Is the CJS a dumping ground for the severely mentally ill? Why 72-hour holds don't work and AOT does!

John Hockenberry Radio Show on Assisted Outpatient Treatment features Mental Illness Policy Org friend Margaret and the author of the study:

Click here to listen to the interview: http://www.thetakeaway.org/2013/aug/02/law-requires-those-severe-mental-illness-receive-treatment-saves-states-money/

Friday, August 02, 2013

A New York State law requires people suffering from severe mental illness to receive treatment when they are not hospitalized. Kendra’s Law was passed by the state as a response to the death of Kendra Webdale in 1999. She was pushed to her death on a New York subway platform by a diagnosed schizophrenic man. At least 44 other states have issued similar laws. In the case of the New York law, a patient must have been committed to a hospital at least twice within the past three years, and must have displayed violent behaviors toward him or her self or others within the past four years in order to qualify for what’s called assisted outpatient treatment, or AOT.

AOT provides patients with a caseworker who ensures that they are attending therapy and taking their medications. The law has caused a fair share of controversy, given that the person is forced to undergo treatment. But a new study shows that the law is not only beneficial to those who are forced into therapy, but ends up saving states money in the long-term.

Dr. Paul Appelbaum , director of the Division of Law, Ethics and Psychiatry at Columbia University’s medical school explains the law.

Margaret, whose son has been forced into assisted outpatient treatment under the law, shares her story.

When Cops Do It Right…

Imagine your child having a brain disorder and you were in this Mom's shoes. If you have a family member or friend who works in law enforcement, please share this story. It could save a life!
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By Laura Pogliano

I just called the county police precinct that services my neighborhood, but not to complain. I wanted them to know that their officers, and one in particular, were ‘getting it right’ in their response to psychiatric emergencies.

My 22 year old son has schizophrenia, the paranoid type. Since February, he has phoned emergency services five times, to ask for help with physical symptoms he’s imagining. Sometimes it’s a heart attack, sometimes his throat is closing, and yesterday, it was to report a gunshot wound, which he didn’t have, to his head. He thought he’d heard a group leader at his psychiatric rehab program say, Who wants directions to Zac’s house? earlier in the day. That delusion frightened him and by night time, he thought he’d been shot in the head…He phoned 911 to report it.

Each time he calls 911, I almost panic. Police have weapons, and there is no shortage of news articles about tragic incidents when police are called to intervene in a psychiatric crisis. Police intervention should not be the route the severely mentally ill have to take to get to care, but it is. The new mental health page the White House put up advises you to call 911 for care, as the official recommendation. As bizarre and sickening as that seems, that you have to call the police when your child is sick, the fact is that they are our new front line for care and our new first responders. 

We waited outside and my son asked me to let him do the talking. He didn’t want them to know he was sick, it would interfere with his reporting the gun shot. A female officer arrived, Officer Langford. My son met her on the sidewalk. She asked his name, shook his hand politely. She asked him what was wrong. He told her he wanted to report being shot in the head. Where were you shot, can you show me? She asked. He pointed to both temples. There was nothing there. She said, oh, I see what you mean. I do see a little spot right there. He told her he was worried about losing brain cells. He thought he’d been shot right in his own bedroom. She asked with what? A pistol, he thought, but he wasn’t sure. She asked when it happened; he didn’t know. He just wanted to report his gunshot wound.

Can I check your pockets? She asked. Do you have anything sharp on you that could hurt me? He said no, and she gently patted his pockets. Then she thanked him for letting her check.

She looked at me, questioning; she took a few steps toward me, and I whispered, He has schizophrenia. Another officer arrived. Before he could approach Zac, Officer Langford leaned in close to him and whispered something. He looked at me: Is he taking medicine? I said yes, faithfully. He handed me a note with a hotline number to call in case of crisis. I asked him to introduce himself to Zac since we need to get to know the police in our area (unfortunately). He shook Zac’s hand, introduced himself and then said he had another call to go out on and left.

What Officer Langford did next was miraculous.

She told Zac, I’m going to go to the car now, and I’m going to check all our databases and see what they say. You wait right here, and I’m going to check the databases for you and find out who’s responsible, ok? We have a lot of databases I can check for you and see how this happened. He agreed to wait. You just hang on, I’m going to check for you! She looked at me. I said quietly, there’s nothing wrong. What are you doing? She said, I know, I’m just going to pretend to check…Ok?

When she came back from the car, she told him: I checked all the databases, we have a lot of them, I checked every single one, and I didn’t find anything at all. No one can get your address, there was no one listed except us, and we’re the police. Nobody can get your address, not your friends or people at the school, nobody. OK? He said he’d heard a group leader giving out his address at the hospital program he attends. He heard him ask, Hey, who wants Zac’s address?
She told him, You know, sometimes people at school or your friends--they just like playing with you. They just tease or say things to cause trouble. I have kids at home, and I know how kids can be, they just like to say things and cause a little trouble. But you don’t have to worry about that. I just checked the databases for you, all of them, and nobody can get your address except us, and now you can laugh if that happens again. You can laugh because you know, if they’re playing you, the police told you nobody can get your information. It can’t happen ok? He agreed. 

I’m trying not to tear up as I relate this next piece:  She asked, is there anything else I can do to make you feel better right now?

He said, Well, no. But did she think he should get his head wound checked out?
She said, oh, I don’t think so. I’ve seen that injury before, lots of times. She rubbed the spot on his temple that he indicated had a bullet hole. Yep, I’ve seen that before, it should clear up by itself in a couple days. Ok?

He said Ok, but it was obvious he was worried. She repeated it a few more times: I’ve seen that before, it should be ok, it’ll be fine in 4 or 5 days, Ok?
She told Zac she couldn’t stay, she had another call to go on, but she was positive he would be fine in a couple days. She told him to have a good night, we thanked her, and she left.

I couldn’t believe my eyes and ears: if she wasn’t trained in CIT and from a pro, she was undoubtedly the most compassionate police officer I’ve ever met, not to mention very skilled in handling psychiatric patients. She validated his concerns; she had an immediate solution for calming him; she asked how she could make him feel better; she addressed every worry he presented, without once asking if he was sick, if he took his medicine; without once ridiculing the delusion.

This morning, I took great pleasure in phoning the Towson precinct and asking that someone tell her sergeant, or captain, or whoever supervised her, to thank her; I have friends whose children with psychiatric illnesses have been tasered, beaten, even shot at…Officer Langford treated my son with respect, with incredible skill, with patience and compassion. I said that Officers like her were so necessary to our journey. And while we’ve met many of your officers as they’ve responded to psych calls here, she went above and beyond what could even be reasonably expected of any of them. She made a fearful young man feel better, something I often cannot do. The officer who answered the phone said she would be glad to pass the message along; most of the calls they got were complaints. I said, I believe you. But this officer needs to be held up as an example of Doing It Right! 

My son came in the house after that experience, drank some juice, got ready for bed. He knocked on my bedroom door. He had his pills in his hand and a glass of water. He took them in front of me, said good night, then lay down to sleep.
There are myriad ways the police visit could have gone wrong. But it didn’t, because a police officer was willing to do whatever she had to, to make a scared and worried young man feel better, and she did.

NEW STUDY FINDS AOT SAVES MONEY. WHY AREN'T MORE STATES USING IT?

THE EVIDENCE IS IN: For people who deny they have a serious mental illness, refuse treatment and cascade into out-of-control behavior that can be threatening to themselves or others, assisted outpatient treatment works. It also saves more money than the costs of hospitalization or jail. Policymakers who say it is too expensive no longer have an excuse not to provide this life-saving tool.

NEW STUDY FINDS AOT SAVES MONEY. WHY AREN'T MORE STATES USING IT?

It just got a lot harder for opponents of court-ordered outpatient treatment for mental illness to argue that it costs too much to use.

A study of mandatory outpatient treatment costs published today in the American Journal of Psychiatry found that use of assisted outpatient treatment (AOT) can vastly reduce overall costs of mental health services for persons with serious mental illness.

 “Common sense has always argued that treating people with severe mental illness is a lot cheaper than hospitalizing people or leaving them to suffer other consequences of being untreated – not to mention more humane,” said Doris A. Fuller, executive director. “Now Duke University and its research partners have produced the numbers to validate it.”

“The cost of assisted outpatient treatment: Can it save states money?” by Dr. Jeffrey W. Swanson of Duke and six other researchers reports that service costs for 634 frequently hospitalized patients with severe mental illness declined 50% in New York City – from $104,753 to $52,386 – in the first year they received AOT after psychiatric hospitalization and dropped another 13% the second year.

Even larger cost savings were reported in five suburban New York counties also analyzed in the study.

Swanson and fellow researchers analyzed the costs of providing program, selected legal and court services and mental health and other medical treatment to people who met the strict criteria for New York’s involuntary outpatient treatment program (“Kendra’s Law”). Dramatic  savings were realized even though the cost of providing outpatient services to people under Kendra’s Law AOT orders was higher.

The researchers said that by saving money with greater use of AOT, mental health agencies could actually find themselves with more resources to meet other mental health needs.

“Unfortunately, compassion for those suffering these consequences as a result of untreated symptoms of severe mental illness has not been enough to motivate most communities to put their AOT laws to work,” Fuller said. “We hope the prospect of saving their taxpayers money will.”

Read our complete statement on the study.
Read the abstract for "The Cost of Assisted Outpatient Treatment: Can It Save States Money?".

Read coverage in the New York Times, "Program Compelling Outpatient Treatment for Mental Illness Is Working, Study Says."

 Treatment Advocacy Center
200 N. Glebe Road, Suite 730, Arlington, VA 22203
703 294 6001/6002 (phone) | 703 294 6010 (fax) |
www.treatmentadvocacycenter.org

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The Real Cost of Assisted Outpatient Treatment, (AOT) -- you just might be surprised!

Read more here:  https://www.crimesolutions.gov/ProgramDetails.aspx?ID=228

A recent examination of assisted outpatient treatment (AOT) implemented in the Nevada County, California looked at the cost savings that resulted from 17 individuals who were enrolled in AOT during the first 2½ years of program implementation (no comparison group was included). The results showed a total cost savings of over $500,000, attributable to decreases in hospitalizations and in jail time of the 17 individuals. For every $1.00 invested in AOT in Nevada County, $1.81 was saved (Heggarty 2011).

AOT reduces 72 hour holds, it reduces the amount of times individuals with serious mental illness are arrested, helps them remain in housing, helps them to become 'independent' of the system, helps them return to the work force, helps them stay alive, reduces domestic violence calls to the police and is MORE humane than inpatient or incarceration.

Kentucky’s embrace of private Medicaid plans leads to complaints

"Once again, a national media outlet, (this time The Washington Post), uses Kentucky's political decisions as a bad example for the rest of the US to learn from! If people who willingly want to access services and treatments are limited, where does this leave those who 'lack insight to their illness/anosognosia' and aren't able to navigate Kentucky's extremely difficult 'managed care' nightmare? Read how Kentucky medical providers hide behind HIPPA handcuffs". ~  GG Burns, KY Mental Health Advocate

Read the "Managed Care" article here:

By Jenni Bergal, Published by The Washington Post on July 13, 2013:http://www.washingtonpost.com/national/health-science/kentuckys-embrace-of-private-medicaid-plans-leads-to-complaints/2013/07/13/6e0c96d2-e9a8-11e2-aa9f-c03a72e2d342_story.html

View video from the Kaiser Health News here:
http://www.kaiserhealthnews.org/Stories/2013/July/14/kentucky-medicad-managed-care.aspx

Brian Stettin will speak to NAMI Members on the “The Untapped Power of AOT in Kentucky”

Brian Stettin, Policy Director of the Treatment Advocacy Center will be the presenter of two morning workshops titled: “Untapped Power of Assisted Outpatient Treatment (AOT)”, on July 20th at the NAMI KY conference. (For more details see the bottom of this post.)

In his presentations, Brian will cut through the common misconception's surrounding AOT. He will share research on its effectiveness, walk through the Kentucky AOT law and explain how it needs to be improved, and explore strategies for grassroots advocates to mobilize to make AOT those who need it a routine component of the Kentucky mental health care system.

Brian Stettin is the Policy Director of the Treatment Advocacy Center, a national advocacy organization based in Arlington, Virginia that works to remove legal barriers to the treatment of severe mental illness.  In 1999, as an Assistant New York State Attorney General, Brian conceived and drafted the original proposal of “Kendra’s Law,” landmark legislation establishing Assisted Outpatient Treatment (AOT) in New York. He was also instrumental in marshaling critical support for the bill, negotiating revisions with the New York Legislature and Governor, and enhancing the law upon its initial expiration in 2005. After leaving the Attorney General’s Office, Brian worked in Albany as Special Counsel to the New York State Commissioner of Criminal Justice Services, and Counsel to the Health Committee of the New York Assembly.  Since joining the Treatment Advocacy Center in 2009, Brian has been active across the U.S. in fostering the creation of local and regional AOT programs; reforming states’ inpatient commitment standards; and nurturing alliances with like-minded groups and advocates.  Brian is a 1991 graduate of the City College of New York and a 1995 graduate of the University of Texas School of Law.

 
Assisted Outpatient Treatment (AOT) is the practice of placing certain individuals with severe mental illness under court order to adhere to their prescribed treatment while living in the community. The target population is people caught in the “revolving door” of the mental health and criminal justice systems, as a result of their chronic inability to recognize their own illness and seek care voluntarily.
 
AOT has been prove in studies to drastically improve treatment outcomes, by lowering rates of hospitalization, incarceration and homelessness. However, it remains controversial within the mental health community, because some view it as an intrusion on the individual’s right to make his or her own treatment choices.
 
AOT is authorized under law in 44 states (including Kentucky) but is underused in nearly all of them. In the select jurisdictions across the country that employ it, AOT is considered an indispensable component of the mental health system. Typically, once an AOT program is up and running, controversy tends to die down as it dawns on people that the approach is not punitive at all, and offers a true lifeline to those in need.
 

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NAMI Kentucky Annual Conference

July 20, 2013

Christ Lutheran Church

9212 Taylorsville Road

Louisville, KY

$25.00 registration fee

1.) 9:15 or 10:30 am  "The Untapped Power of AOC in Kentucky"  Presenter Brian Stettin, Policy Director of the Treatment Advocacy Center, VA

Assisted Outpatient Treatment (AOT) is the practice of placing certain individuals with severe mental illness under court order to adhere to their prescribed treatment while living in the community.  The target population is people caught in the "revolving door" of the mental health and criminal justice systems, as a result of their chronic inability to recognize their own illness and seek care voluntarily.

2.) 9:15 or 10:30 am  "How to Effectively Advocate your Legislators"  Presenter Carl Boes, Jr., BA Philosophy Masters of Public Administration

Participants will learn to use their personal experiences to inform and inspire decision makers as they consider the future of public mental health services

3.) 9:15 or 10:30 am  "Counseling SSA Beneficiaries on Work Incentives and Employment"  Presenter: Tim Sloan, a twelve year veteran of counseling disabled Social Security beneficiaries on work incentives and employment.

4.)  9:15 or 10:30 am "Mental Health Courts, both the Enhanced Supervision docket Misdemeanants in District Court, and the Mental Health Court for Circuit Court Felony offenders".  Presenters: Judge Judith Bartholomew, District and Family Courts, Jim Burch of Seven Counties and Susan Jones, with the Jefferson County Attorney office

The workshop is a collaborative effort between the courts and Seven Counties

11:45-12:45Lunch___________________________

12:45-1:00 Break

1:15-2:15 Keynote Speaker Karen Winters Swartz, Author

Where Are the Cocoa Puffs? A Family's Journey Through Bipolar Disorder is Winter's debut novel. Her second novel: Reis's Pieces: Love, Loss and Schizophrenia was released in May 2012. She is an active board member of National Alliance on Mental Illness (NAMI) Syracuse and has traveled throughout the country advocating for mental illness awareness.

 

6.) 2:30 or 3:45 pm   "Caregiving Elderly Parents: How to Navigate the Challenges"  Presenter: Jim Schorch, LCSW, LMFT, has been in private practice for 12  years   
The workshop will focus on the common struggles faced by adult children as they care for the unique needs of their parents failing health and mental health needs, how to provide for their own self-care, and access available resources.

7.) 2:30 or 3:45 pm   "Advocating for a Mentally Ill loved One who is Caught in the Criminal Justice"  Presenter: Rebecca Cotton , Attorney for Protection and Advocacy
Discusses the manual " Mentally Ill persons Caught in the Criminal Justice System:  A support manual for family and friends she wrote in her second year of law school.

8.) 2:30 or 3:45 pm  "NAMI ON Campus"  Presenters:  Marcie Timmerland, NAMI Lexington and Jaxcy Odom, UK Student

NAMI On Campus is an exciting extension of NAMI's mission into the campus community.  NAMI on Campus clubs are student-let clubs that tackle mental health issues on campus by raising mental health awareness, educating the campus community, supporting students, promoting services and supports and advocating.

4:45 Closing 

To register, contact: NAMI KY

Somerset, KY 42501
Phone: (606)-451-6935 or 1800-257-5081
Fax: 606-677-4053
namiky@bellsouth.net
www.ky.nami.org

Has Kentucky Progressed in the Past 21 Years?

This national report was published in the Lexington Heard Leader on September 10, 1992

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Ky. called worst in using jails for mentally ill

Study count non-criminals held not helped

Staff wire reports

Washington- Kentucky is the worst state in the nation for handling people with mental illness because it widely uses jails as substitute holding pens, two advocacy groups said yesterday.

Kentucky has the nation's highest percentage of jails holding mentally ill people who have not committed crimes, according to report by Ralph Nader organization Public Citizen and the National Alliance for the Mentally Ill.

"Kentucky looks like the worse when he comes to misusing, abusing jails as mental health facilities," said Dr. E Fuller Torrey, a research psychiatrist and the principal author of the report.

"Kentucky is using jails as substitute mental hospitals," Torrey said. "This is a practice that should have gone out in the 1800s."

Kentucky and 15 other states expressly allow mentally ill people to be held, at least temporary, in jails Torrey said. Eight states outlaw the practice; others have no blanket rules or laws on the issue.

Kentucky was cited because it has the highest percentage, 81.1%, of jails holding mentally ill people not facing criminal charges, according to the report, which was based on a survey of 1391 cities and county jails nationwide.

The state with the second highest percentage is Mississippi with 75.9%. On average, 29% of jails in the United States hold mentally ill people who haven't committed crimes.

The state with the highest percentage of seriously ill patients among its total population was Colorado, at close to 11 percent.

"We agree, for the most part, that we have a problem in the state," said Brad Hughes, a spokesman for the Kentucky cabinet for Human Resources. "I don't know whether it's the worst in the nation."

Kentucky allows people with mental problems to be arrested on involuntary commitment warrants and sent initially to local jails.

Mentally ill people can be held in County and regional jails for up to 72 hours before being sent to mental hospitals, Hughes said. To help mentally ill people more than 48 hours, jails must send in mental health professionals.

"The state Human Resource Cabinet has lobbied since 1986 to outlaw jails as a temporary place to keep the mentally ill,: Hughes said. However the legislature had repeatedly rejected the change, largely because of the $1.7 million cost.

Reacting to the report, the Kentucky Alliance for the Mentally Ill yesterday called on the Governor Brereton Jones to include the issue in the special legislative session on health care slated for November.

"Little will be done to rectify the problem unless the governor, members of the General Assembly and the Public except the moral and physical responsibility for this criminalizing the illness, said Susie McElwain, the groups Executive Director.

The state Human Resource Cabinet will investigate the report claims that Kentucky's 15th community mental health centers are doing a poor job of assessing and treating mentally ill people, Hughes says.

But he rejected claims in the report the Kentucky has cut the number of hospital beds at state mental hospitals to save money, leaving mentally  ill people without treatment.

"We don't have a waiting list he said." "People aren't being turned away."

The report estimated that nationwide 30,000 seriously mentally ill patients are imprisoned in jails, were the causes of illness often go untreated and where they face high levels of physical abuse and rape.

Nearly three in 10 American jails are "surrogate mental hospitals", holding seriously mentally ill people who have not been charged for crime report said. More than 7% of the people held in jail including those facing criminal charges, have severe mental disorders.

Flathead County Mont., Has the worst record along Counties,

Flathead County Sheriff Jim DePont said the two local hospitals, Kalispell Regional Hospital an Glacier View do not accept private emergency psychiatric admissions.

Shane Roberts, chief operating officer at the regional hospital said,
"It is true we do not have dedicated psychiatric unit at the hospital, but for medical need psychiatric patients are accepted."

DePont said the state hospital is about 250 miles away and so crowded that it frequent takes months to get a patient in.

Expert involved with the report gave several reasons for the increasing use of jails as a surrogate psychiatric hospitals, chief among them where the steady deterioration of the network of hospitals, social workers, clinics and outreach programs that used to exist to care for the mentally ill. Police in many parts of the country appeared to pick up the mentally for a variety reasons, such as disturbing the peace or for their own safety and put them in jail in lieu of appropriate psychiatric facility.

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Fast forward to June 2013, watch this video and be the judge if Kentucky has moved foward since 1992! http://www.youtube.com/watch?v=qEu_6miQlx0