Why can't America care for the mentally ill?

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com
 

Read more: http://www.foxnews.com/opinion/2012/12/17/why-cant-america-care-for-mentally-ill/#ixzz2FN5gt9au

Suggestion #8

In most states there is no way to arrange court-ordered, involuntary outpatient use of medications (including antipsychotic medications) even if someone is very violent or has reported extremely violent thoughts in the hospital, even if that person is psychotic and also addicted to cocaine or heroin, and even if that person is court-ordered to take such antipsychotic medications in the hospital.

Once that person hits the streets he or she is too often free to never visit a psychiatrist, again, to never take another medication and to never be drug-tested.

My response to: 'I Am Adam Lanza's Mother'

painting: the mental health nightmare

Once again, the news of a nightmarish killing spree had descended over our nation! Yet again by a disturbed young person, (barely a man) who is no doubt been surviving some form of mental illness.

Since early Friday, I have received dozens of text messages and emails from relatives, friends and acquaintances around the US, who are aware of our personal challenges to help my son or from those who support our efforts to amend Kentucky's Outpatient Treatment laws. 

One such response to the tragic deaths in Sandy Hook, is an article written by a Mother and Blogger named Liza Long. Liza published an entry on her daily blog titled: 'I Am Adam Lanza's Mother'.  Within a few hours, her story was republished on the Huffington Post as:

'I Am Adam Lanza's Mother': A Mom's Perspective On The Mental Illness Conversation In America

Within hours, it had been re-tweeted or republished over 810,000 times. On Liza's blog, the The Anarchist Soccer Mom, over 2000 people have left comments.

This is my response about this tragedy, to the victim's families and to Kentuckians:


I TOO COULD BE ADAM LANZA's MOTHER. 
(Except I would have never had guns in my home.)

Our son, who has suffered his entire life with an mental illness, has been bullied and tormented by people in his schools, our neighborhood and yes at Church. I am certain these horrific scars have impacted him. I am fearful of my son's threats and abuse toward me, but can only learn how to protect myself from him since the adult system gives me few options otherwise. 

Just recently when I attempted to communicate with my son regarding how concerned I was of his increasing mania, he replied, "I'll blow your f___ing brains out if you send me to the hospital again. The second I get out I'll murder you!" Yet a few hours later, my son never remembers he said such horrible things.

The process families must endure to obtain an emergency 72-hour hold is unthinkable. People with acute psychosis are literally arrested by law enforcement officers, transported to a state hospital, (or most times jail) in handcuffs and more times than not are released within a few hours. Why? Because by the time they are finally evaluated by a mental health professional -- they no longer present as a threat to self or others. The entire process is inhumane and goes without reason why those individuals living with a mental illness, who are in recovery -- strongly oppose involuntary treatment laws.

At one time or another, our son has received all of the labels the media has discussed regarding the CT tragedy. By the time our son was 10 years of age, he had been evaluated, diagnosed and treated by psychiatrist, psychologist, neurologists, nutritionist, allergist and behaviorist ... for sleep disorder, ADHD, sensory integration, Tourette syndrome, obsessive compulsive disorder, bipolar disorder, psychotic disorder, frontal lobe and executive function deficit.

With much effort, special accommodations, supports and services where available for our son in the school system. In addition, my husband and I traveled as far away as Cincinnati, Ohio seeking help from experts. Before mental health parity, we paid 100% of our son's medical bills. Insurance companies discriminated against us also, blaming our son's symptoms on bad parenting and his free will to be different and to have challenges I suppose.



Time and time again, we were ridiculed by family members and our peers for giving medications to our explosive and often out of control child! Once, after our son's doctor admitted him to a local psychiatric hospital, we were later investigated by Kentucky Cabinet for Health and Family Services, CHFS for the possibility that perhaps we were abusing our son. Even our own parents suggested our son's behaviors were our fault. Amazing, parent's aren't blamed if their children develop cancer, yet with mental illness everyone blames others.

As difficult and challenging as it was for all, our son did succeed. Labeled as a gifted genius, he was doing well and even attended college and worked at a skilled job in the community, while still in high school. He was able to achieve this success due to medicine, therapy, case management and a counselor from the Office of Vocational Rehabilitation.



At age 17, in an attempt to escape the stigma of his mental illness, our son refused treatment! It was not long before he quickly became aggressively psychotic.
 
My husband and I filed an out-of-control petition in the court system, just 6 months prior to our son’s 18th birthday -- hoping to save his life and us from his reckless and often dangerous behavior. But instead of going to a hospital or treatment facility, he was ordered to jail, punished for behaviors that were symptoms of his untreated brain disorder!
 


Months turned into years. He was homeless, desperate for food and still refused to accept treatment. When he was petitioned to a hospital, he was not held long enough to stabilize. Now, our son frequently threatens homicide or suicide which makes our life -- and his -- a living hell. He is trapped in a carousel of insanity and without long term treatment will never escape.

As our son aged into the adult system, a well meaning 

therapist who I dearly respected told me, "I must learn to let go". She suggested I buy the the book titled: 'The Sociopath Next Door', attend Al Anon classes and learn how to disconnect my love. She said, "you will not be able to help your son". She did not want to see me self destruct. At the time, I was riddled with serious autoimmune diseases due to the chronic caregiver stress. It has taken years of effort and training to become healthy enough to advocate for my son's life and others.

The very resources and laws in place to support my son as a child  --  are not available for him as an adult! Why? Because of his civil rights, our federal and state mental health laws and the fact that state funds had been redirected from the department of behavioral health to the criminal justice system. It is absurd! 

If a young person lacks insight to their illness (anosognosia), regardless as to how complex their symptoms are -- parents and 'ultimately the community' can do nothing until they fail or 'explode' and become part of the criminal justice system, commit suicide or homicide as Adam Lanza did!

Regarding the comments from readers on Liza's story, who believe GOD is the answer and 'if' we just prayed more our troubled children would be rid of their demons -- for years, church members turned their backs and avoided us! On more than one occasion, church leaders condemned us for our son's impulsive and disruptive behaviors and made it clear they didn't want our son in the same Sunday school classes or private Christian Schools, with their own children!

Children or young adults are not born with evil in their hearts. But they are born with brains that malfunction!  It is society's reactions to these troubled children's symptoms that create monsters.

 Mothers told their children that our son was bad and they could not play with him! Imagine the pain children with special needs like my son must endure? They may look normal, but their brain dysfunction -- regardless of the label, does not allow them to act normal.

Yet in spite of it all, our son did graduate due to the compassion, special accommodations and supports of a few key people. In the adult system, there are few special accommodations for those who act differently -- they quickly become outcast. And then we wonder, what could make a young man snap and kill children or worse  -- his own Mother?


Bless all the Mothers like Liza Long.



Bless all of those victims families suffering across the US.



And, yes God, Bless Adam and Nancy Lanza's soul -- because they were also victims of a cold, broken mental health system.

GGB -- Mother, Artist and Kentucky Brain Advocate

Comments on: Across nation, unsettling acceptance when mentally ill in crisis are killed

Posted: December 10
Updated: Today at 1:55 PM

By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer

Even as they face a growing number of disturbed people, police often lack crisis training. And the leadership and data-gathering needed to stem the bloodshed are largely absent.

To read the entire 4-part series, click here: http://www.pressherald.com/specia/Maine_police_deadly_force_series_Day_4.html

or read:

Families mostly powerless when mentally ill adult resists help

With headlines such as this, what family member in their right mind would call the police for help -- when their ill loved one becomes to much to handle? With civil commitment laws making it almost impossible to get needed medical attention for those who lack insight and refuse treatment -- what should a family do? My husband and I call this difficult decision the 'carousal of insanity' that is worse than Russian Roulette!  GG Burns, KY Mental Health Advocate

A few quotes from this very long, but informative article:

In many cases, mentally ill people shot by police have threatened, injured or even killed others. Sometimes, they have threatened suicide or expressed a desire to be shot by the police. Frequently, the use of deadly force seems excessive, if not utterly unnecessary.

It also could save taxpayers money, they said, if government leaders were able to demonstrate that it's more cost-effective to fully fund mental health services and police training up front, rather than risk more expensive responses and sometimes tragic results when crisis situations go wrong.

The Justice Department typically only steps in when police shootings of the mentally ill or other minorities ignite public outrage. Then, its Civil Rights Division requires police departments to make after-the-fact, local policy and operational changes -- including crisis intervention training promoted by NAMI and other organizations -- that can produce questionable, unverified results.

NAMI's Honberg acknowledges that even his group has failed to push for a unified, national approach to the problem, though the organization targets over-incarceration of the mentally ill as a major concern. At least 17 percent of the 2.2 million people in U.S. jails and prisons are mentally ill, according to recent studies.

Honberg agrees that similar attention should be paid to police shootings of the mentally ill.

"(It's) not a national priority, and it should be, not only for humanitarian reasons, but for economic reasons as well," Honberg said.

Alabama Deputies' shooter struggled with mental illness -- another preventable tragedy!

By MELISSA NELSON-GABRIEL — Associated Press

FAIRHOPE, Ala. — The mother of an Alabama man accused of shooting two sheriff's deputies wrote of his increasingly erratic and threatening behavior in three requests to have him placed in mental institutions against his will in recent years, according to court documents that have surfaced since the shooting that left one of the men dead. Read the entire article here:http://www.kentucky.com/2012/11/27/2422992/deputies-shooter-struggled-with.htmlhttp://www.kentucky.com/2012/11/27/2422992/deputies-shooter-struggled-with.html

Read more here: http://www.kentucky.com/2012/11/27/2422992/deputies-shooter-struggled-with.html#storylink=cpy

Editorial review: By GG Burns, KY mental health advocate and founder of the Change Mental Health Laws in KY project.

I recently read about this preventable tragedy and took the time to GOOGLE Michael Jansen, who obliviously needed help. After a few minutes search, I realize this preventable tragedy had hit the associated press and was repeated in over 70 newspapers across the US. Violence sells newspapers, not educational solutions to an ever growing problem of individuals suffering with serious and persistent mental illness who need to access medical treatment.

I immediately identified with his 84-year-old Mother, Mrs. Helen Jansen and wondered if my life or my son's life could one day end in a brief newspaper article like this. Stories like this appear in the news frequently, sometimes daily and make my heart weep. I understand all too well the hopelessness a Mother feels when they are unable to help their adult child receive the necessary medical care needed to be a productive citizen in the community. I can't imagine how this Mother feels now that she was unable to help prevent her son's death and the death of another. 

My thoughts turned to what kind of headline would have been 'if' Michael Jansen, had received an 'assisted' outpatient agreed order 2 years ago and had remained in treatment? I wonder if this slain deputy's family will blame Micheal Jansen for the death of their son, husband or Father -- or will they blame the broken mental health system? I wonder if any good will come from this pointless and preventable tragedy?

Alabama, like every state, has its own civil commitment laws that establish criteria for determining when court-ordered intervention is appropriate for individuals with severe mental illness who are too ill to seek care voluntarily. The state authorizes both inpatient (hospital) and outpatient (community) treatment, which is known in Alabama as "court-ordered outpatient treatment." It is one of the 27 states whose involuntary treatment standard is based on a person’s “need for treatment” rather than only the person’s likelihood of being dangerous to self or others.  

For inpatient treatment, a person must meet the following criteria:

• be a real and present danger to self/others or,
• without treatment will continue to suffer mental distress and deterioration of ability to function independently, and
• be unable to make a rational and informed decision concerning treatment.

For assisted outpatient treatment, a person must meet the following criteria:

• without treatment will continue to suffer mental distress and deterioration of the ability to function independently, and
• be unable to make a rational and informed decision concerning treatment.

For more info about AOT laws in all 50 states click here.

Pay-Now-or-Pay-Later

Mental illness is a pay-now-or-pay-later disease. People who don’t get routine treatment when they are more stable often end up needing emergency treatment after they become less stable – and when it costs more. Along the way from more to less stable, they also often generate significant public costs from arrest, incarceration, victimization, etc.

Click here to read a recent article written by Treatment Advocacy Center on:

Chicago’s Psych Patients Didn’t Disappear, They Just Got Sicker

KRS 202A.081 Court-ordered community-based outpatient treatment.

Kentucky's legal policy for assisted outpatient treatment, AOT. 

(1) Following the preliminary hearing but prior to the completion of the final hearing, 
the court may order the person held in a hospital approved by the cabinet for such 
purpose for the committing judicial district, or released, upon application and 
agreement of the parties, for the purpose of community-based outpatient treatment. 
No person held under this section shall be held in jail unless criminal charges are 
also pending.

(2) A hospital shall discharge a patient there held and notify the court and attorneys of 
record if any authorized staff physician determines that the patient no longer meets 
the criteria for involuntary hospitalization. 

(3) If a patient is discharged by the hospital pursuant to subsection (2) of this section, 
then the proceedings against the patient shall be dismissed.
(4) The release of the person pursuant to subsection (1) of this section for the purpose of community-based outpatient treatment does not terminate the proceedings against the person, and the court ordering such release may order the immediate holding of the person at any time with or without notice if the court believes from an affidavit filed with the court that it is to the best interest of the person or others that the person be held pending the final hearing, which shall be held within twenty-one (21) days of the person's further holding.
(5) If the person is released pursuant to subsection (1) of this section for the purpose of
community-based outpatient treatment, the final hearing may be continued for a
period not to exceed sixty (60) days if a provider of outpatient care accepts the
respondent for specified outpatient treatment. Community-based outpatient
treatment may be ordered for an additional period not to exceed sixty (60) days
upon application and agreement of the parties.

Effective: July 15, 1994
History: Amended 1994 Ky. Acts ch. 498, sec. 6, effective July 15, 1994. -- Amended
1988 Ky. Acts ch. 139, sec. 8, effective July 15, 1988. -- Created 1982 Ky. Acts
ch. 445, sec. 10, effective July 1, 1982.
Legislative Research Commission Note.  This section was enacted in 1982 Acts,
Chapter 445, which contains the following language in Section 45 of that Act: "This
Act shall become effective on July 1, 1982." The Ky. Constitution, in Section 55,
requires that a reason be set forth for the emergency. However, no reason is set forth
in this Act. The effective date for 1982 Acts with no emergency provision is July 15,
1982.

Did you know?

By: Robert Friedman, Attorney with the Department of Public Advocacy in Lexington, Kentucky

Did you know? I didn’t think so. Neither do many law enforcement officers.
KRS 202A.251 Prohibition against detention in jail without criminal charges pending --Criminal charges not to be placed to avoid transportation.



No person held under the provisions of this chapter shall be detained in jail unless criminal charges are also pending. No peace officer or any other person shall place criminal charges against a person who is mentally ill and in need of hospitalization pursuant to this chapter solely or primarily for the purpose of avoiding transporting the person to a hospital or psychiatric facility.



This is the law, but it it widely disregarded. A lot of police officers are simply unaware of it. A few just wink at it and take persons with mental illness to jail.

Here’s the “cash value”: if the officer knows the person is mentally ill and thinks he/she might be dangerous, the officer cannot legally place charges without taking the person for a psych exam first. 

People need to demand that the police observe the law ... probation officers, too. If your elected officials turn away when you bring it up, vote the crooks out!
Otherwise, people with serious, chronic, mental illnesses—schizophrenia, bipolar I, schizoaffective disorder—end up getting arrested for petty garbage—criminal trespass 3rd, disorderly conduct—and taken to jail. 

This is both cruel to person with mental illness and costly to the public. (Jail ain’t cheap to the taxpayers, nor should it be.) We don’t have to change the law to do better. We just have to know it and observe it.

Note: "These are my views, and I am not speaking on behalf of the DPA."  ~ Robert Friedman