation from NAMI KY, NAMI Somerset and NAMI Nelson County.

Rep. David Floyd (R-Bardstown) co-sponsored the HB 16 bill with Rep. Darryl Owens (D-Louisville) with the goal to abolish the death penalty in Kentucky for people with severe mental illness.

Reporter Stephenie Steitze from the Louisville Courier-Journal reports Sheila Schuster, executive director of the Kentucky Mental Health Coalition, said groups such as the American Bar Association, American Psychological Association and National Alliance on Mental Illness hope the legislature would consider such legislation during the next session. Those who are less severely mentally ill would still be eligible for the death penalty, Schuster said. She said just 2 percent of the state's total population is considered severely mentally ill, while up to 20 percent of the population is mentally ill.

HB 16 only applies to those who are determined by a judge to have been severely mentally ill at the time of the offense. Severe mental illness results in diminished capacity to appreciate the consequences of one’s conduct or to exercise rational judgment. The death penalty cannot serve as a deterrent for someone who cannot understand the consequences of his/her actions.

I admired the testimonies from Dr. Russ Williams and Psychologist, Ernie Lewis with the Kentucky Association of Criminal Defense Lawyers. This panel of experts presented compelling affirmations on behalf of those that suffer with serious and persistent mental illness which are biological brain disorders. These disorders such as schizophrenia, schizoaffective disorder as well as mood disorders such as major depression, bipolar mania, or mixed mania, often impact a person’s ability to understand consequences. Dr. Williams explained that in the past few years, science had come a long way in accurately diagnosing mental disorders with a reliability of 70-90%. Dr. Williams mentioned his experiences and history of working with criminals with mental disorders at the Kentucky State Reformatory, and is now the director of psychology at Central State Hospital, a 192-bed adult psychiatric hospital located in Jefferson County. While Dr. Williams illustrated the path of complexity of symptoms associated with serious brain disorders, Mr. Lewis lead a legal defense worthy of any capital case regarding the defense of people suffering with these disorders.

Much discussion was opened to the floor to discuss competency vs. criminal responsibility, including an excellent report by Mr. Lewis regarding the US supreme court has ruled in favor that individuals with mental retardation and juvenile offenders (under the age of 18) cannot be subject to the death penalty due to their diminished capacity. “The Court held that it is inconsistent with evolving standards of decency and would be cruel and unusual punishment to execute persons whose moral culpability is less due to their mental condition and development.”

As an advocate on a mission to help others understand “symptoms of mental disorders". I was frankly shocked to hear the question posed from Representative Harry Moberly (D) House District 81. Moberly asked, “what about these criminals with mental disorders that intentionally do not take their medications?” The audience of advocates groaned, as we all know this specific population of individuals who suffer with severe mental disorders, often do not realize they are sick. Therefore, they do not see a need to be in compliance with their medications! This symptom is called anosognosia or “lack of insight” and is often more debilitating than delusions or hallucinations. Anosognosia keeps the person from receiving the medical treatment they need to remain stable and out of jail. This is one of many reasons states such as Kentucky need better assisted outpatient treatment, (AOT) laws to help people that would normally end up in jail or prison and costing the state millions more than it would to support them in the community.

As recent report from the Treatment Advocacy Center, (a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses) … mentions there is an interim version of the DSM (Diagnostic and Statistical Manual) called DSM-IV-TR, which has been in circulation since 2000 and will be withdrawn when the DSM-V is released. The interim version recognizes anosognosia, the inability to recognize one’s own illness, as a frequent feature of schizophrenia. The importance of including anosognosia in the DSM-V cannot be overstated. Clinicians must understand that a severely mentally ill who insists that nothing is wrong is not merely “in denial.” As stated in the DSM-IV-TR, “[t]his symptom predisposes the individual to noncompliance with treatment and has been found to be predictive of higher relapse rates, increased number of involuntary hospital admissions, poorer psychological functioning, and a poorer course of illness."

This is a message to all that read this: please help me educate our legislators and all public officials running for office! How can we expect better funding and treatment for those suffering with these severe mental disorders if we are spending our money and time paying for them to be ill in jail?

Additional information about this hearing can be viewed here:

Judiciary Committee hears testimony on ending the death penalty for the severely mentally ill

Congress moves forward on FY 2011 spending bills for mental illness research and services

Fiscal Year 2011 Spending Bills Move Forward on Mental Illness Research and Services, Housing and Veterans Programs

Justice Department Programs

A separate bill funding programs at the Justice Department for FY 2011 includes a number of federal discretionary programs to help communities address the challenges posed by “criminalization” of untreated mental illness. These are competitive grant programs for eligible jurisdictions that include mental health courts and other jail diversion and court-base treatment programs. For FY 2011, the Senate Commerce-Justice Appropriations bill (S 3636) allocates $11 million for Mental Health Courts and $11 million for programs under MIOTCRA (the Mentally Ill Offender Treatment and Crime Reduction Act), $1 million less than the FY 2010 amount.

Funding for Housing and Homelessness Programs

Funding for housing and homelessness programs for FY 2011 is included in the Transportation-HUD Appropriations bill (HR 5850 & S 3644). The T-HUD bill passed the House on July 29, 2010 and was reported by the Senate Appropriations Committee on July 23. Both bills include critical investments in affordable housing programs that serve low-income adults living with serious mental illness. As with the other bills covering domestic discretionary federal spending, the T-HUD bill is unlikely to reach the President’s desk before December.

for more info click here:

Trapped in Kentucky's CPTU by Jenn Ackerman

 
We are the surrogate mental hospitals now,” says Larry Chandler, warden at the Kentucky State Reformatory in La Grange, Ky. With the rising number of mentally ill, the reformatory was forced to rebuild a system that was designed for security. Never intended as mental health facility, treatment has quickly become one of their primary goals.
Unfortunately, this situation is not unique to Kentucky. The continuous withdrawal of mental health funding has turned jails and prisons across the US into the default mental health facilities.
A 2006 report by the U.S. Department of Justice shows that the number of Americans with mental illnesses incarcerated in the nation’s prisons and jails is disproportionately high. Almost 555,000 people with mental illness are incarcerated while fewer than 55,000 are being treated in designated mental health hospitals.
In Kentucky alone, it is estimated that almost 25 percent of all Kentucky prisoners are afflicted with a serious mental health problems such as schizophrenia and bipolar disorder.
The problem with the mental health system in our country did not spring up overnight.
“There was a shift in the way our society sees mental illness,” says psychologist Dr. Stephanie Roby. “We saw a fallout from the 60s when we were institutionalizing everyone. Society reacted by saying the community needs to be more responsible for these individuals.”
The goal was to reduce the number of mental health patients housed in government-operated institutions and to shift the care to local communities where programs would be created to handle their special needs.
“It was a great idea in theory,” says Dr. Roby. “Unfortunately, mentally ill people do a lot of inappropriate things, they are misunderstood, they commit crimes and then they end up in CPTU.”

Kentucky’s CPTU

To alleviate the strain in the state’s prisons and jails, the Kentucky Department of Corrections decided to concentrate its efforts in one location and created the Correctional Psychiatric Treatment Unit at the Kentucky State Reformatory in 1998.
What started out as a 13-bed special unit has grown to a 150-bed treatment unit for the state’s most severely mentally ill inmates. Staffed by licensed mental health professionals, the unit provides crisis intervention, stabilization and individual counseling.
“We are a mental hospital right here in prison and there is no difference other than the clients are incarcerated and they are called inmates,” says Kevin Pangburn, mental health director for the Kentucky Department of Corrections.
“As soon as you walk through the doors, you hear people screaming, kicking their doors and crying,” says Matthew Estepp, an inmate at Kentucky State Reformatory and an inmate watcher in CPTU. Although CPTU is located within a reformatory, “it’s like walking into a different world,” he says.
The goal in CPTU is “to stabilize people and get them in the least restrictive area as safely and as expediently as possible,” says Dr. Tanya Young, CPTU program director and psychologist.
The unit consists of three wings. The inmates placed in C wing are on 23-hour lockdown and evaluated for the purpose of stabilization and receive the most intense supervision. The other two wings in CPTU, A and B, are for those who have been stabilized in CPTU but the doctors believe need more monitoring and structure but don’t need to be locked down for 23-24 hours a day.
The hope is to move the inmate out of lockdown and isolation as quickly as possible and into A or B wings. Once they are stabilized in CPTU, the aim is to send them back into general population in the prison system or society depending on the length of their sentence.
“If they can’t mainstream in this population, surely they can’t exist outside of here when all of this support is pulled,” says the warden. To view more of more of Jenn's photos and videos click here:http://www.jennackerman.com/trapped/feature/

Julia Lish, a correctional officer, comforts an inmate during one his psychotic episodes. "Its going to be OK," she repeats as he cries and yells to the voices in his head.  "They are rejects of society and warehousing them in prison isn't the way to go. Most of them don't have life sentences - they will get out some day." says psychologist Dr. Tanya Young. Locked down for 24 hours a day, many inmates spend their day staring out the window of their cell. "What do they do when they get out? There needs to be something else to absorb them or take them in," she adds.

All text and photos created by Jenn Ackerman. Copyright © 2008 Jenn Ackerman · www.jennackerman.com | jenn@jennackerman.com | +1.757.412.5119

Assisted Outpatient Treatment Program for Mentally Ill vs. Jail

Assistance to the Incarcerated Mentally Ill (AIMI)

Shackled Feet of Mental Patient - AIMI

see larger image

John M Grohol, PsyD, reports that mentally ill offenders who went through Minnesota's mental health court received a 20 to 25 percent improvement in offender outcomes. Although any decrease in imprisonment of the country's most vulnerable citizens is valuable to the mentally ill, their families, and taxpayers, the rate of improvement could easily and inexpensively triple if mentally ill offenders were placed in Assisted Outpatient Treatment programs (AOTs). AOTs combine subsistence assistance with mandatory psychiatric treatment. AOT program participants in New York received better between 85% and 97% reduction in their rates of arrest, hospitalization, homelessness, and incarceration. Enforced treatment makes the difference.

Mental patients often stop taking their meds and keeping psychiatric appointments soon after prison or hospital release due to a condition called "anosognosia" that makes it impossible for them to know that they are sick. Discontinuation of psychiatric treatment frequently causes these persons to lapse back into psychosis and eventually break the law. New York AOT program participants' 90% decrease in homelessness, arrests, hospitalizations, and incarcerations compared their experiences three years prior to program participation shows clearly that WE ALREADY HAVE THE ANSWER.

It is only common sense that if a person is mentally deficient, he is unlikely to make wise decisions about mental health care, especially during a psychotic episode. It is wrong to leave it up to sick people whether to treat or not, especially those exiting prisons and mental institutions. This issue needs to be addressed before more soldiers suffering from PTSD transition back home to civilian life. A study of the Balkan Wars soldiers showed that around 54% had some level of PTSD. People who have been trained to kill when they feel threatened will soon fill our cities, and some are soldiers who have been stressed beyond their limits of endurance like Sgt. John Russel. It is wrong to put any of our sick citizens in the position of going untreated and eventually be jailed for crimes and/or wandering homeless because they don't have the mental stability to seek help. Acute mental patients are even more likely to be hurt themselves than to hurt others, and many die during arrest attempts or by suicide. The reduction in arrests and recidivism among AOT program participants demonstrates plainly that the communities were safer because of the program. AOTs can end the madness.

In addition to being highly effective at restoring mentally dysfunctional persons to a wholesome existence and increasing community safety evidenced by fewer arrests, AOT program participation is far cheaper than incarceration. Each inmate in the general prison population costs taxpayers up to $50,000 per year per prisoner plus an additional $100,000 annually for each chronically ill prisoner who receives special housing, trained guards, and regular treatment. These hefty prison fees come after the cost of police services, attorney fees, and court costs. Since AOT programs reduce recidivism by up to 90%, billions of dollars could be saved off the nation's prison budget by releasing mentally ill persons from prisons and hospitals only under court ordered participation in an AOT program.

Court ordered AOT participation for mentally ill persons released from inpatient facilities and prisons (at least during parole or probation) would relieve them of a responsibility that most chronic mental patients are unable to handle reasonably: their mental health care. Rigid requirements in most states prevent enforced treatment unless mentally ill persons are immediately dangerous to themselves or others. Therefore, the released mental patients' families are not allowed to enforce their treatment, and anosgnosia prevents psychiatric patients from seeking or agreeing to psychiatric services, especially during a psychotic episode when help is most needed. Na Yong Pak is a 32-year-old woman who was released from a mental health facility in Georgia last year despite her family's protests. She is a schizophrenic patient with violent tendencies. Within 12 days of hospital release, Na Yong quit taking her meds (or never started after release from the mental hospital) and set her mother on fire, burning her to death. See this family's tragic story here: http://www.ajc.com/metro/content/metro/gwinnett/stories/2009/02/11/burned_woman_mental.html

There has been ZERO reduction in costs to taxpayers resulting from closing hospitals and reducing mental health services in the communities. In fact, a significant cost increase resulted from shifting sick people to the prison system. The mentally ill are not being incarcerated rather than treated in order to save money or save sick people from institutionalization. The difference is who gets paid - private prison profiteers rather than hospitals and outpatient treatment providers.

Methods and reasons for decriminalizing mental illness are examined in the article HUMAN RIGHTS FOR PRISONERS MARCH, as well as reasons why AOTs are not more broadly applied despite being a less expensive, highly effective, lifesaving approach to dealing with mentally illness, particularly for those exiting prisons and hospitals. See the article at this link:
http://my.nowpublic.com/world/human-rights-prisoners-march-was-postponed-weather

Comment continues after Dr. Grohol’s article and an excerpt from the Philadelphia Inquirer. Dr. Grohol is the CEO and founder of Psych Central. He has been writing about online behavior, mental health and psychology issues, and the intersection of technology and psychology since 1992. The Philadelphia Inquirer published an editorial in favor of AOTs being more widely used in March 2009. It is the first mainstream news source to publish an editorial in support of AOTs replacing imprisonment for mental patients. Notice was published by Treatment Advocacy Center (TAC) at this link:
http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=1347&Itemid=97

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Imprisoning People with Mental Illness
by John M Grohol, PsyD
July 18, 2009

People with mental illness are increasingly ending up being imprisoned, rather than in the mental health care system where many of them belong. With the down economy, states and counties — who are primarily responsible for the health of the indigent — cut social services first. And with most public psychiatric hospitals long-since closed, people who have a mental disorder end up being warehoused not in hospitals, but in prisons.

Yes, we succeeded in closing down the state mental hospitals. But we moved the population not to outpatient facilities, but to our prisons.

Now, finally, people are realizing the short-sightedness of locking people with mental illness up, as the spiraling prison costs of doing so become a burden to cash-strapped local governments.

In Philadelphia, a new mental health court has just started, meant to divert people away from prison and into mental health treatment. By doing so, the hope is that they can reduce the incidence of mental illness within prisons, and provide better care for people with a mental disorder in the process.

The new court is part of an approach called “sequential interception,” which includes programs designed to intervene so that people with mental illness don’t get caught up in the criminal justice system - or even killed by it. [...]

The court and the CIT are responses to a complex problem that began decades ago when the closing of state hospitals released mentally ill people into the community without adequate support or services.

Decades later, the high numbers of mentally ill people occupying prisons - some reports put the number at 30 percent of the inmate population - suggests that in too many cases, prisons have replaced state hospitals.

Imagine that — up to 30 percent of prisoners could have a treatable mental disorder. And guess what kind of mental health care most prison systems offer? Limited, if any (federal prisons tend to do a better job in this area than state-run prisons, but none come close to offering the kinds of services one would typically find in their local community).

Human Rights Watch has called out the U.S. prison system for its warehousing of the mentally ill and giving them inadequate care:

In 1998, the Bureau of Justice Statistics reported there were an estimated 283,000 prison and jail inmates who suffered from mental health problems. That number is now estimated to be 1.25 million. The rate of reported mental health disorders in the state prison population is five times greater (56.2 percent) than in the general adult population (11 percent).

Women prisoners have an even higher rate of mental health problems than men: almost three quarters (73 percent) of all women in state prison have mental health problems, compared to 55 percent of men.

“While the number of mentally ill inmates surges, prisons remain dangerous and damaging places for them,” said Jamie Fellner, director of Human Rights Watch’s U.S. Program and co-author of a 2003 report, “Ill-Equipped: U.S. Prisons and Offenders with Mental Illness.” “Prisons are woefully ill-equipped for their current role as the nation’s primary mental health facilities.”

Prison systems are horrifying places to be in the first place. They are even more so for someone who is suffering from schizophrenia or bipolar disorder and doesn’t have access to standard treatments for them. The previous Human Rights Watch report noted:

Inmates with mental illness are often punished for their symptoms. Being disruptive, refusing to obey orders, and engaging in acts of self-mutilation and attempted suicide can all result in punitive action. As a result, the report noted, prisoners with mental illness often have extensive disciplinary histories.

Frequently, the prisoners end up in isolation units. “In the most extreme cases, conditions are truly horrific,” the report stated, adding:

Mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls. … Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.

These are conditions one would expect in a third-world country. Not in the U.S. And not for people who are often most in need of compassion and care.

What research is there to show such mental health courts help? On Friday, a study was released that showed a 20 to 25 percent improvement in offender outcomes under the mental health court system in Minnesota. Dr. Grohol's article is at this link: http://psychcentral.com/blog/archives/2009/07/18/imprisoning-people-with-mental-illness/

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Philadelphia Inquirer on Assisted Outpatient Treatment Programs
http://www.philly.com/inquirer/opinion/20090330_Editorial__Mental_Health.html
March 30, 2009

EDITORIAL: MENTAL HEALTH, Better treatment

Court-ordered outpatient treatment for the mentally ill is effective for the individual and less expensive for the state. But in Pennsylvania, it's rarely used.

That's because the state's outdated 1976 mental-health law requires ill people to be a "clear and present danger" to themselves or others before a judge can order them to get treatment.

By the time people with mental illness deteriorate to that point, outpatient services are often not appropriate. They usually end up hospitalized.

If such people receive community-based treatment before they deteriorate too far, the results are positive. But people with mental illness often don't recognize they need help, and won't agree to treatment voluntarily. Forty-two states have some form of assisted outpatient treatment for the mentally ill. And a bill pending in the state Senate would bring Pennsylvania up to date in providing round-the-clock outpatient services. (The New Jersey Senate is also considering similar legislation).

Sponsored by Sen. Stewart Greenleaf (R., Montgomery, Bucks), SB 251 would allow judges to order outpatient mental-health treatment for people involuntarily for up to six months. It would apply only to patients who have been hospitalized at least twice within the previous three years, or have been involved in a serious violent incident within the past four years.

The new standard would be a "likelihood" of danger for receiving treatment involuntarily. The bill provides for a court hearing and legal representation for the mentally ill person. (See the link above for full article.)

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MARY'S COMMENTARY

THERE IS NO MYSTERY AS TO WHY 1.25 MILLION MENTALLY ILL AMERICANS ARE IN PRISON. IT HAS TO DO WITH MONEY, AS DR. GROHOL WROTE, BUT NOT SAVING TAXPAYERS MONEY.

Imprisonment of the mentally ill has to do with prison profiteering by sacrificing the weakest members of our society. Criminalizing mental illness benefits prison profiteers, like excessive sentencing, denial of DNA testing rights, denial of new trials with substantial evidence of doubt, mandatory three-strikes laws, and many wrongful convictions, which result most often from inadequate defense by public defenders.

Some believe that public defenders offices have limited resources because of the lack of capital. The opposite is true. Every inmate, whether innocent or guilty, costs taxpayers around $50,000 per year to incarcerate, an amount which varies by state. Providing poor legal defense actually costs taxpayers more money than providing adequate defense, as it frequently results in innocent people being sentenced to expensive prison terms or offenders being sentenced to excessive terms of incarceration. A 30-year-old man who is sentenced to life in prison costs taxpayers around $3.5 million dollars if he lives to his full life expectancy. That amount can more than double if the inmate is or becomes chronically mentally or physically ill. Therefore, public defenders' lack of adequate resources results in unjustified human suffering and substantial avoidable expense to taxpayers even if just one wrongful conviction or overlong prison sentence occurs.

Most instances of imprisoning mental patients are violations against their civil rights, because so many of them lacked an understanding of their Miranda rights (giving accused persons the right to remain silent with the understanding that what they say during police interviews can and will be used against them). Acute mental patients also usually lack the ability to contribute to their own defense at trial. Na Yong Pak's brother reported that after she burned their mother to death within 12 days of release from the mental hospital, Na Yong had no idea whatsoever why she was in prison. What good is it that taxpayers spend millions of dollars "punishing" people like Na Yong? Acute mental patients like Na Yong recognize that they are being punished by imprisonment and often tortured by solitary confinement while cold and naked in small isolation cells, but many of them have no idea why they are made to suffer.

Prisons are called "correctional institutions," and the primary objective is punishment for wrongdoing. Prisons are also supposed to be rehabilitation facilities, even though precious little is done to rehabilitate inmates. Acute mental illness cannot be "corrected" by punishing sick people; neither can mental illness be "rehabilitated." It is a chronic health condition and must be treated, not punished. The victims of the devastating illness need care, like victims of heart disease, diabetes, or any other chronic illness. The cost of treating mental illness in outpatients under an AOT program which combines subsistence assistance with mandatory psychiatric treatment costs substantially less than the average cost of $3.5 million required for lifetime imprisonment after expensive trials that sick people may not even understand.

Nationwide application of Kendra's Law for non-violent mentally ill offenders and hospitalization for violent sick people would save billions annually off America's prison budget and restore 1.25 million Americans to a more wholesome existence. AOT programs have the capacity to facilitate moving many mentally ill offenders from being a taxpayer burden to becoming taxpayers, themselves.

WHENEVER THERE IS A SOCIAL ILL, LOOK AT THE MONEY TRAIL AND SEE WHERE IT LEADS. THERE IS ALWAYS A MONETARY CAUSE FOR EVERY SOCIAL PROBLEM. ( link: 1 Timothy 6:10 )

WHATEVER THE PROBLEM, CHECK AND SEE WHO PROFITS, whether it is a matter of war and peace; poor prison rehab programs; withholding treatment from the mentally ill unless they have the wherewithal to seek psychiatric services (reserving them for prison); environmental injustice; equipping all police officers with Tasers that they should recognize as being less lethal, not "non-lethal"; inadequate public school education (keeping people ignorant); ousting God from public everything (so the Government will be the highest authority in the minds of the people), the proposal of forcing all U.S. citizens to choose between accepting a potentially harmful or deadly H1N1 vaccine or be incarcerated in FEMA camps, etc. Someone profits from every social problem.

Work by this author written to bring Assistance to the Incarcerated Mentally Ill include:

ASSISTED OUTPATIENT TREATMENT PROGRAM vs. JAIL FOR MENTALLY ILL
http://my.nowpublic.com/health/assisted-outpatient-treatment-program-mentally-ill-vs-jail

ENFORCED TREATMENT vs. PRISON FOR ACUTE MENTAL PATIENTS and UPDATES, by MARY NEAL http://my.nowpublic.com/health/enforced-treatment-vs-prison-acute-mental-patients-and-updates-mary-neal

WRONGFUL DEATH OF LARRY NEAL
http://WrongfulDeathOfLarryNeal.com

ANNOUNCING ASSISTANCE TO THE INCARCERATED MENTALLY ILL http://my.nowpublic.com/health/announcing-assistance-incarcerated-mentally-ill-aimi

Mary Neal
http://wrongfuldeathoflarryneal.com