(Feb. 10, 2015) HIPAA privacy laws kept doctors from sharing important medical information with Livia Ligett's family about her brother’s illness, she said. Now she is grappling with the death of her mother at the hands of her brother, 26-year-old Ari Ligett (“Family’s tragedy could shed light on privacy laws,” NBC News, Feb 9).

“Everyone in the family assumed he was on his medications,” said Ari’s father, Ron Ligett. “If we had known he was no longer on medication we would have intervened.”

Ari was showing signs of mental illness by age five, according to his family. “He would never explore the outer world. He would only cling to his mother or me – literally cling to our clothes,” said Ari’s father. “He paced incessantly and talked to himself.”

Doctors diagnosed Ari with a range of conditions from autism to schizophrenia.

In 2012, Ari purchased cyanide and began plotting to kill his mother, Beverly Ligett, according to court reports. In October of the same year, Ari managed to convince his mother to ingest the cyanide. After she died he dismembered her with a handsaw.

"I think everyone can read my mind, see past the future and shape change," Ari said during police questioning. Two men had agreed to help him dispose of the body, he told police.

How did such a sick young man fall through the cracks of the mental illness treatment system?

Ari’s sister blames the HIPAA privacy rule.

Just days before her death, Ari’s mother called Ari’s doctors desperate for information about her son’s illness and treatment plans. The calls went unanswered because HIPAA laws prevented the psychiatrist from sharing that information, according to court records of the psychiatrist’s testimony during Ari’s trial.

“Something should have been different and it wasn’t,” said Ari’s sister. “Now I have lost my mother. If that's not an eye-opener for the system failing, I don't know what is."

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(Feb. 9, 2015) The nonpartisan Government Accountability Office this week released a scathing report on the lack of leadership in the Department of Health and Human Services for coordinating federal efforts related to serious mental illness.

It described 112 separate programs in eight federal agencies with little coordination. "The absence of high-level coordination," the GAO concluded, "hinders the federal government's ability to develop an overarching perspective of its programs supporting and targeting individuals with serious mental illness." The report was especially critical of the lack of any formal evaluation mechanism for the majority of the programs, so there is no way to tell whether they are working.

The main target of the report was the Substance Abuse and Mental Health Services Administration, or SAMHSA, an HHS agency that is required by its enabling legislation "to promote coordination of programs relating to mental illness throughout the federal government." In 2003 President George W. Bush's Commission on Mental Health noted the lack of coordination among federal programs. In response, a Federal Executive Steering Committee for Mental Health, led by HHS, was formed. This produced some improvement in program coordination, as noted by the GAO in 2008. But, astonishingly, the Steering Committee hasn't met since 2009.

Not coincidentally, the new director of SAMHSA, Pam Hyde, assumed her position in November 2009. A lawyer by training, Ms. Hyde has made clear that Samhsa's mission is to be mental health, not mental illness. Incredibly, "Leading Change: A Plan for SAMHSA's Roles and Actions 2011-2014" didn't include a single mention of schizophrenia or bipolar disorder, despite running more than 41,800 words.

Ms. Hyde promoted a social worker to be the director of the agency's Center for Mental Health Services, a center that doesn't include a single psychiatrist. There is only one psychiatrist among all of Samhsa's 570 employees and her expertise is in substance abuse, not serious mental illness. Thus it is not surprising that the GAO notes that "coordination related to serious mental illness has been largely absent across the federal government."

Meanwhile, problems related to serious mental illness have continued to get worse. Such individuals comprise at least one-third of the homeless population. And according to our analysis of data from the Justice Department, American Correctional Association and the American Jail Association, there are now 10 times more people with serious mental illness in U.S. jails and prisons than in state mental hospitals. Individuals with untreated serious mental illness are responsible for 10% of all homicides in the U.S. and approximately half of all mass killings.
And what has been Samhsa's response? In September the agency sponsored a "National Wellness Week" during which it suggested that drinking fruit smoothies and line dancing would achieve wellness. And during last month's "historic" East Coast snowstorm, Samhsa opened four hotlines for individuals worried about the storm.

The GAO report was prepared after congressional hearings that culminated with Pennsylvania Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act" of 2013, which gained wide bipartisan support before being killed by the Democratic leadership of the last Congress. That desperately needed legislation included proposals to reform Samhsa and create a leadership position to coordinate federal programs for mental illness. The GAO report strongly supports such a position. Its title says it all: "HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness." The current absence of such leadership is shocking.

Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center
Doris A. Fuller, executive director of the Treatment Advocacy Center

This article originally appeared in the Wall Street Journal on February 6, 2015.

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(Feb. 6, 2015) Echoing years of Treatment Advocacy Center criticism, the nonpartisan U.S. Government Accountability Office (GAO) Thursday issued a devastating, 61-page report that found little evidence the federal agency charged with coordinating mental health programs is serving people with the most severe mental illness.

The Substance Abuse and Mental Health Services Administration (SAMHSA) was specifically singled out for failing to serve people whose welfare they are charged with serving. The GAO report said SAMHSA “has shown little leadership in coordinating federal efforts on behalf of those with serious mental illness.”

“Although SAMHSA is charged with promoting coordination across the federal government regarding mental illness, its efforts to lead coordination – specifically on serious mental illness – across agencies have been lacking,” concluded the report delivered to the House Energy and Commerce Subcommittee on Oversight and Investigations.

Among the problems identified in the report:

• The GAO identified 112 programs spread across eight federal agencies with combined budgets of $5.7 billion in 2013 that might support individuals with serious mental illness but only 30 targeted specifically for this population.
• Of the 30 targeted programs, fewer than half had been evaluated or were scheduled to be evaluated. As an example, a multi-agency committee established to improve coordination for such programs has not met since 2009.
• Few agencies were found to be tracking their programs for serious mental illness, and many were unable to say how much money was actually being spent for the target population or if individuals were actually participating in such programs.

“This is a stunning independent validation of what we been saying for years: The people who need help the most are being neglected by the federal agency responsible for ensuring they get help,” said Doris A. Fuller, executive director of the Treatment Advocacy Center. The GAO found that of the 30 programs specifically targeted for individuals with a severe mental illness, most of those were in agencies like the Veterans Administration and Department of Justice, whose missions don’t include mental health.

The report was prepared in response to a bipartisan request from subcommittee Chairman Tim Murphy (R-PA) and Ranking Member Diana DeGette (D-CO). Subcommittee members heard testimony at a series of hearings exposing a systematic pattern of focusing federal dollars elsewhere than on those with the profound psychiatric diseases such as schizophrenia and severe bipolar disorder. This population, estimated at 10 million by the GAO to include individuals with severe depression, is at significantly greater risk for homelessness, arrest and incarceration, suicide, homicide and a number of other negative results when they do not receive treatment.  

“The Oversight subcommittee wanted to know whether the needs of society’s most vulnerable citizens were being addressed by the federal agencies charged with meeting those needs, especially SAMHSA,” said Fuller. “The GAO found they are not.”

Rep. Murphy introduced in 2013 the “Helping Families in Mental Health Crisis Act” to address the deficiencies exposed by the subcommittee investigation.

(Feb. 5. 2015) A Congressman whose own son struggles with severe mental illness backed a mental health bill in Washington State last week (“Dent backs mental health bill,” Columbia Basin Herald, Jan. 31).

Congressman Tom Dent said his family felt locked out of effective treatment for years after his son was diagnosed with bipolar disorder at the age of 19. Medication helped his son but serious problems arose when he stopped taking it.

“Through the years we helped him as he fought the spiders that crawled up the walls and the snakes that crawled around on the floors," Dent said, describing his son’s torment with psychosis. “We loved him, and we hugged him, and we couldn’t find him help.”

Following an encounter with law enforcement, Dent’s son received three weeks of treatment in a hospital. But when doctors said he was ready to be released, Congressman Dent disagreed.

"They wouldn't listen to me," Dent said.

Joel’s Law (HB1258) seeks to change that. The law would allow immediate family members to petition a court to temporarily commit a loved one with severe mental illness if a mental health professional denies them treatment.

The bill was inspired by Joel Reuter, who was killed in 2013 during a shootout with Seattle police while suffering a manic episode. Joel’s parents, Treatment Advocacy Center supporters and advocates played a major role in getting the bill introduced last year.

The bill passed with a 98-0 vote and now moves to the state Senate.

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The majority of Americans believe that “radical” or “significant” changes are needed in the way the US handles mental health conditions, according to a new poll released Tuesday.

Ninety-six percent of Americans believe mental health conditions are a “serious” public health problem in the US, and 66% believe they are “very serious” concern.

Former Congressman Patrick Kennedy and former Surgeon General David Satcher, M.D., released the findings at the National Press Club during a “State of the Union in Mental Health and Addiction” presentation by the new Kennedy Center for Mental Health Policy and Research.

“We didn’t hear mental health addressed in the President’s State of the Union message,” said Kennedy, who called it “shocking” that mental health is not a bigger part of the federal agenda.

“This should be a tipping point for Congress to act,” Kennedy told the audience and media. “This is a bipartisan issue.”

Among other findings of the telephone poll of 800 registered voters by Public Opinion Strategies:

• 74% of Americans believe the current health care system treats physical health with greater importance than mental health.
• 71% say that “radical” or “significant” changes are needed in responding to mental health conditions.
• The main change they support is expanding treatment options.

Majorities of Democrats, Independents and Republicans – as well as men and women – shared these views, demonstrating anew that mental illness is a bipartisan issue.

As an organization dedicated to improving treatment access for individuals with the most severe mental illness, the Treatment Advocacy Center applauds the polling effort and welcomes the public’s recognition that the mental health system is in need of dramatic change. Passage of the landmark “Helping Families in Mental Health Crisis Act” authored by Rep. Tim Murphy is a perfect place to start.

“The science is in” on mental illness, Kennedy said. “The question is: Are we going to act on it?”

The 114th Congress is now in session. We will soon find out.

The new Kennedy Center for mental Health Policy and Research is a partnership of the Kennedy Forum and a Morehouse School of Medicine grant from the NIH. Satcher is director of the Satcher Health Leadership Institute at the Morehouse medical school.

(Feb. 4, 2015) Yesterday, the Contra Costa County Board of Supervisors voted 5-0 to implement Laura’s Law, making it the eighth county in California to embrace assisted outpatient treatment as a tool for making treatment possible for individuals with severe mental illness. 

“We believe it’s an investment in helping families and people with serious mental illnesses,” Contra Costa County Supervisor John Gioia said in a statement. “We’ve heard from many families (who want) an opportunity to help their own family members.”

First enacted in 2002, Laura’s Law, provides for court-ordered outpatient treatment for individuals with a severe mental illness, but only operates in counties where the board of supervisors authorizes its application.

California has finally reached a tipping point in the implementation of this lifesaving tool. Already, seven counties (Los Angeles, San Francisco, Orange, Nevada, Yolo, Placer and Mendocino) have embraced the law. With the addition of Contra Costa County, the number of Californians with access to Laura’s Law reaches more than 15 million.

We expect many more to come. San Diego’s Board of Supervisors voted last week to create a plan to implement Laura’s Law within the next three months. (“Supervisors support Laura's Law,” UT San Diego, Jan. 27).

We offer heartfelt thank-yous to the advocates who work tirelessly to pass Laura’s Law. Your hard work is paying off for families and people suffering from mental illness across the state.

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(Feb. 2, 2015) Chief of Police Michael Biasotti, a member of the Treatment Advocacy Center board of directors, retired last Friday after ten years with the New Windsor Police department (“New Windsor police chief ends long career,” Mid Hudson News, Jan. 31).

Biasotti is immediate past president of the New York State Association of Chiefs of Police and serves on the board of both the New York State Law Enforcement Accreditation Council and New York’s Executive Committee on Counter Terrorism.

As a prominent member of law enforcement, Biasotti has been a resounding voice for the right of people with severe mental illness to seek treatment, even when they are unable to seek it.

People “who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility,” Biasotti has said. “Unfortunately law enforcement often ends up being a last resort…it shouldn’t be that way. Treatment keeps patients safer. It keeps the public safer and it keeps officers safer. But more importantly, it’s the humane thing to do.”

Biasotti received accolades from the National Alliance on Mental Illness of New York State for “outstanding advocacy on behalf of the seriously mentally ill” in December 2014.

Although Biasotti is leaving his role with New Windsor police, he promises to continue advocating on behalf of people with serious mental illness.

As he left, police officers lined up to salute the departing chief. The Treatment Advocacy Center joins them now, in saluting Biasotti and celebrating his well-deserved retirement.

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(Jan. 30, 2015) Two more California counties are considering implementing Laura’s Law for people with untreated severe mental illness.

Following its board of supervisors’ 4-1 vote last Tuesday, San Diego County will proceed in taking steps to implement Laura’s Law. The Law will give courts power to order treatment for people with severe mental illness under certain conditions (“Supervisors support Laura's Law,” UT San Diego, Jan. 27).

“This is one more tool in the toolbox,” said Supervisor Dianne Jacob. “It’s not going to fix everything, but it is something I believe is going to save lives.”

Contra Costa is also finally considering adopting Laura’s Law for its most vulnerable citizens. If enacted, the law will bring relief and protection to people with severe mental illness and their families.

Laura's Law is named after Laura Wilcox, who was shot to death in 2001 while working at a public mental health clinic in Nevada County. The man who shot Wilcox suffered from schizophrenia and had refused psychiatric treatment.

Under the law, people who have a mental illness, are potentially violent and who refuse treatment can be court-ordered to follow an assisted-outpatient treatment plan.

Studies show that court-ordered outpatient treatment laws such as Laura’s Law can vastly reduce overall costs of tax-supported services associated with severe mental illness by reducing expensive hospitalizations, arrests and incarcerations. Nevada County, which implemented Laura’s Law in 2008, estimates it saves $1.81 for every $1 invested. A Duke University study of New York’s assisted outpatient treatment (AOT) program found it reduced public costs so much that states could actually expand mental health services with the savings from having more people on AOT.

California has finally reached a tipping point as this lifesaving tool gains momentum across the state. Already, seven counties (Los Angeles, San Francisco, Orange, Nevada, Yolo, Placer and Mendocino) have embraced court-ordered outpatient treatment with wraparound services. That means more than 14 million Californians live in counties with Laura’s Law.

We applaud San Diego and Contra Costa counties for working to bring a proven treatment option to its most vulnerable populations.

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(Jan. 29, 2015) “Imagine that you’ve come upon a medical emergency. What’s your first instinct?” This is the question posed by John Wetzel, secretary of corrections for Pennsylvania (“Is treating mental illness the proper role of corrections?” Lancaster Online, Jan. 25).

“Dial 911, and ask for an ambulance,” he writes. “Now, contrast that with coming upon someone having a mental health crisis. What’s your first instinct? Dial 911, and ask for police.”

It should not be the case that people with medical emergencies end up in the hospital while people suffering a psychiatric crisis end up in jail, Wetzel says.

Further, the criminal system should not be adjusting to the influx of people with mental illness, he writes. But, “I’m concerned that the criminal justice system will adjust, is adjusting, and in many cases has adjusted” to the influx of people with mental illness.

“We all need to learn to look at people with mental illness as deserving of treatment and compassion, and that does not necessarily always include incarceration.”

We couldn’t agree more. One way to ensure that the criminal justice system isn’t forced to become the primary way that people with mental illness receive treatment is to make sure that people with serious mental illness get treatment before they end up in jail or prison.

To do this, Pennsylvania might start by improving its civil commitment laws. In a survey of state laws that allow people access to treatment, even if they are unable to seek it, Pennsylvania received a C-.

If Wetzel really wants to reduce the burden of mental illness on the jails and prisons, he should consider promoting common-sense laws that would ensure that the criminal justice system never adjusts to, or accepts, people with serious mental illness.

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(Jan. 28, 2015) Kathy Bruno was hopeful that her son Eric, 24, would finally receive treatment for his schizophrenia after his arrest in 2013. But prison was not the answer she had hoped for, and now Kathy is advocating in the nation’s capital to save her son. (“Erie woman advocates mental health reform in D.C.,” Erie Times-News, Jan. 27).

Officers arrested Eric nearly two years ago after he caused a disturbance in an Erie, Pennsylvania police station while in a psychiatric crisis.

Bruno was initially relieved, thinking he would be sent to a psychiatric hospital given his obvious need. “I thought, ‘Thank God, he is going to get some help and he did not hurt anybody,’” said Kathy.

Instead Eric spent months in the Erie County Prison. Prison staff watched him arguing with himself in front of a mirror in his cell for hours at a time. But despite his obvious need, they could not force Eric to take medication.

Eric was eventually transferred to a hospital for criminal defendants with severe mental illness and stabilized with the help of medication. However, he soon regressed after suffering a concussion during a fight with another defendant.

Bruno shared her story yesterday in front of Congressman Murphy and mental health advocates.

"I am trying to get them to hear," Bruno said. "It is hard to get your adult family member to get treatment if they do not believe they are sick."

"My hope for Eric is that he gets the right type of help,” she continued. “He has to take his medication and on medication he can have a good life. Maybe not a normal life, but a good life.”

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