Sunday, October 17, 2010

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.

Tuesday, August 31, 2010

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:

Thursday, August 26, 2010

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.












Wednesday, August 11, 2010

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

Monday, August 2, 2010

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:

Tuesday, July 20, 2010

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/