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

AOT Myths: Debunked

There is a lot of misinformation about assisted outpatient treatment.

Here is a quick look at some of the myths and realities involved.

MYTH: Assisted Outpatient Treatment is going to fill hospital wards.

REALITY: Assisted Outpatient Treatment is designed to help people succeed out of the hospital. It helps those with a history of non-compliance induced dangerousness comply with treatment and therefore prevents them from deteriorating to the point where they need hospitalization.

MYTH: Assisted Treatment will empty hospital wards.

REALITY: Inpatient hospitalization will still be needed for those incapable of surviving safely in the community. Assisted outpatient treatment facilitates early short-term rehospitalization for those noncompliant and likely to become dangerous.

MYTH: Assisted outpatient treatment does not work.

REALITY: Studies in Iowa, North Carolina, Hawaii, Arizona and other states have definitively proven assisted outpatient treatment works.

MYTH: Assisted Outpatient Treatment will bust the budget.

REALITY: Assisted Treatment is not expensive because it does not mandate any services that individuals with brain disorders are not already entitled to (example: case management, medications, rehabilitation). Assisted Outpatient Treatment Orders merely require the system to facilitate compliance for non-compliant individuals by giving them the services they need to keep well and the surrounding community safe.

MYTH: Assisted outpatient treatment is unconstitutional.

REALITY: Forty-one states and the District of Columbia have assisted outpatient treatment laws. The Supreme Court has overturned none of these laws.

MYTH: Assisted treatment infringes on civil liberties.

REALITY: It is the illness, not the treatment that restricts civil liberties. Medicines can free individuals from the “Bastille of their psychosis” and enable them to engage in a meaningful exercise of their civil liberties. Assisted outpatient treatment cuts the need for incarceration, restraints, and involuntary inpatient commitment, allowing individuals to retain more of their civil liberties.

For more information: www.treatmentadvocacycenter.org

Anosognosia Fact Sheet

When a person cannot appreciate that they have a serious psychiatric illness, a tremendous challenge to family members and caregivers follows. About one-half of people living with schizophrenia, and a smaller percentage who live with bipolar disorder, have this clinical feature. Individuals with Alzheimer's disease and dementia also often have this feature. The medical term for not seeing what ails you is anosognosia, or more commonly known as a lack of insight. Having a lack of awareness raises the risks of treatment and service nonadherence. From the person's point of view, if they feel they are not ill why should they go to appointments, take medication or engage in therapy?

Why can't a person see what is so apparent to those around them? The best thinking indicates this is a core feature of the neurobiology of the conditions. Frontal lobes organize information and help to interpret experiences. In conditions like schizophrenia and Alzheimer's disease, frontal lobe difficulty is central to the neurological processes that underlie the disorders. Psychological denial is not the reason for the lack of insight in these illnesses.

There are situations where a person's lack of insight can, at times, create dangerous situations. This combination of no insight and dangerous acts often requires intervention. In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT), also known as outpatient commitment. AOT status requires a person to engage in treatment and gives the state authority to bring the person to a treatment center if they do not. All states that have these laws have protections and a process for assessing whether this intervention is appropriate. In most states, doctors are required to submit an affidavit of the person's state and the reasons for the requested AOT status and a judge decides.

NAMI: www.nami.org

LEAP: I Am Not Sick I Do Not Need Help by Xavier Amador

AOT: For a list of current state laws see www.treatmentadvocacycenter.org

Violence Against Homeless Persons

By:David Christiansen

In the dark hours early on August 27, while sleeping behind a building near Winchester Road in Lexington, a 61-year-old homeless man was set on fire. He is currently in intensive care at UK hospital, but is expected to survive. So far the police have no suspects in this hate crime.

However, the incident is not considered a hate crime at all because current law does not include homelessness as a eligible category for such an offense. The National Coalition for the Homeless is seeking to change that. In their on-going effort to highlight this type of crime, they publish a bi-annual report detailing their research into hate crimes committed against homeless people. In their most recent edition, Hate Crimes against the Homeless: Violence Hidden in Plain View, they tabulated these crimes from across the country. Kentucky is barely noted in their statistics with just 3 incidences in the last twelve years (California had 225 and Florida 198). These statistics exclude any acts of violence committed by homeless individuals against each other and a crime is included only if the attack was primarily motivated because the victim was a homeless person. The scope of the problem is highlighted in the report as follows:

"Over the past twelve years (1999-2010), hundreds of homeless people have been attacked and killed. While this report provides alarming numbers, many attacks go undocumented. Homeless people are treated so poorly by society that their attacks are often forgotten or unreported. In 2010 alone, one hundred thirteen incidents resulted in twenty-four deaths. Since 1999, The National Coalition for the Homeless has recorded one thousand, one hundred eighty-four acts of violence that have resulted in three hundred twelve deaths".

Another section of the report seeking to understand factors associated with these hate crimes, states that:

"There is a documented relationship between increased police action and the increasing numbers of hate crimes/violent acts against homeless people. Many cities...... have enacted severe anti-camping, panhandling, anti-feeding, and other criminalization of homelessness laws. Many of these cities ..... are also cities where hate crimes against homeless individuals have frequently occurred. One possible explanation for this is the message that criminalizing homelessness sends to the general public: “Homeless people do not matter and are not worthy of living in our city.” This message is blatant in the attitudes many cities have toward homeless people and can be used as an internal justification for attacking someone who is homeless".

Homelessness in Lexington has been accorded increased attention recently with a number of city ordinances proposed to our City Council and now under review, including such items as a "nuisance" ordinance to give police more options to control unwanted street behavior and another proposed ordinance change that requires any group planning to open a daytime drop-in center for homeless persons to undergo greater public scrutiny before being allowed to proceed. In addition, the city's Board of Adjustment is moving forward with closing down the Community Inn, a shelter for homeless men and women operated under the auspices of Emmanuel Apostolic Church.

The Mayor has recently established a Commission on Homelessness to address these and other homeless issues in Lexington. Given concerns about increasing violence against homeless persons and public policies that seek to criminalize homelessness, it seems far better for our city to approach concerns regarding homelessness in a collaborative and compassionate way as an inclusive community and not slip into the ugly and hostile patterns to which some cities have succumbed. As we increasingly move toward objectifying homeless persons as "them" and not "us", we risk our sense of community.

"We are not enemies, but friends. We must not be enemies. Though passion may have strained it must not break our bonds of affection". It is time to better appreciate these words spoken by Kentucky's most famous native son, Abraham Lincoln. Our city will be far better served by allowing ourselves to listen to "the better angels of our nature", as Lincoln suggested, as we seek to understand and find solutions for homelessness. Demonizing our homeless neighbors as the enemy will only lead to more fear, hatred and violence.

David Christiansen, MSW
Executive Director
Central Kentucky Housing and Homeless Initiative

Read the edited version of David's Story here on the LHL.

Demonizing the homeless leads to fear and violence

Read more here: http://www.kentucky.com/2012/09/10/2330686/demonizing-the-homeless-leads.html#storylink=cpy

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Read more here: http://www.kentucky.com/2012/09/10/2330686/demonizing-the-homeless-leads.html#storylink=cpy

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