Treatment of individuals with serious mental illness in jails and prisons - a survey

 
Dear NAMI leader,

We can all agree that individuals with serious mental illnesses do not belong in jails or prisons.
The reality, however, is that many such individuals are in jails and prisons as a result of the increasingly failed mental illness treatment system. Many jails and prisons now report that 20 percent or more of their prisoners have severe mental illness as a primary diagnosis, frequently complicated by substance abuse.
Being in jail or prison when your brain is working normally is difficult enough, but being in jail while you are psychotic is a nightmare. And practices for psychiatrically treating such individuals vary widely, even within a single state. In fact, there appears to be considerable confusion among families, and even among some jail and prison officials, regarding the legal circumstances under which individuals with serious mental illness can be involuntarily treated in jails and prisons when they are psychotic and unaware of their own illness.
For this reason, the Treatment Advocacy Center is undertaking a state-by-state survey of laws and practices for treating jail inmates who refuse treatment for a severe and persistent mental illness. This information is being collected by Mary Zdanowicz, a lawyer. When it is complete later this year, the survey will be permanently posted on the website of the Treatment Advocacy Center and be accessible to everyone, along with the other state-related information already available there.
As part of this survey, we are collecting anecdotal information about the experiences of individuals with serious mental illness (e.g., schizophrenia, bipolar disorder, schizoaffective disorder or severe depression with psychotic features) who should have been treated involuntarily while they were in jail or prison but, for whatever reason, were not treated. I am aware that some of these cases end up as disasters. Conversely, I am aware that some such individuals are involuntarily treated with a good outcome. We are interested in collecting examples of both bad outcomes when involuntary treatment was not provided and good outcomes when it was provided.
Could you please forward this request to any of your NAMI members who may have a family member in jail or prison and may be interested in the involuntary treatment problem? I would like them to send us the details of that treatment situation. In our report, we will not identify the individuals or the jail/prison by name, only by state, except in cases in which the information is already public.
NAMI members who wish to contribute such information can send it to me directly at jailprisonsurvey@treatmentadvocacycenter.org. It should be sent to me by August 1.

Thank you for your help with this survey. When we release it later this year, we will send you a copy.
Sincerely,

E. Fuller Torrey, MD

Congressman Tim Murphy Joins White House Conference on Mental Health Renews request for MH spending and program details

For Immediate Release: June 3, 2013
Contact: Dain Pascocello, 202.225.2301

Washington, D.C. — Congressman Tim Murphy (PA-18), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, renewed his call today for the White House Office of Management and Budget (OMB) to ...release information related to the federal government’s funding of programs to treat the seriously mentally ill.

Today, Chairman Murphy is participating in the White House’s National Conference on Mental Health, led by President Barack Obama, to “discuss how we can all work together to reduce stigma and help the millions of Americans struggling with mental health problems recognize the importance of reaching out for assistance.”

In a letter delivered to the President, Chairman Murphy asked that the White House comply with an April 10, 2013 committee request to OMB Acting Director Jeffrey Zients to detail all programs dedicated to the treatment and research of mental illness, the amount each program receives annually, and the amount dedicated to the treatment of serious mental illness. Zients has failed to respond to the Committee request.

“We need to get a handle on how much is spent, where it goes, and if federal tax dollars are being used to effectively diagnose, treat, and research mental illness,” said Chairman Murphy. “An audit of spending on federal mental health programs enables Congress to make informed decisions so we can fix our broken mental health system and hold agencies accountable if funds are not getting down to the level of helping patients and supporting families.”

Murphy has been investigating both the social barriers to mental health reform as well as the effectiveness of existing federal mental health programs in his subcommittee’s ongoing review.

At an May 22 Oversight hearing to examine federal spending on serious mental illness at the Substance Abuse and Mental Health Services Administration (SAMHSA), Murphy and committee investigators revealed questionable spending, including $22,500 to commission a painting, more than $80,000 on a staff-directed musical skit, and hundreds of thousands of dollars on questionable conferences (such as “Unleash the Beast”) during which individuals with serious mental illness were encouraged to stop taking their medications.

“The wasteful spending and failed programs at SAMHSA need to end. Resources are desperately needed for science and evidence based treatment programs,” said Murphy. “Federal programs intended to help patients are actually endangering the lives and the public by discouraging the seriously mentally ill from taking medication or seeking clinical help. It’s as if SAMHSA doesn’t believe serious mental illness exists.”

Text of the letter follows:

June 3, 2013

The President
The White House
1600 Pennsylvania Avenue, Northwest
Washington, DC 20500

Dear Mr. President,

In the wake of the tragic violence at Sandy Hook Elementary School in Newtown, CT, the link between mass violence and mental illness has received renewed attention. Even more so, we are once again confronted with the fact that serious mental illness is an area that demands greater attention, so that we may help individuals and families in need.

Towards that end, I welcome and commend your efforts through the National Dialogue on Mental Health to work on reducing stigma, fostering greater understanding, crafting appropriate policies, and directing resources to programs that most effectively help individuals with serious mental illness.

As you know, immediately after the tragedy in Newtown, Connecticut, the Committee on Energy and Commerce began examining violence, serious mental illness and federal mental health programs with an understanding that, in nearly every episode of recent mass violence, there is a perpetrator who has an untreated or undertreated serious mental illness.

Members of this Committee have sat down with the nation’s leading researchers and clinicians on serious mental illness. In addition, Committee staff has met representatives from numerous federal agencies involved in mental health research and treatment, including the National Institute of Mental Health (NIMH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicaid and Medicare Services, and various groups and stakeholders to better understand what federal programs exist and whether they are effective.

On March 5, 2013, the Subcommittee on Oversight and Investigations, which I chair, held a bipartisan public forum, “After Newtown: A National Conversation on Violence and Severe Mental Illness,” to focus on mental health treatment and research into serious mental illness and violence. The Oversight Subcommittee also heard from experts who are on the forefront of treating the seriously mental ill and conducting research. Based on the discussion that took place at this forum, the Subcommittee has held two more hearings: “Does HIPAA Help or Hinder Patient Care and Safety?” on April 26, 2013, and “Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill,” on May 22, 2013.

Through the work of the Committee, serious questions have been raised on whether federal resources are being directed to evidence-based programs that are most effective at treating the seriously mentally ill. We know that various agencies across the federal government have different programs for the care and treatment of the mentally ill. To determine exactly what funding and programs exist, the Committee sent a bipartisan letter on April 10, 2013, to Office of Management and Budget (OMB) Acting Director Jeffrey Zients, requesting that OMB compile a list of all programs, the amount each program receives annually, and the amount dedicated to the treatment of serious mental illness. As of today, the Committee has not received a response to this letter.

Mr. President, we know that the seriously mentally ill are far more likely to be victims of violence than perpetrators. We also know, though, from the testimony of experts who have appeared before the Committee that those who suffer from serious mental illness, like schizophrenia, bipolar disorder or major depression, are two or three times more likely to exhibit violent behavior – to themselves or others. They are one of the most vulnerable populations, not only because they are more likely to be victims of violence, but also because there does not appear to be a coordinated system for helping these individuals or their families get treatment. Further, some with the most serious mental illnesses may not even recognize that they are sick and refuse treatment.

Tragically, these violent acts are wholly preventable, but effective treatment and hospitalization has been replaced with homelessness and incarceration. Nearly a third of homeless persons have a serious mental illness, and in some prisons, half of female inmates and twenty percent of male prisoners have a mental illness.

Given our shared commitment in finding solutions, I respectfully ask your assistance, Mr. President, in securing the information requested by the Committee. With this information, we can ensure federal funding is reaching those with serious mental illness and those programs provide the most effective care because tragically, less than half of children and adults with diagnosable mental health problems receive treatment.

Thank you for your attention to this matter. I look forward to working together to fix our broken mental healthcare system so we prevent tragedies like Newtown from occurring again and give families the hope and resources they need to help loved ones suffering from illness.

Sincerely,

Tim Murphy
Member of Congress

Andrew Cohen, "In our zeal to dehumanize criminals we have allowed our prisons to become medieval places of unspeakable cruelty so far beyond constitutional norms that they are barely recognizable."

USA Today allows Pete Earley to share the real truth! Obama deserves praise for focus on mental health, but failed to invite right experts.

When it comes to sharing the truth on how it really is in America, Mr. Earley writes the truth with exceptional skill!

Personally, I can only judge what is happening across Kentucky with the 'untreated and seriously mentally ill', based on our own nightmares and what I hear from other families.  (I hear more than my share of stories, that I'm not allowed to write about due to fear of our family members losing services -- fear of discrimination they may lose opportunities or jobs  -- or worse due to pending criminal hearings.)

In my humble opinion, Kentucky like many other states, could adopt, fund and provide the best medical services/Medicaid expansion possible, the best supportive housing/employment programs imaginable, the best Assertive Community Treatment Teams and Mental Health Courts -- yet, 'without a Judge's order for a realistic Assisted Outpatient Treatment program', there will still be a large percentage who will fall through the cracks, end up in jail or homeless.  Kentucky will still waste state dollars and sadly, these individuals, (often very young adults) will not receive medical attention for their condition due to their own civil rights and the laws in place!

This is insane, but more so inhumane.

Currently, SAMHSA dollars provide funding to several Kentucky agencies. I am most familiar with how the  Kentucky Dept of Behavioral Health Developmental and Intellectual Disabilities provides block grants that help support the NAMI affiliates. These funds are used to support NAMI's siguature programs such as the NAMI Family to Family classes, conferences, peer centers and training. These classes and workshops help many families and individuals dealing with a mental illness, learn how to cope with one of the most challenging health conditions on the planet. We can only be thankful for appropriate use of these dollars, but baffled by the evidence of miss use of other funds across America. (Please watch video of hearings for more detail.)

Thank you USA Today, Mr. Earley and other national advocates for reporting these hearings while the national medial focuses their attention elsewhere.

Thank you Rep. Tim Murphy, R-Pa, for chairing a House investigative subcommittee and looking into the real problems. http://energycommerce.house.gov/hearing/examining-samhsas-role-delivering-services-severely-mentally-ill

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Obama deserves praise for focus on mental health, but failed to invite right experts.

Pete Earley 6:11 p.m. EDT June 4, 2013

President Obama deserves credit for hosting a White House summit on mental health on Monday, but the White House forgot to invite the people who arguably deal daily with more mentally ill persons than anyone else.

No police officers, sheriff's deputies, correctional officers, probation officers or judges spoke at the summit. No high ranking Justice Department official attended. Nor was there any detailed mention by the president or his hand-picked speakers about the recent mass murders in Newtown, Conn., Aurora, Colo., and Tucson or on the Virginia Tech campus committed by young men with diagnosed mental disorders.

Given that the summit was prompted by last December's Sandy Hook Elementary School mass shooting, the aversion by the White House to actually discuss that shooting is disheartening.

By the federal government's own admission, more than 360,000 individuals with severe mental illnesses, such as schizophrenia and bipolar disorder, are currently incarcerated in American jails and prisons. More than a half million are on probation. More than a million go through our criminal justice system each year. The largest public mental facility in our nation is -- not a treatment center -- it is reputably the Los Angeles County jail.

How could the White House ignore these troubling statistics at a mental health summit or the frightening reality that our jails and prisons are today's de facto mental asylums? How could law enforcement and criminal justice officials be excluded from conversations about how to reform our mental health care system? How could a presidential summit be held without anyone talking in detail about the mass killings that made it necessary?  

Read more here:

http://www.usatoday.com/story/opinion/2013/06/04/pete-earley-on-obama-and-mental-health/2389313/

Solutions: Sickness in the system - stopping cycle of mentally ill

A massive overhaul is needed in Kentucky's mental health system!

Is ACT, (Assertive Community Treatment) the solution? Will ACT benefit the most seriously mentally ill individuals who lack insight they are ill, (anosognosia)? Will their civil rights still trump their ability to access treatment, without changes in Kentucky's outpatient treatment law?

Please post your comments here, or on the link under the WDRB story. 

Solutions: Sickness in the system - stopping cycle of mentally ill

Brian Stettin testified in pending legislation, Why the Stakes Are So High

From Treatment Advocacy Center:

Why the Stakes Are So High

(March 21, 2013) Among the critical contributions we make to mental illness policy reform is testifying in support of pending legislation that would make treatment possible for more individuals in psychiatric crisis.

The following excerpt from testimony delivered this week by Policy Director Brian Stettin relates to a bill pending in Maryland that would improve the inpatient commitment standard. The case he makes, however, is relevant to public policies that affect individuals and families living with untreated severe mental illness from coast to coast.

First and foremost, I would like to point out why the stakes are so high for the families here today and the thousands of Marylanders they represent.

These families are keenly aware of the enormous strides that medical science has made in recent decades to offer real hope of recovery to people with severe mental illness. The key, of course, is to get those individuals under medical treatment.

We know, for example, that people who are receiving treatment for a severe mental illness are no more likely to engage in violence than anyone else and that treatment is the key to maintaining strong bonds with friends and family, as well as to avoiding hospitals and jail. 

But securing that treatment for a family member in psychiatric crisis can be harrowingly difficult. A primary reason for that is anosognosia, a symptom of brain dysfunction which afflicts many – though by no means all – people with schizophrenia and severe bipolar disorder. A person with anosognosia is simply unable to recognize his own illness – no matter how painfully obvious it may be to everyone around him. The person is convinced to the core that he is perfectly fine. And so, quite naturally, he rejects all efforts to get him into treatment. 
 
That is what the families here today are grappling with – watching the people they love fall apart, truly unable to seek voluntary help or accept it when offered, because their diseases prevent them from seeing that anything is amiss. Which, I hasten to add, is not to say that they are perfectly happy in their current condition. On the contrary, many lead lives of daily torment, with no way to escape terrifying delusions.

And so at some point, we as a society must decide what we’re going to do: either leave the person to face the consequences of that “choice” to refuse treatment or to override that “choice,” as we might hope others would do for us if we were to come untethered from reality.

And this is where Maryland’s civil commitment law comes into the picture.
This is where every state’s civil commitment laws come into the picture. Advocates anywhere are encouraged to adapt the message for their own use in promoting treatment law reform and implementation.
To comment, visit our Facebook page.

http://www.treatmentadvocacycenter.org/about-us/our-blog/100-md/2272-parents-beg-maryland-laws-need-to-change

Kentucky Mom speaks out to make a difference!

When mentally ill kids become legal adults, getting them proper treatment shows gaps in system  

Written by: Chris Kenning

LEXINGTON, KY. — Joann Strunk’s “roller-coaster ride through hell” began nearly 10 years ago when her then 16-year-old daughter, Sarah, began hearing voices.

Sarah was diagnosed with schizophrenia, and her young life became marked by hallucinations, angry outbursts and depression. There were hospitalizations and several suicide attempts.
For Joann, a single mother, handling a severely mentally ill daughter while navigating a fragmented system of care with limited insurance was a constant struggle. But when Sarah became a legal adult and Joann was no longer in charge of her treatment, things got much tougher. 

Please take the time to read the entire article here. The closing statements by Joann's daughter, Sarah are profound. Her words resinate the pain of surviving a life with mental illness. http://www.courier-journal.com/article/20130317/NEWS01/107120005/-1/EXTRAS34/

"Please share a few words of wisdom and support, (in the comment section either here or on the Courier-Journal's website) for this brave Mother and her daughter, who have exposed their painful journey in hopes a better system of care will develop in Kentucky!"

GG Burns, Mental Health Advocate and Blogger

_________________________________________________________

Please email the Courier Journal and thank them for writing and sharing Sarah's and Joann's story at: Managing Editor, Jean Porter, (502)
582-4244,  jporter@courier-journal.com and"Chris Kenning" "Chris Kenning" ckenning@louisvil.gannett.com