(July 8, 2014) Kay has postponed her retirement indefinitely so she can support her son with untreated severe mental illness, writes Stephanie McCrummen in the Washington Post about a family torn apart by psychiatric disease (“Behind the yellow door, a man’s mental illness worsens,” the Washington Post, June 28).

This week, the Treatment Advocacy Center will share brief excerpts from the tale. Today, we share Kay’s perspective, who does not want to let her son hit rock bottom, as many suggest she should.

Kay’s perspective:

“She, too, wishes her son could be committed to a psychiatric facility of some kind, but because that is not possible she texts him that she is bringing groceries.

“The last time her mother saw him was several weeks before, when she was bringing food and he came outside. It was evening, and he would not let her inside, so they sat on the porch. She tried to talk to him, but he took almost every word as having a double meaning. When she said ‘hi,’ he said, ‘I’m not high.’ When she said she didn’t mean it like that, he said, ‘Do you think I’m stupid?’

“[T]he psychiatrist tells Kay that she needs to stop bringing food, stop paying for his car and take him off her credit card. He says that she is enabling her son’s delusional behavior and that any support should be conditional on him seeing a doctor. Otherwise, the psychiatrist says, she should cut him off and let him get worse.

“During his one involuntary commitment, she had visited him nearly every one of those 24 days. She still regrets how it happened, the handcuffs in the middle of the street. She regrets that he was in a locked ward with patients who she guessed were homeless and an elderly man who walked around naked one day, which she is sure embarrassed her son. She worried that he felt demeaned. She promised him then she’d never do anything to put him back there again.

“Only now, almost three years later, she knows he needs help, and she knows that cutting off his financial support might be the only means to that end.”

Read the entire story by Stephanie McCrummen.

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(July 7, 2014) The torment of a family unable to get help for a loved one with untreated severe mental illness is the subject of Stephanie McCrummen’s devastating piece in the Washington Post (“Behind the yellow door, a man’s mental illness worsens,” the Washington Post, June 28).

For the next four days, the Treatment Advocacy Center will share brief excerpts from the tale.

One point of view in McCrummen’s narrative is that of the ex-wife, Jennifer, as she watches helplessly while her ex-husband deteriorates.

Jennifer’s perspective:

“She has been watching him deteriorate for three years now.... He began reading conspiracy theory Web sites. He started saying he was going to jail and taking batteries out of cellphones. Jennifer told herself it was stress and tried to get him to see a counselor, but he wouldn’t.

“Then one day a package arrived, and he told her to take the kids outside, and she watched as he put on a biohazard mask and used long-armed tools to open the box, which contained a crank radio he ordered.

“He started wearing all yellow or all white. When they visited a relative who had a gun with five bullets mounted on a wall, he said the bullets were a sign that their family of five was going to be killed. Jennifer kept trying to persuade him to see a counselor, but there was nothing else she could do to get him treatment until the day he disappeared with the boys.

“What she wishes is that her ex-husband, whom she still loves, could be involuntarily committed to a psychiatric hospital for however long it takes doctors to figure out what’s wrong, for medications to work, and for him to once again be the person she married.

“But because she can’t have him committed, she is doing the only thing she can think of to do. In accordance with the divorce decree, she is selling the house, which she is hoping will force her ex-husband into a situation desperate enough that he might meet the standard for involuntary commitment. For him to get better, she realizes, she and his family have to let him get worse.

“’He’ll be homeless. . . . And we just have to let it happen.’”

Read the entire story by Stephanie McCrummen.

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(July 2, 2014) July is National Minority Mental Health Awareness Month, an effort the Treatment Advocacy Center is supporting with a series of messages focusing on how people from racially diverse groups suffer dual discrimination.

America's mental health policies discriminate systematically against all of the nation's most vulnerable citizens - people with serious mental illness - but they double down on discrimination in minority communities.

African-American men in psychiatric crisis are less likely to be given a psychiatric evaluation for hospitalization than individuals with similar symptoms who are white, for example, and more likely to be sent to jail. What’s more, once they arrive in their cells, mentally ill black inmates are less likely to receive treatment than mentally ill white prisoners.

Just this month, Psychiatric Services published findings that individuals from minority communities are less likely to receive adequate follow-up following discharge from a hospital - which we know makes them more likely to be rehospitalized or otherwise trapped in the revolving door of poor outcomes, including criminalization.

"This study found low rates of follow-up, and even lower rates of adequate treatment, following discharge, across all racial ethnic groups and we found that blacks were significantly less likely than whites to receive any follow-up within 30 days of discharge," the authors wrote in "Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups" (Psychiatric Services, July 2014).

Follow the Treatment Advocacy Center on Facebook or Twitter to learn more about dual discrimination during National Minority Mental Health Awareness Month.

(June 27, 2014) In less than three years, Laura Pogliano spent $250,000 on psychiatric care for her 22-year-old son who has schizophrenia, a number that reflects both state and federal discrimination in laws that allow access to treatment for mental illness (“Mentally ill suffer in sick health system,” USA Today, June 26).

“Every parent I know has to fight for treatment for their child,” Pogliano told reporter Liz Szabo about how state laws prevent people with severe mental illness from accessing treatment. In Pogliano’s case, civil commitment laws kept her from getting her son into treatment when he started deteriorating psychiatrically. In Maryland, where she lives, mandatory inpatient treatment is only available to people who are deemed dangerous to themselves or others – leaving families like hers out in the cold.

“Many patients can only get help after they’ve become psychotic,” said Ron Manderscheid, executive director of the National Association of County Behavioral Health & Disability Development Directors.

When Pogliano's son did manage to meet the standard for treatment, doctors were sometimes unable to locate available psychiatric beds - forcing her into the more expensive private system.

Szabo attributes lack of psychiatric bed availability to discrimination at the federal level in the way that Medicaid and Medicare reimburse treatment of mental illness.

Medicaid funds may be used to treat physical health conditions, but they are more difficult to use for mental health treatment and Medicare limits the number of days people can get treatment for a mental illness in hospitals. “Without federal support, states haven’t been able to afford to keep their psychiatric hospitals open,” Szabo writes.

“By denying hospital care to the mentally ill, Congress has set two standards for health, effectively telling the country that the mentally ill are less deserving of a decent life than others,” Representative Tim Murphy told Szabo. Murphy has a bill that currently aims to help more people get access to inpatient care.

All of this means that people with mental illness wait nearly a decade after their symptoms first appear to get treatment, or like Pogliano, pay exorbitant amounts to get loved ones into care, according to Szabo. Ultimately, this denial of coverage results in many under-treated people who become so ill they often wind up homeless, in jail, or a risk to themselves or others.

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(June 26, 2014) Six months after implementing the Affordable Care Act in Pennsylvania, mental health professionals say they have not seen greater use of mental health care in their region (“ACA hasn’t boosted use of mental-health care services in Philly region,” Kaiser Health News, June 24).

People aren’t accessing treatment because “there is still a lot of stigma [attached to mental illness],” says Patricia Kleven, director of outpatient mental health services at the Belmont Center for Comprehensive Treatment.

Actually, “the main issue is the Medicaid gap,” said Joseph Rogers, chief advocacy officer for the Mental Health Association of Southeastern Pennsylvania. "If you don't have private insurance and you are not poor enough to be on Medicaid, it is very difficult to get behavioral-health services."

But perhaps it isn’t just stigma or the Medicaid gap that are preventing people from using services. Even though the Affordable Care Act has significantly increased insurance coverage for mental health care, it won’t help the people who need treatment the most.

These are the people who suffer from a condition called anosognosia, an anatomical brain condition that affects approximately 50% of individuals with schizophrenia and 40% of individuals with bipolar disorder. People with anosognosia are simply unable to recognize their own illness – no matter how painfully obvious it may be to everyone around them. They are the people sleeping on the front steps of a community clinic, but who will not walk inside to seek treatment.

If we really want to address the most vulnerable people we need to foster universal adoption of mental illness treatment laws based on a person’s need for treatment and provide sufficient public psychiatric beds to treat individuals in psychiatric crisis.

(June 25, 2014) To continue raising public awareness of mental illness treatment issues, the Treatment Advocacy Center has published a fact sheet providing state-by-state population numbers on the prevalence of schizophrenia and severe bipolar disorder, including the number of those people who are untreated during a 12-month period.

”Prevalence of Untreated Serious Mental Illness by State” provides the public with a central source of state-by-state information about the following:

1. Number of adults diagnosed with schizophrenia and severe bipolar disorder
   
   
2. Total number of those diagnosed with untreated schizophrenia
   
   
3. Total number of those diagnosed with untreated severe bipolar disorder

The numbers were calculated using 2014 U.S. Census Bureau population data and National Institute of Mental Health (NIMH) estimates of prevalence and treatment by diagnosis.

Individuals with untreated schizophrenia or severe bipolar disorder are the most at-risk populations for a host of poor outcomes that affect them and their communities. These consequences of non-treatment include arrest, incarceration, hospitalization, homelessness, victimization and violence, including suicide, homicide and other violent acts.  

“Prevalence of Untreated Serious Mental Illness by State” is published as a public service of the Treatment Advocacy Center to further evidence-based knowledge and understanding of mental illness treatment issues in America.

All of the Treatment Advocacy Center’s resources can be found at TACReports.org, including our studies on mental illness in jails and prisons, state civil commitment laws and law enforcement shootings involving people with untreated severe mental illness.

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(June 23, 2014) I was the probate judge in Contra Costa County for 11 years. I am here to support the implementation of Laura’s Law in our county.

Laura's Law provides a very thorough protection of the civil rights of the persons with severe mental illness. But, you will hear claims that Laura's Law is an infringement of civil rights.

At the core of our civil rights is our ability to choose to do what we want. When a person is unable to understand the nature and consequences of their decisions because of their illness, that person is fundamentally deprived of the ability to exercise any civil rights.

When we consider civil rights in this context, we should consider the annihilation of the civil rights of victims of homicide by persons with untreated severe mental illness.

We should consider the civil rights of people who are severely injured, whose lives are changed forever.
We should consider the civil rights of the families of the victims of the violence by persons with mental illness.

We should consider the horror for someone who is treated successfully, then learns they have done terrible things while untreated. They will find no comfort in being told we only cared about their civil rights and not at all about giving them the treatment they needed.

We should consider the civil rights of the vast majority of persons with mental illness who are shunned because of the public’s fear that all mentally ill people are violent, making it harder for consumers to find places to live and to get jobs.

We make a mockery of civil rights when we ignore people with severe mental illness, leaving them on the streets until they do something we characterize as a crime, then we lock them in our overcrowded jails and prisons.

Laura’s Law will fill a gap in our mental health system. We currently have no option treating people with severe and persistent mental illness who have demonstrated violent tendencies and do not accept treatment voluntarily.

Don Edward Green
Testimony from Contra Costa County, California

(June 20, 2014) Individuals with untreated serious mental illness, especially women, are extremely vulnerable to being victimized. A recently updated Treatment Advocacy Center backgrounder reviews existing studies on this association and offers summaries of them.

Victimization of persons with severe psychiatric disorders, the backgrounder says, “frequently involves acts such as theft of clothing or money but also includes assault, rape, or being killed.” These disturbing acts are unfortunately quite common, according to research on the subject. Some of the key research findings the background refers to are:

1. A 2014 analysis of five American studies of victimization among adults with mental illness that found that 31 percent of study participants had experienced at least one episode of physical violence;

2. A 2012 meta-analysis of victimization studies that found that 24 percent of mentally ill individuals had been victimized; and

3. A 2009 review of victimization studies that found victimization to occur more frequently among individuals who were also abusing drugs and/or alcohol and among those with the most severe symptoms.

Also of particular note is a 2002 North Carolina study that showed that individuals with severe psychiatric disorders were victimized only half as often when on outpatient commitment orders as compared to their peers who were not participating in outpatient commitment.

The victimization of individuals with serious mental illnesses is a disgraceful consequence of the failure to provide these individuals with timely treatment that could reduce their vulnerability. Our backgrounder, “How often are individuals with serious mental illness victimized?” can help advocates to educate stakeholders in their communities about one of the biggest reasons to support better treatment standards and assisted outpatient treatment laws.

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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(June 19, 2014) A bill that will vastly improve Ohio’s laws on assisted outpatient treatment was signed into law this week by Gov. John Kasich.

Even though assisted outpatient treatment (AOT) has long been a legal option in the Buckeye state, Kasich’s signature rewards years of perseverance by Ohioans determined to make court-ordered outpatient treatment more widely available.

Until this point, only Summit and Butler counties have managed to issue AOT orders successfully. Elsewhere, ambiguity in the wording of the AOT law and uncertainty about how to apply it led to its under-use – and left countless individuals with serious mental illness stuck in the revolving door of hospitalization, incarceration and homelessness.

The amendments enacted yesterday will encourage greater implementation of AOT by improving the state’s commitment standard and by allowing private individuals – including family members – to petition the courts for involuntary commitment of a person in need, among other changes.

The Treatment Advocacy Center offers thanks and congratulations to the many families and stakeholder groups who fought for the law’s passage under the steadfast leadership of NAMI-Ohio.

We also offer thanks to the legislation’s primary sponsors: Sen. Dave Burke (R-Marysville), Sen. Charleta Tavares (D-Columbus), Rep. Peter Stautberg (R-Anderson Township) and Rep. Margaret Ann Ruhl (R-Mount Vernon) who shepherded the bill through unanimous votes in the Ohio House and Senate OR whose leadership resulted in unanimous approval in both the Ohio House and Senate.

Working with Health Management Associates in Ohio and funding from the Margaret Clark Morgan Foundation, the Treatment Advocacy Center is currently in the final stages of preparing a cost-savings study of AOT based in part on the Summit County, Ohio, experience. With the new law on the books and the study results in hand, welook forward to working with our Ohio friends to promote widespread implementation of this proven method of helping at-risk individuals live safely and successfully in their communities

(June 18, 2014) San Francisco must move forward and adopt Laura’s Law to allow court-ordered outpatient treatment for people with serious mental illness, Fred Martin writes in the San Francisco Chronicle (“Mentally ill individuals need care and treatment not jail,” June 17).

“Adopting Laura's Law is about public safety. It is about whether we offer treatment for those with serious mental illness or abandon them to the streets or jail,” Martin says. “It is a means to help individuals avoid being forcibly hospitalized or jailed. It may help someone with severe psychosis avoid a violent confrontation."

As the chairman of the Committee on Mental Illness of the Episcopal Diocese of California, which works closely with homeless and incarcerated populations, Martin witnesses firsthand how America’s mental health system struggles to help the most severely ill among us.

With a shortage of public psychiatric beds and community-based treatment available only to those who seek it voluntarily, the consequences of untreated severe mental illness are apparent on the streets of San Francisco.

Bringing the law to the city will save taxpayers money. 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.

Last month, Orange County voted to bring this lifeline to treatment to its most vulnerable citizens and their families.

Next Monday morning, residents of San Francisco will have the opportunity to publicly voice their support for Laura’s Law to the Rules Committee in Room 263 at the San Francisco City Hall.

It’s time to bring Laura’s Law to San Francisco.

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