(Oct. 23, 2014) Two hours after entering jail, young mother Kathryn Schneider was found hanging in her cell following an apparent suicide. Her history of mental illness and suicide attempts were well known to the Koochiching County jailers ("Koochiching County jail suicide highlights lapses in care of mentally ill,” Oct. 14).

Despite her known history of mental illness and suicide attempts, Kathryn was not screened for medical or mental health problems on the night of her death - checks that could have been instrumental in saving her life.

“I feel betrayed by law enforcement. Katie had put herself in an environment where she was supposed to be kept safe,” Schneider’s sister stated in the aftermath of Kathryn’s death.

Video footage shows “a woman who methodically prepared to end her own life” and that nobody tried to stop her.

“It is apparent that facility staff needs significant retraining,” said a senior Corrections Department inspector. “This includes holding supervisors and line staff accountable.”

But Kathryn’s suicide reflects problems not only in Minnesota jails but also in the prison system at large. Most county and federal prisons are poorly equipped to treat patients with mental illness. Prison and jail officials are being asked to assume responsibility for the nation’s most seriously mentally ill individuals, despite the fact that the officials did not sign up to do this job; are not trained to do it and face severe legal restrictions in their ability to provide treatment for such individuals.

What’s more is that people with mental illness should not be landing in jails and prisons in the first place. Today, there are ten times more patients in jail instead of in a psychiatric hospital, according to our study "The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey."

There is clearly something wrong with a system when people with a psychiatric disease end up behind bars rather than in treatment. 

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(Oct. 22, 2014) To help meet the demand for evidence-based information on mental illness treatment issues, the Treatment Advocacy Center has named 13 esteemed psychiatrists – three of them past presidents of the American Psychiatric Association – as founding members of the organization’s Psychiatric Advisory Board.

“As public and official awareness of mental illness issues has grown in the last two years, the unique role of the Treatment Advocacy Center as a central source of data and as the leading mental health organization that drives public policies for the most severely ill has made us a clearinghouse for informed background and comment,” said E. Fuller Torrey, M.D., honorary chair of the panel.

“The agreement of these esteemed psychiatrists to make their extraordinary clinical and scientific knowledge available will give the organization even greater capabilities,” Torrey said.

Members of the panel were nominated and approved by the Treatment Advocacy Center Board of Directors. Dr. Mike Knable, executive director of the Sylvan Herman Foundation, will serve as chair.

See the complete list of psychiatrists joining Drs. Knable and Torrey on the founding board.

(Oct. 21, 2014) Diagnosed with paranoid schizophrenia, 68-year-old Nancy Wenzel has spent the last two decades cycling in and out of psychiatric hospitals, homeless shelters or living on the streets.

When Joseph Parker, Wenzel’s son, reunited with her after nearly two decades earlier this month, Wenzel was sleeping on a cement slab next to an abandoned restaurant. Parker determined he would get his mother into treatment (“A son fights to save mother from Fitchburg streets,” Telegram and Gazette, Oct. 20).

He did not know how difficult that would be in Massachusetts.

Parker tried to bring his mother to the local hospital in attempt to get her back onto medication, but she refused treatment.

“The mental health program is not for me,” she said. She also accused Parker of posing as her family.

Parker was told by hospital staff that if he tried to get his mother to stay against her will the hospital would call the police and Wenzel could press charges against her son for kidnapping.

“They said it is all about human rights, but it is not a human right for her to go homeless, refuse medications and treatment and kill herself,” Parker told the Telegram and Gazette. “I think I have a human right to intervene with my mom and not watch her die on the streets."

But in order for someone with severe mental illness, like Wenzel, to qualify for court-ordered treatment in a hospital in Massachusetts, she would need to be a danger to herself or to someone else.

"I cannot fathom for the life of me how difficult it is to help your loved ones," Parker said. "How a man-made law on the books trumps my human right to help my mother. There has to be a better way.”

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(Oct. 20, 2014) Orange County rolled out Laura’s Law at the beginning of this month for the most hard-to-reach people with severe mental illness (“How can Laura’s Law help Orange County’s mental health community?,” Oct. 20).

John and Susan, who have an adult daughter with severe bipolar disorder, have seen their daughter cycle in an out of hospitals more times than they can count. Each time she leaves the hospital she stops taking her medication because she does not believe she is ill, only to end up in the hospital again.

Now they will count on Laura’s Law for help, they say.

Key benchmarks of implementation in Orange County will include a county behavioral health team to engage patients with individual services like health care, housing, life skills training and for some, court-ordered medication.

“This is another tool to get people into services,” said Anthony Delgado, a county adult behavioral health division manager.

Nevada County launched the program in 2008. Since then the consequences of untreated mental illness have declined by nearly 50 percent for county participants with severe mental illness. Homelessness has dropped 54 percent, days spent behind bars have declined 52 percent and days spent in a psychiatric hospital have declined by 43 percent.

“Achieving lasting treatment for these individuals is not impossible,” said Carol Stanchfield, a licensed therapist and treatment center director in Nevada County. “People are going to get better.”

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(Oct. 17, 2014) People with serious mental illness are often rendered invisible, writes Liza Long in the Idaho Statesman (“Guest Opinion: Ignoring the mentally ill won’t make them go away,” Oct. 10).

Long drew her observations after speaking with members of her community who live with severe mental illness at a lunch in her hometown of Boise, Idaho.

“They just want to sweep us under the rug. We are invisible. People want to pretend we don’t exist,” said David who spoke up about his struggles. Another attendee said he could barely afford the cost of medications he needs to manage his mental illness.

Stories like these highlight the destitution the most severely ill often face, frequently further complicated by insurance issues.

A large majority of people with severe mental illness are underinsured, covered by Medicaid or not insured at all.

Medicaid is now the single largest payer of mental health care in the United States, and psychiatrists, including those in community-based hospitals and clinics, academic medical centers, and private practice, play a central role in treating Medicaid beneficiaries with serious mental illness.

“Medicaid expansion would go a long way to helping adults who have mental illness,” Long said. But in states choosing not to expand Medicaid, things will likely only get worse for people with SMI.

Idaho, which has chosen to reject the expansion, will likely see a substantial loss of funding for state hospitals and additional psychiatric bed loss.

The flip side of rejection could mean more people in psychiatric crisis will fill emergency departments, end up in jail or prison or among the homeless population.

“Mental illness is not a personal choice or a character flaw,” wrote Long.

Our public policies need to reflect that.

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(Oct. 16, 2014) Bodio Hutchinson stabbed two park rangers several times after they responded to calls that he was threatening passersby with a knife at the Boston Common in Boston, Massachusetts.

Hutchinson, a homeless man diagnosed with paranoid schizophrenia, has a long and sordid history of violent and bizarre behavior, including unprovoked attacks on strangers. He punched a woman in Newtown Square and bit the man who came to her aid last year. In total, he has over 17 convictions.

When one of his convictions led to jail time at Nashua Street Jail in 2010, it took nine officers to restrain him during a violent outburst.

But “perhaps the worst part of this is that through it all, our court and mental health systems have been utterly useless — unable to save Hutchinson from himself, or to protect us from him,” writes Adrian Walker for the Boston Globe (“Why couldn’t anyone stop Bodio Hutchinson?” Oct. 16).

Hutchinson’s lawyers say he struggles to understand reality and that he has no memory of the attack.

“That’s tragic,” says Walker. “But his daily struggle shouldn’t imperil anyone who happens to cross his path. Plainly our mental health system doesn’t seem to be up to the challenge posted by a 290-pound paranoid schizophrenic.”

Walker wonders why our mental health system is failing people like Hutchinson. He implores legislative candidates to stop paying lip-service to mental illness treatment issues and actually take action.

In Massachusetts, where there is no assisted outpatient treatment (AOT) law and a high threshold for inpatient treatment, passage of AOT and less restrictive inpatient treatment criteria would be a great place to start.

 

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(Oct. 15, 2014) Kevin Briggs recalls the day in 2007 when he was unable to talk a jumper back from the ledge of the Golden Gate Bridge in an interview with Gregg Zoroya for USA Today (“The cost of not caring: The suicide crisis,” Oct. 9).

Briggs, a California Highway Patrol officer, has talked many potential jumpers back from the ledge of San Francisco’s most famous bridge and is one of the searing stories presented in USA Today’s examination of suicide as a consequence of letting people with mental illness fall through the cracks of our fragmented treatment system.

The lifetime risk of suicide among individuals with schizophrenia is about five percent and about 10 to 15 percent for people with bipolar disorder, according to a Treatment Advocacy Center backgrounder.

“The country seems almost complacent with this staggering death toll,” writes Zoroya. “But the suicide rate keeps climbing.”

My son would be alive today if there had been a way to keep him medicated, Pat Milam said. Milam’s son killed himself in 2011 with a homemade explosive and frequently refused treatment for his mental illness.

But most lawmakers are not interested public policies that would provide treatment for people at risk for suicide. “If the public doesn’t think you can do anything about it, they won’t support it,” said Alex Crosby, a CDC epidemiologist. (HR 3717 does provide a glimmer of hope for the most severely ill).

“The nation must find a way to treat despair before the only resort is a police officer begging someone not to jump,” Briggs told USA Today.

We couldn’t agree more.

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(Oct. 9, 2014) Stories of homelessness, addiction, violence and suicide attempts were told by nearly three dozen speakers who have a loved one with severe mental illness in Contra Costa, California, earlier this week.

Many of the family members spoke of loved ones who are too sick to recognize their own illness and requested tools to help the mentally ill into treatment (“Helping the severely mentally ill who don't realize they need to be helped,” Contra Costa Times, Oct. 8).

The pleas for help were directed toward the county supervisors, who were considering implementing Laura’s Law to allow assisted outpatient treatment (AOT) for the most severely ill.

If Laura’s Law had existed three years ago, my son would not be charged with a murder he doesn’t understand he committed, said the mother of a man diagnosed with paranoid schizophrenia.

Another mother told the story of her son, “who refuses to see doctors, take medication or accept counseling,” she said. “For three years he’s been in and out of police cars, ambulances, emergency rooms, psychiatric wards and back onto the streets.”

Even though all five supervisors said Laura’s Law has value, only two supervisors voted in support of implementation and the decision was extended for an additional 90 days while the board waits for a cost analysis.

"We need to help those who don't realize they need a treatment plan,” said Mary Piepho, one of the supervisors who voted in favor of implementing the court-ordered outpatient treatment program. “The point is to prevent crisis before it occurs."

Contra Costa shouldn’t wait too long to offer this life-saving tool to its most severely ill. In May, Orange County supervisors voted unanimously to adopt Laura’s Law and July saw San Francisco and Los Angeles vote to fully implement the program – covering more than 14.5 million Californians and making the state a better place to live.

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(Oct. 8, 2014) For more than 20 years, I have watched a family member ride the roller coaster of Washington’s mental-health system. This has included countless stints at most of the state’s psychiatric hospitals, arrests, incarcerations, suicide attempts and victimization of others.

For short periods, especially while under court order, there were times of wellness. My family member is part of a subset of the mental-health population that is severely ill and hard to treat due to frequently disregarding the need for treatment.

The Washington public mental-health system has never been able to provide proper treatment for my relative. Partly, this is because Washington’s legal criteria for mandated inpatient and outpatient psychiatric treatment are, quite illogically, the same. The other reason is that Washington lacks enough inpatient psychiatric treatment beds and a budget to fund them.

Budget permitting, the current laws mandate a crisis-oriented system. If a person is severely mentally ill and unable to realize and manage it due to the illness, the roller coaster is a way of life.

The only way a person can be court-ordered into less-restrictive outpatient treatment in Washington is after reaching the point of inpatient hospitalization or after incarceration.

No system in Washington exists to ensure that the small subset of mentally ill people prone to dangerousness receive mental-health care if the need exists on a continuous basis. No legal avenue exists for concerned others to petition for those in need to receive such services.

From a taxpayer perspective, incarceration and hospitalization are financially costly. From a citizen perspective, there are other costs.

In 1999, New York state effectively addressed the issues that Washington has yet to. Kendra’s Law, legislation backed by National Alliance of Mental Illness, is named after a woman pushed to her death by a man who was severely mentally ill.

Kendra’s Law differentiates the legal criteria for mandated outpatient treatment with a petition process. Concerned loved ones and professionals can petition. Stringent criteria must be met. The criteria include, but are not limited to, a person having severe, untreated mental illness and a history of risk to self or others. The people who qualify for treatment under Kendra’s Law account for about 10 percent of very ill psychiatric patients. Left untreated, this 10 percent makes up about one-third of the homeless and nearly a fifth of incarcerated populations.

In Washington, the question that seems to come up most often regarding Kendra’s Law is: What about civil rights? There is not much further a person can be limited regarding civil rights than incarcerating them or placing them in an inpatient setting involuntarily.

Also, Kendra’s Law does not mandate medication. And Washington state is already doing what New York is, but only after use of more restrictive means. Regarding my observation of wellness cycles of my relative, studies of Kendra’s Law indicate that the very presence of a court order may be a critical ingredient of its effectiveness.

Multiple independent studies of Kendra’s Law show reduction in inpatient hospitalization, homelessness, arrests and incarceration among participants. Costs to New York’s mental-health system decreased by 50 percent in the first year after legislation of Kendra’s Law and continued to fall in following years.

Washington needs to take a cue from a cost-saving legislation like Kendra’s Law. Washington also needs to work on funding psychiatric beds and jails, reducing recidivism, increasing public safety and saving people from self-harm.

Kendra’s Law has proved to do all of this. Washington needs solutions to the mental-health system’s inability to meet the needs of those who are most ill and unsafe while not increasing costs to taxpayers. The solutions exist. Part of the solution is working in New York. It is time for Washington to pay attention.

Jaffee's column originally appeared in the Seattle Times.

Rachel Jaffee has worked in social services for around 15 years, including mental health. She is studying for a master’s degree in social work at the University of Southern California.

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(Oct. 6, 2014) Before you vote in the November elections, ask the legislative candidates if they would vote for laws that would help people with mental illness get the care they need, plead Doug and Nancy Reuter in an op-ed for the Seattle Times (“Ask candidates about reforms to mental-health care and Joel’s Law,” Sept. 24).

The Reuters’ son, Joel, suffered three psychotic episodes over nine years.

The first two psychotic episodes occurred while the family was living in Arizona. During each episode, the Reuters signed papers to have their son involuntarily committed to treatment in a hospital.

Having our son committed “was the hardest thing we had ever done,” they said. “But . . . at least Arizona’s law allowed us to get him timely help.”

In Joel’s case, “help” in Arizona meant both court-ordered outpatient and inpatient treatment.

Joel suffered a third psychotic episode after he moved to Washington. But Washington state law required that Joel be gravely disabled or a danger to himself or to someone else before he received involuntary treatment.

Dozens of calls made by family and friends who could see that Joel was deteriorating and needed treatment went unanswered. When they were answered, the family was told that Joel would need to have a loaded gun in his hand with his finger on the trigger to get help.

When he finally did get into treatment, it only lasted 14 days and there was never any follow-up after he was released.

Three weeks after Joel was released from the hospital, in the middle of a psychotic episode, Joel aimed a gun at police because he thought he was killing zombies. The police responded with fire and Joel’s life ended in tragedy.

To prevent tragedies like this, incoming state lawmakers and Governor Jay Inslee must provide more psychiatric beds and improve the assisted outpatient treatment (AOT) law for people with severe mental illness, urge Joel’s parents.

“Let’s adopt a policy of treatment before tragedy.”

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