Neighboring state's challenges with mental health laws and mental health courts

This article was recently published in Tennessee, but it could easily be about one of hundreds of mentally ill inmates currently sitting in Kentucky's jails and prisons. Each day Kentucky state funds are used to wearhouse people that need medical attention, not time behind bars.

Joan Garrett, award winning journalist for the Chattanooga Times, reports one Tennessee family's frustrating experience of a sick son caught in the Revolving Door of Criminalization:

"In the cellblocks of the county jail, suspected murderers, drug traffickers, burglars, wife beaters and rapists wait for hearings and trials. Somewhere among them sits Dennis James' schizophrenic son.

 His crime? He's sick."

"Kyle's case is a textbook example of how thousands of mentally ill cycle through -- court and jail, court and jail, court and jail -- with no psychiatric improvement, raising questions about whether judges should be handing down sentences or treatments."

Read this powerful story here: Chattanooga Times: Hamilton County Jails Are Often Home for the Mentally Ill - Advocates Say They Have Better Idea

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Ind. scrambles to address ruling on mentally ill inmates

 

Ken Falk, left, legal director of the ACLU of Indiana, says at least 11 mentally ill inmates isolated in Indiana prisons have committed suicide, one of the reasons a federal judge ruled Monday that the state has violated prisoners' Eighth Amendment protections from cruel and unusual punishment.(Photo: Charlie Nye, The Indianapolis Star)

Tim Evans, USA TODAY10:34p.m. EST January 2, 2013

Indiana Department of Correction called "deliberately indifferent" to treatment problems.

Story Highlights

• Prisoners considered mentally ill are being confined to their cells 23 hours a day or more
• They're not getting enough access to mental health care
• The isolation and lack of treatment are causing worsening symptoms, even suicide

Read more here: http://www.usatoday.com/story/news/nation/2013/01/02/mental-illness-prisons/1804987/

Lawmakers Examine Violence and Mental-Illness

WASHINGTON, DC
Tuesday, March 5, 2013

Parents to Congress: Police no solution to mental illness!

As part of the ongoing review by lawmakers into mental health issues raised by the Newtown shooting, the House Energy and Commerce Committee talked with leading health experts to explore issues related to severe mental illness and violence.

The panelists discussed the treatment of mental illness and obstacles to seeking treatment for individual with the condition. They spoke about the most effective federal, state and local programs for prevention and early detection of severe mental illness in children and young adults.

The committee's hearing, titled "After Newtown: A National Conversation on Violence and Severe Mental Illness," included professional and personal perspectives from mental health advocates, physicians and members of victim's families.

View here: http://www.c-span.org/Events/Lawmakers-Examine-Violence-and-Mental-Illness/10737438534-1/

Opening Statement of the Honorable Tim Murphy: “The common factor in many mass tragedies is an underlying mental illness. The lessons for Americans from the horrifying tragedy in Connecticut is that we had better take off our blinders and deal with such illness or we are sure to face the same problem again. It is not only what’s in a person’s hands that it's what is in his mind."

What Families Want Congress to Know

Pete Earley, awarding winning author and and internationally known mental health advocate has asked families to to share input on "What Should I Tell Congress?"

by Pete Earley 

Read more here:

http://www.peteearley.com/2013/03/01/what-should-i-tell-congress/

I generally publish a blog from my files each Friday. However, I have been invited to participate in a forum entitled “After Newtown: A National Conversation on Violence and Severe Mental Illness” on March 5th, before an investigative subcommittee of the  U.S. House Committee on Energy and Commerce.

I mentioned in last Monday’s blog that Reps. Tim Murphy (R-Pa.) and Diana DeGette (D-Co.) are holding the forum and I’m thrilled to report that Pat and Debbie Milam also have been invited to give testimony. I wrote about the death of their son, Matthew,  in a blog entitled: A Father Grieves: No One Listened to Parents.

Along with my formal invitation came a list of potential questions that might be asked at the forum, which will begin at 10 a.m. in Room 2123 of the Rayburn House Office Building in Washington D.C. and is open to the public.  I don’t know if it will be covered by C-Span but hope it will.

Okay, now is your chance to sound off.  Here are the questions:

Below are my responses to Pete:

1. In what ways is mental illness more — or less — treatable than other serious medical conditions?
 

Mental illnesses are very treatable, but both education and resources for the individual and their family, should be an important requirement of a treatment plan — not just pills. Also, ruling out other deficits, diet deficiencies, hormonal imbalances, etc., should be required testing before a psychiatric diagnoses is determined. Historically, few tests are required before a person is diagnosed.

Additionally, not all mental illnesses are the same. An individual who has become depressed or anxious, after experiencing a traumatic event may not require the same multidisciplinary outpatient supports, as an individual who is acutely psychotic, has lost touch with reality and believes aliens are about to kill them or their family members.

Hospitals must recognize that a discharge plan should be more than an appointment to see an outpatient provider every 3 months and a prescription for pills! Just as in heart disease — diet, exercise, lifestyle changes are needed to recover, so should be solutions for an individuals with severe and persistent mental illness, SPMI. In other words, individuals with a history of SPMI, who are too sick to recognize they are sick, shouldn't be categorized the same.

2. What are the greatest obstacles to seeking treatment for individuals suffering from mental illness and their families?

HIPPA, lack of assisted outpatient treatment, (AOT) laws and a mental health system that was never designed to work! The current system is beyond broken. Families should not be forced to turn to the DOJ and criminalize their young sons/daughters in order to obtain a band aide — which might be no more than 2 weeks of inpatient care or worse, a judge's order to seek treatment for an illness they may not realize they have — through probation. "Would we force a patient with cancer or Alzheimer's into jail first, attempting to teach them to not have their illness? This approach is essentially what families face across the US"!  It should be illegal for a families and providers to turn our backs, due to civil liberties — forcing the sickest to become homeless.

3. Among individuals with untreated and severe mental illness, when, if at all, is violence — directed at the self or others — most likely?

When resources and supports aren't available. Violence occurs when individuals with 'untreated' SPMI become desperate due to hunger, lack of basic needs or inability to be successful in the community. When their ability to think logically becomes impaired, violence can be triggered quickly and can be unpredictable. Additionally, individuals with untreated SPMI may seek revenge to hurt a family member, who isn't able to help their loved one carry out their delusions or other psychotic beliefs. Some family members become 'trapped in their fears' — if they attempt to have their loved one involuntary hospitalized, they will become victimized or hurt themselves, if their loved one isn't held long enough to stabilize. Which is often the case. Legal statues for inpatient commitment laws can force family members into horrific situations and can lead to deadly consequences. Treatment Advocacy Center has a preventable tragedy data base for these families — this alone should speak volumes. Why hasn't congress listened before now?

4. What is the record of federal state, and local programs geared towards improving health outcomes among individuals with severe mental illness?

Preventive programs for 'children at risk', have produced positive outcomes in our state, (Kentucky). However, the track record for adult programs for individuals with SPMI are underfunded, ineffective or misused — in comparisons to programs designed for individuals with developmental/intellectual disabilities. Those who recognize they are ill and are able to request assistance, become an active participant in their own recovery and can utilized programs easier. However, advocates for freedom and choice, too often leave out the other 40% who lack insight to their illness.

Sometimes funds from federal grants become tied up administrative or marketing cost for awareness campaigns, etc., than actually assisting individuals and their families who have the most severe cases. It seems grants actually create conflict among advocacy groups, instead of encouraging groups to work collectively. Additionally, navigating state or federal programs — can be a draining and full time job for a caregiver, which result in health problems, lost income or jobs. This creates hardships on the entire family, resulting in additional drains on the welfare or social security system.

5. What are the most effective federal, state, and local programs for prevention and early detection of severe mental illness in children and young adults?  

Programs that provide wrap-around services for the entire family. Programing shouldn't stop for the family, after their children with SPMI aged out of the system at 18! Adequate transitioning is needed between the youth and adult systems. HIPPA Laws have become a huge barrier for families attempting to help their young adults who have SPMI.

6. How can federal programs be improved to reduce barriers to access and improve outcomes for individuals with severe mental illness?

A federal mandated Assisted Outpatient Treatment, (AOT) law should require individuals who are too sick to know they need help, (anosognosia) and often end up in the revolving door of homelessness and frequent incarcerations. Families should be considered part of the solution of the over all treatment plan for both inpatient and outpatient programing. Frequently, family members are left to pick up the pieces and support our very ill family member, yet are rarely considered in developing the treatment plan. HIPPA is to blame in most cases.

FIFTY YEARS OF FAILING AMERICA'S MENTALLY ILL

By E. Fuller Torrey, MD, for the Wall Street Journal

"The evidence is overwhelming that this federal experiment has failed, as seen most recently in the mass shootings by mentally ill individuals in Newtown, Conn., Aurora, Colo., and Tucson, Ariz. It is time for the federal government to get out of this business and return the responsibility, and funds, to the states.

Altogether, the annual total public funds for the support and treatment of mentally ill individuals is now more than $140 billion. The equivalent expenditure in 1963 when Kennedy proposed the CMHC program was $1 billion, or about $10 billion in today's dollars. Even allowing for the increase in U.S. population, what we are getting for this 14-fold increase in spending is a disgrace.

Including President Kennedy, five Democratic and five Republican presidents have presided over the 50-year federal experiment. Jimmy Carter and George H.W. Bush appointed presidential commissions to examine the failed programs, but nothing useful came from either. 

Nor is President Obama likely to do anything, since his lead agency, the Substance Abuse and Mental Health Services Administration, has essentially denied that a problem exists. Its contribution to the president's response to the Dec. 14 Newtown tragedy focused only on school children and insurance coverage. And its current plan of action for 2011-14, a 41,000-word document, includes no mention of schizophrenia, bipolar disorder or outpatient commitment, all essential elements in an effective plan for corrective action." 

On Feb. 5, 1963, 50 years ago this week, President John F. Kennedy addressed Congress on "Mental Illness and Mental Retardation." He proposed a new program under which the federal government would fund community mental-health centers, or CMHCs, to take the place of state mental hospitals. As Kennedy envisioned it, "reliance on the cold mercy of custodial isolations will be supplanted by the open warmth of community concern and capability."

President Kennedy's proposal was historic because the public care of mentally ill individuals had been exclusively a state responsibility for more than a century. The federal initiative encouraged the closing of state hospitals and aborted the development of state-funded outpatient clinics in process at that time.

Over the following 17 years, the feds funded 789 CMHCs with a total of $2.7 billion ($20.3 billion in today's dollars). During those same years, the number of patients in state mental hospitals fell by three quarters"”to 132,164 from 504,604"”and those beds were closed down.

From the beginning, it was clear that CMHCs were not interested in taking care of the patients being discharged from the state hospitals. Instead, they focused on individuals with less severe problems sometimes called "the worried well." Federal studies reported individuals discharged from state hospitals initially made up between 4% and 7% of the CMHCs patient load, and the longer the CMHC was in existence the lower this percentage became.

It has now become politically correct to claim that this federal program failed because not enough centers were funded and not enough money was spent. In fact, it failed because it did not provide care for the sickest patients released from the state hospitals. When President Ronald Reagan finally block-granted federal CMHC funds to the states in 1981, he was not killing the program. He was disposing of the corpse.

Fifty years later, we can see the results of "the open warmth of community concern and capability." Approximately half of the mentally ill individuals discharged from state mental hospitals, many of whom had family support, sought outpatient treatment and have done well. The other half, many of whom lack family support and suffer from the most severe illnesses such as schizophrenia and bipolar disorder, have done poorly.

Read the full article by Dr. E. Fuller Torrey, founder of Treatment Advocacy Center, in the Wall Street Journal.

 

Dear President Obama, your solution will not help!

Chip Somodevilla/Getty Images

Dear President Obama, These measures will not help, it will overload teachers and expect them to wear too many hats. Our son experienced mental health symptoms since birth. Even though he had supports in the community and school system -- "his right to say no to treatment" -- at 18, as he aged into the adult system  -- has lead to serious and costly consequences. Regardless of having a good insurance plan and a loving supportive family, there was no way to help him remain in treatment.

As long as we allow our youngest, most vulnerable citizens to be protected by HIPPA and Civil Rights laws, they will continue to fall through the cracks!  (Where most end up in jail or homeless -- wasting state funds and their lives!)

When a person lacks insight 'to their illness', (anosognosia) there should be additional protections -- same as Alzheimer's patients.

A federal assisted outpatient treatment, (AOT) law in one way to make changes -- stop focusing on guns!

READ MORE HERE:  http://www.npr.org/blogs/health/2013/01/17/169597304/obamas-plans-for-guns-put-focus-on-mental-health-of-the-young
Obama's Plans For Guns Put Focus On Mental Health Of The Young

by Sarah Varney

January 17, 201310:49 AM

Learn more about Kentucky's outpatient treatment law under the KRS.202A.O81 and support HB78 and SB33, here:http://changementalhealthlawsinky.blogspot.com/2013/01/hb78-and-sb33-new-bills-to-amend-krs.html

Listening To Those In The Trenches -- Solutions for Leaders

Pete Earley, American journalist and bestselling author said,

"We don’t need lists. We need improved and better-funded community mental health services. We need a national dialogue about our existing mental health laws with an eye toward protecting civil rights but also getting people help before they become an imminent danger."

 I agree with other advocates, Pete's article needs to be reprinted in every media outlet possible! Keep up the great work Pete!

Dr. Tracey Skale, the chief medical director at the Greater Cincinnati Behavioral Health Services,

Read more here: http://www.peteearley.com/2013/01/16/listening-to-those-in-the-trenches/

Stop Minimizing Mental Illness: Worst Things to Say

I typically only post Kentucky related stories or share national articles that explain news/options for Assisted Outpatient Treatment, but this is worth the read. SO TRUE! 

Natasha Tracy tells it like it 'really' is!

Let’s Not Forget, People Die From Mental Illness

The idea that mental illness is serious isn’t something that I made up, it is a fact. Estimates are 1 in 5 people with bipolar disorder commit suicide and 1 in 2 people (yes, that’s half) attempt it. And of course there are hospitalizations, work absences, destroyed families, having to go on disability, and so on. This is serious stuff people. It is not a runny nose.

Read her article by clicking here:

Stop Minimizing Mental Illness: Worst Things to Say