(Aug. 29, 2014) Like most people with serious mental illnesses, I have as a result of my illness experienced my share of prejudice and discrimination.

I have been denied jobs, lost jobs and had acceptance to grad school rescinded because of my illness. I would probably never have landed the good job from which I am retired had it not been illegal to ask questions about past mental illness on a job application at that time. When I experienced a psychotic episode several years after landing the job, I had proven myself enough of an asset to the company that they decided to keep me on. It was the first time I had an episode without it costing me something substantial. I never advanced from that point on, but I did keep my job.

Now I am over 60 and retired, and I intend to speak out to anyone who will listen. The first thing I want to speak out about is shame.

When I looked up the incidence of serious mental illness from the National Institute of Mental Health (NIMH), I found that more than one percent of the population is schizophrenic and more than two percent are bipolar. Most sites set the figure at four percent of the population with serious mental illnesses. That's a lot of people. Most of us would be astonished to think that four of every hundred people we meet or know are seriously mentally ill.

Like many families, my family never talked about my issues or my mother's, who was twice hospitalized because of a serious mental illness. It was as if mental illness in a family member brought shame upon the whole family. We were ashamed because we had some bad genes.

Society generally seems to believe that unlike a disease of the heart or liver, there is something shameful about a disease of the brain. True, our brain diseases sometimes cause us to behave in embarrassing ways and sometimes in dangerous ways. But I don't feel personally responsible when I do something embarrassing because of my disease. That's not me acting. It's my disease acting. This is not a cop-out or a failure to accept personal responsibility. I have done many things while psychotic that I would never have considered doing when it was me in control and not the disease in control. Should I be ashamed of those things? I don't think so. I regret many of them, but I am not ashamed,

On the day that he resigned as president of the United States, Richard Nixon told his staff that the people who hate you don't win unless they get you to hate them. When people tell us we should be ashamed, we lose when we agree.

It's easy for me to say, “Speak out! Tell everyone about the issues you deal with! Educate everyone you can!” I'm over 60 and retired.

But the gay pride movement proved that public opinion can be transformed if people speak out. It's harder for us -- it's true. Many of us don't know we have a problem. Those of us currently psychotic are unable to articulate our cause. But those of us who have learned how to manage our diseases have an obligation to speak out for all of us. Logically, mental illness is no more shameful than heart disease or cancer.

Whether or not you want to speak out, don't be ashamed.

Joseph Bowers
Author of Life Under a Cloud: The Story of a Schizophrenic
Purchase a copy of the book here.

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(Aug. 28, 2014) Kyle, 24, was kept in solitary confinement for nearly six months at the San Diego Central Jail while waiting to get into treatment for his schizophrenia and bipolar disorder, according to the San Diego City Beat (“Lost in the criminal justice system,” Aug. 27).

“Five-and-a-half months. No medication, in his own cell in isolation,” his mother, Sarah, said. “All he did was sleep.”

Kyle has been in and out of treatment facilities since he was 18. But last June he was charged with assaulting and verbally threatening a police officer nearly a week after walking away from a psychiatric hospital. The encounter was his first with law enforcement and it landed him in jail.

Even though Kyle was diagnosed with a severe mental illness, he waited six months behind bars before a judge declared he was incompetent to stand trial and ordered him into psychiatric treatment at Patton, California’s largest public hospital. He still waited another 70 days in jail before a bed opened up and he was transferred to the hospital.

Kyle is not alone in this type of mistreatment. “Statewide, more than 200 inmates who’ve been declared incompetent to stand trial are waiting in jail,” notes the San Diego City Beat.

Sarah told the City Beat that she hopes the right outpatient treatment program will help her son stay in treatment and out of jail.

Sarah's hope reminds us that San Diego cannot afford to wait to implement Laura’s Law for Kyle and the countless others like him who are also languishing in jails and prisons. Just this week Placer County voted to implement the assisted outpatient treatment law and in the last two months, Orange and San Francisco counties have voted to implement while Los Angeles has expanded its pilot program.

Kyle, his family and everyone else with severe mental illness who is boucing between jail and treatment cannot wait any longer.

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(August 26, 2014) Stigma is one of the most important problems encountered by individuals with severe psychiatric disease, lowering self-esteem, contributing to disrupted relationships and negatively impacting the ability to socialize, obtain housing and become employed.

And it’s getting worse, recent studies report.

The Treatment Advocacy Center’s backgrounder, “What is the main cause of stigma against individuals with serious mental illness?” updated in March 2014, explores three topics:
 
•    Increased stigma against individuals with mental illness
•    The association of violence and stigma
•    How stigma can be decreased

According to the backgrounder, it is “self-evident that stigma will not be decreased until we decrease violent behavior committed by mentally ill persons, and this can only be done by ensuring that they receive treatment.”

Treatment Advocacy Center backgrounders are useful tools for raising awareness about mental illness and treatment issues. For a complete list of backgrounders, visit the “Reports, Studies, Backgrounders” page of our website. To see the Treatment Advocacy Center’s original research, visit our TACReports.org site.

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(August 22, 2014) My beautiful son deserves to receive help in his life and a chance for happiness. But instead, we feel like second class citizens, neglected by friends, neighbors and law makers who slash funding and block access to care.

My name is Nina McDaniel and I am the proud mother and advocate to my 32-year-old son, Michael, who has schizoaffective disorder.

Michael asked us to drive him to the hospital on his grandmother’s birthday in 2010.

“I feel like I am a burden on society and I have no purpose in life, I want to kill myself,” he told the emergency room. I received a phone call from the hospital 12-hours later that they had discharged him and he will be waiting for us on the curb outside.

We went home with Michael and 4 days later, he asked to be taken back to the hospital, getting there via ambulance and finally being admitted. The diagnosis was still chronic paranoid schizophrenia and he was hospitalized for only 7 days. Again and again the same cycle, the hospital has become the revolving door yielding no results toward insight or recovery. Just like other discharges, Michael stopped taking his medicine.

It was obvious that Michael was deteriorating at a rapid rate. Because of mental health laws and falling through the cracks, there was nothing that we could do to intervene. We watched this internal torture and endured the verbal abuse while praying to God to end all our pain. Michael stopped watching television, spent all of his time in the pool room or bathroom and talked to himself continuously.

Michael’s enduring torture is just one symptom of this disease.

It is not a political issue, it is a humanitarian issue. Thousands are being lost every single day and families are falling apart due to the challenges of being a caregiver. Every tragedy that involves severe mental illness makes me wonder if anyone in Washington is listening.

I respectfully challenge members in government and advocacy groups to set aside their differences and take a UNITED stand for mental health.

Nina McDaniel
Mother of Michael
Part I of Nina’s story ran last week.

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(Aug. 20, 2014) More than 40% of individuals with severe mental illness end up behind bars at some point in their lives.

As a resource to family members whose loved ones become involved in the criminal justice system, the Treatment Advocacy Center has created a web page of steps caregivers can take both before and after a family member or friend becomes involved with law enforcement, the criminal justice system or both.

For example, if a loved one is untreated and has a pattern of unpredictable behavior, visiting your local zone or police precinct station during business hours and explaining the circumstances with the community resource or other officer may help officers be better prepared to respond appropriately if a psychiatric crisis erupts.
  
If your family member is arrested and charged with a crime, determining whether his or her charges would merit consideration for mental health court will equip you to be more effective in advocating for jail diversion.

Links are provided to Treatment Advocacy Center reports that will help you determine what mental health diversion programs exist where you live.

For more resources for use in a mental health crisis, visit the Get Help section of our website.

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(Aug. 19, 2014) National Minority Mental Health Month is over, but the dual discrimination against minorities with severe mental illness goes on.

In the July issue of Psychiatric Services, a team of researchers looked at outpatient follow-up after hospitalization for mental health crisis and found that “blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge” (“Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups”).

“Hospitalization serves a crucial function in mental health systems by providing treatment for individuals with acute psychiatric needs,” the authors wrote. Timely follow-up after hospitalization can reduce the duration of disability and, for certain conditions, the likelihood of rehospitalization.”

Rates of follow-up (defined as being seen in a follow-up appointment within 30 days of hospital discharge) were abysmal for the whole population: Less than 26% of hospital dischargees – an extremely fragile population considering how difficult it is to get into a hospital in the first place – received follow-up treatment, the study found.

After adjustment for need and socioeconomic status, the analyses found that blacks were “significantly less likely than whites” to receive follow-up with 30 days and “also less likely to receive adequate care beginning within 30 days of discharge.”

Bias against minority patients by their providers was found to heighten barriers to recovery.

“When patients from racial-ethnic minority groups perceive provider discrimination or bias during inpatient treatment, the negative impacts on mental health and follow-up can be profound and potentially debilitating,” the researchers said.

Their results “reassert the need for interventions to improve continuity of care for all acuity levels of mental health services, especially for black patients,” they concluded.

Read an abstract of “Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups” here.


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(Aug. 18, 2014) Antipsychotics like clozapine and mood stabilizers like lithium are a part of recovery for people with severe mental illness, and they also cut violent crime, according to a study published in the Lancet (“Antipsychotics cut violent crime, study finds.” May 8).

Antipsychotic drugs are an important part of the picture in most people’s journey to recovery from serious mental illness. They are also a complex piece of an approach to address the biology of these illnesses. The Treatment Advocacy Center’s backgrounder, "Antipsychotic Medications and the Brain ” updated in June 2016, demystifies the way these drugs act on the brain.

As the backgrounder explains, “changes in brain structure are caused both by the disease process of schizophrenia and bipolar disorder and by the antipsychotic drugs used to treat these diseases.”  Moreover, that these drugs produce changes to the structure of the brain should not surprise anyone. The backgrounder describes the following structural brain changes the drugs cause:

• Decreased brain volume with associated increased volume of the ventricles;
• Increase in size of the striatum; and
• Increased density of glial cells in the prefrontal cortex.

It is important to apply an informed perspective to understanding treatment for serious mental illnesses like schizophrenia and bipolar disorder. One area of controversy remains the safety and impact of antipsychotic drugs – and with justification. However, not all criticisms are created equally, and as we know, antipsychotic drugs both require careful monitoring by physicians and have the potential to help change lives for the better for those experiencing psychosis.

The backgrounder can be an important tool towards informing community members, politicians, and media about antipsychotic medications, along with education about the many devastating consequences of non-treatment of serious mental illness.

For access to more of our backgrounders, which summarize information about severe mental illness, policies and programs related to its treatment, and the consequences of lack of treatment, visit the “Reports, Studies, Backgrounders” page on our website.

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(Aug. 15, 2014) I am a member of our community who lives with anxiety, sadness, fear, exhaustion, frustration, grief and society blames me for not doing enough for my son. When I drive my son to the hospital there is no one there to answer my questions or offer emotional support and when I come home, there is no consoling or casseroles waiting from friends. There will be no fundraisers to help with hospital bills.

I grieve and reminisce for the son I once raised by love and support the new child before me now. If my son had a heart attack, cancer or was in a car accident, my life would be different. My name is Nina McDaniel and I am the proud mother and advocate to my 32-year-old son, Michael, who has schizoaffective disorder.

Michael was a hard worker from a young age. Even though Michael was awkward and enjoyed being alone, he always showed a huge heart and always helped others in need. His smile warms your heart and his affection is contagious.

His downward spiral began in July 2007. He began wearing sunglasses all the time, even to bed. He also became paranoid over secret messages on the radio, helicopters flying overhead and thought his sister and her husband were part of a conspiracy.

We filed our first petition for commitment also in July 2007. This commitment resulted in only three days in the psychiatric unit. We filed another petition for commitment in August that resulted in five days of treatment in a psychiatric unit. That time he was rapidly losing weight by starving himself. Even though we were trying to save Michael’s life, this began the endless cycling through the mental health system in order to attain help.

Things only got worse. In 2008, we rushed Michael to the emergency room after he tried to end his life by consuming a large amount of alcohol. The hospital just dismissed him as an alcoholic.

At one point we received a call from our daughter, who cried, “Michael swallowed a handful of my medicine, come quick!” We called the crisis unit, but nothing was done because Michael refused to voluntarily speak with them. Under the law, he still had the right to refuse treatment and remain psychotic.

After one terrifying episode that included verbal threats and a potential weapon, I was able to get Michael committed for 20 days. After the 20 days we decided as a family that we could not bring Michael home, he needed to remain in the mental health system. But that is not what happened. The hospital declined my request to have Michael placed in an intensive program. It ultimately became clear that if we did not take him home, the alternative would have been a homeless shelter and we were not going to leave him homeless.

My beautiful son deserves to receive help in his life and a chance for happiness. But instead, we feel like second class citizens, neglected by friends, neighbors and law makers who slash funding and block access to care.

Nina McDaniel
Mother of Michael
Part II of Nina and Michael’s story will run next week.

 

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(Aug. 14, 2014) The suicide of actor and comedian Robin Williams has brought renewed attention to the unspeakably sad and often baffling topic of suicide, a lethal act of violence against oneself. 

Too often overlooked in discussions of mental illness and violence is the fact that the most likely victim of a violent act associated with psychiatric disease is the individual him/herself. Homicide currently takes the lives of about 15,000 people a year in the U.S., an estimated 1,500 of whose deaths are associated with untreated mental illness. In 2011, suicide took almost 40,000 lives, and NIMH Director Tom Insel has said every one of those losses is associated with mental illness.

The Treatment Advocacy Center’s recently updated backgrounder, “How many people with schizophrenia and bipolar disorder commit suicide?” looks specifically at suicide associated with schizophrenia and bipolar disorder, the disease from which Williams suffered. The top two risk factors listed are depressive symptoms and substance abuse, both of which he had suffered.

The suicide of a prominent member of society makes big headlines, but smaller headlines every day paint a grim picture of a cause of death that is preventable with appropriate and effective treatment. At Saline Memorial Hospital in Benton, Arkansas, for example, the hospital’s ambulance service answered 147 mental-health emergency calls reporting suicidal thoughts, intentions or attempts in just the first 151 days of 2014 (“Suicide, mental illness touch many in Saline County,” July 20).

Treatment Advocacy Center backgrounders are useful tools for raising awareness about mental illness and treatment issues. For a complete list of backgrounders, visit the “Reports, Studies, Backgrounders” page of our website. To see the Treatment Advocacy Center’s original research, visit our TACReports.org site.

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(Aug. 13, 2014) Comedian Robin Williams, who died of asphyxiation after hanging himself this week, has already been removed from Everyday Health’s list of 10 famous people with bipolar disorder.

From his “Mork and Mindy” days in the late ‘70s, Williams brought laughter to whole continents of people. For individuals and families living with bipolar disorder, he brought the inspiration of seeing someone who shared the disease achieve such heights.

In a reflection on the sad end to Williams’ life, blogger Elad Nehorai has made an eloquent plea for understanding Williams' death was not self-inflicted but disease-inflicted.

“Williams did not make that choice,” writes Nehorai, who says he has been suicidal himself (“Robin Williams didn’t kill himself,” PopChassid, Aug. 12). "If only you could grasp it. It was not him. It was his illness.

“It can be so hard to understand for the mentally healthy. Just as I cannot possibly comprehend what it means for someone to have AIDS or cancer, I think it can be truly hard for people to wrap their minds around the idea that for some people, a choice cannot be a choice....

“Robin Williams did not kill himself. His disease, whatever it was, killed him.”

Williams' humor and his inspiration will be sorely missed. 

Read the entire blog on PopChassid.

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