(June 16, 2014) Responding to a mother’s 911 call for medical help for her son, the police instead shot and killed Jason Harrison, a 38-year old who suffered from severe mental illness. Harrison’s mother had asked law enforcement for help getting her son to a hospital for treatment (“2 Dallas police officers on leave after mentally ill man shot, killed,” June 15).

Harrison reportedly suffered from bipolar disorder, paranoia and schizophrenia. At the time of the shooting, he was carrying a screwdriver which he refused to drop. “In my eyes, it looked like the police overreacted,” said Harrison’s older brother, David.

Harrison’s family was unable to get him into treatment because he never appeared to be a danger to himself or anyone else, they said. “I just really wish that he could have got the help that we had really been trying to get for him so that maybe it could have had a different outcome,” Harrison’s brother said. “We'll never know.”

Deaths like these are unsurprising tragedies. Over the last half century, the responsibility of law enforcement officers for seriously mentally ill people has increased sharply. In fact, untreated severe mental illness is an increasing factor in officer-involved homicides, according to our study “Justifiable Homicides: What is the Role of Mental Illness?.”

Inevitably, the increasing number of confrontations between law enforcement officers and persons with serious mental illness leads to some unfortunate outcomes. Among the most tragic are officer-related shootings of mentally ill individuals, many of which are fatal.

Until we return the responsibility for the care of people with mental illness back to mental health agencies, we will continue to see these types of preventable tragedies.

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(June 10, 2014) In early April of 2012, my son announced he was crippled and went to bed in the middle of the day. His ankle was pulverized. He had a brain tumor.  His back was broken in three places. He promised to get up when he healed.  I asked him, When will that be? He said that he wasn’t sure, but probably not soon. I left his bedroom and closed his door.

In the next two weeks, he quit eating and drinking. He couldn’t trust anyone to bring him food. He saw poison being pumped into the water supply. He could only use the rest room with assistance. He smelled; his clothes were turning black. His lips were crusted and cracked, his hair matted.  I sat by his bed, putting ice chips in his mouth and wiping his face, begging him to make a good decision for himself and see a doctor.

Two weeks later, police crept up the stairs to his room and helped him, shaking, weak, and filthy, into a squad car to go to the hospital.

If you think that’s an odd series of events, it’s because I left something important out. My son is severely mentally ill. He has schizophrenia, a thought disorder that includes hallucinations, delusions, and paranoia.  Before the April events, he had quit taking a medicine called Clozapine, used for hard-to-treat cases.  Between February and March, he quit bathing and changing his clothes. He became disorganized and missed work, then got fired. He began sitting in the living room all day, not speaking, and staring at a television that wasn’t turned on.  He made no phone calls, saw no friends, made no attempts to engage in any activity. He couldn’t answer questions, even when they were direct.

As he degenerated, his doctor and I had many conversations—why was he deteriorating so dramatically? Was he under medicated, over medicated or wrongly medicated?  On the day my son went to bed, he announced there would be no more doctor visits and weekly labs—required by law to get meds dispensed—and no more pills. By the end of March, it was clear—whatever the reason, he was floridly psychotic. He was sicker than he’d ever been. He really, really needed to get to a hospital.

In early April, I phoned Crisis Intervention teams, both county and city, three times, but no one would come. Finally, I went to the local courthouse and begged a judge for an emergency petition. In Maryland, it’s a legal remedy to bring a person who is a danger to himself or others in for an evaluation. The police served it the next morning. His bed was waiting at Johns Hopkins, but the law requires transporting to the nearest hospital, one that has no psych unit.  He was transferred to Hopkins where he refused medication.

On April 16th, he lost a hearing on his competency. He was still in a wheelchair, still in his same clothes, and unmedicated. A week later, he lost a medical panel convened to decide if medication was warranted. He was still in a wheelchair, in the same filthy clothes, but was now mute and catatonic. After a 48-hour appeal process, he finally received an injection of an antipsychotic. This was his 9th hospitalization in four years. He was unmedicated overall approximately three months and lost forty pounds.

He was discharged from the hospital nearly two months after he was admitted. He walked his sister down the aisle at her wedding on July 28th.

I support the bipartisan mental health reforms in the Helping Families in Mental Health Crises Act (HR 3717), to help young men like my son have a chance to recover. There was a legal remedy in our case and we used it: my son’s refusal to eat while paranoid made him a danger to himself.

I support HR 3717 because it closes the legal gaps that prevent parents like me, a caretaker of a severely ill adult child, from getting our children to care. It provides real medical parity for our sick children. It ensures that federal funds awarded into the billions of dollars each year are truly earmarked, with proper oversight, toward care for those like my son, who is sometimes too sick to know he’s sick.

HR 3717 gives parents the rights as caregivers that are essential for assisting our children and ensuring their continued health. It marks funds for an assisted outpatient treatment (AOT) model that has proven results in reducing failures of the mentally ill to function in the community, and greatly reduces incidents of violence and incarceration among those most affected.

This legislation rectifies the many, many wrongs we’ve committed as a wealthy, compassionate country—that the mentally ill have been rotting in jail cells and under our cities’ bridges for almost forty years as a lifestyle choice.

If you oppose HR 3717, I want to ask you: What should I have done as a mother, when my son went to bed and tried to starve himself to death? One of the absurdities of our situation is that if my son had any other brain dysfunction, I would be legally negligent and abusive in not seeking medical help, but with the same injured brain, in a different disability, I am “supporting a choice” he makes to starve himself while delusional.  Today, he is living in an apartment with a friend, going to therapy daily, planning for work and school. I’m sure he is not sorry that I violated his rights, or fought to give him his life back.

Reread my story, and think about just the impact of that single absurdity on a family struggling to help stabilize a young adult with a severe mental illness. The promises of community health care are bereft of meaning—a clear 40% never receive any care in the community. Parents like me know that without real reform, our children will languish, suffer and too many times, die of illnesses that are treatable.

HR 3717 will ensure that children like my son can all have a better future because there will be remedies in place to get quality, continuous, appropriate medical care for our children.  If the reforms seem drastic, it’s because there is so very much to fix, so very much broken, in our mental health system.  

In the end, as a mother, I know that passing HR 3717 is the humane answer to helping us help our children.

Laura Pogliano
Maryland

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(June 12, 2014) The Alabama Department of Corrections is indifferent to the serious medical needs of inmates and they're condemned to facilities where “systemic indifference, discrimination and dangerous…conditions are the norm,” according to “Cruel Confinement,” a new report from the Southern Poverty Law Center (SPLC).

The system fails to identify inmates with mental illnesses, provide adequate mental health care or equip the facilities for mentally ill inmates, the SPLC said. “Psychiatric medication is often stopped or changed without any discussion between the psychiatrist and the patient.”

One prisoner reported hearing voices and engaged in self-harming behavior for eight years before the prison staff identified him as in need of mental health care.

“The failure to identify prisoners in need of mental health care or to provide them with the level of care needed is a violation of the Eighth Amendment,” the report says.

Of the 60 patients who did actually receive medication for a mental illness in April 2014, none had any further contact with a mental health professional, according to the report. There are 4 full-time psychiatrists and 5.6 psychologists for all the inmates in the Alabama corrections system.

“This disregard for adequate health care and the law endangers the health and the lives of prisoners,” the report notes.

The report was based on inspections of Alabama’s 15 prisons, interviews with more than 100 prisoners, a review of thousands of pages of medical records as well as depositions and media accounts and the policies, contracts and reports of the Alabama Department of Corrections (ADOC) and two of its major contractors.

Read the entire report here.

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(June 11, 2014) Aaron Ybarra, the gunman who killed one student and wounded two others in Seattle last week had reportedly stopped taking his medications six months prior to his shooting spree because he “wanted to feel the hate” (“Seattle shooter went off meds,” Associated Press, June 10).

Approximately fifty percent of mass killings are committed by people with untreated severe mental illness.

“I just want people to die and I’m gonna die with them,” Ybarra wrote in his journal on the day of the shooting. The amount of ammunition found on Ybarra suggested a mass killing was exactly what he was planning.

Ybarra, 26, had a well-documented history of mental illness and voices that instructed him to hurt people, according to his attorney Ramona Brandes. Three years prior to the shooting Ybarra was hospitalized after he heard Columbine killer Eric Harris’ voice in his head “telling him to hurt people,” court records show.

It's become harder and harder to ignore the fact that the majority of the people pulling the triggers in preventable tragedies have turned out to be severely mentally ill, not in control of their faculties and not receiving treatment.

At a time when the country is demanding a better mental health system, the state must do better for itself and those suffering from untreated mental illness.

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(June 10, 2014) Even though he had over 100 encounters with police officers, a man with untreated mental illness in Huntsville, Alabama, never received help in a treatment facility, according to reporter Margo Gray (“Huntsville man falls through mental health gap 100+ times,” WSFA.com, June 9).

Local police say they picked him up for crimes related to his mental illness over 168 times. The crimes included public lewdness, disorderly conduct and trespassing.

So why hasn’t this unnamed man received treatment?

In Alabama, when a person with mental illness encounters law enforcement, the officer is required to reach out to the mental health system. The charge is suspended until a petition is filed for court-ordered treatment. If the person is considered an “immediate danger to self or others” he or she can be committed for up to 150 days.

But there is a problem with this standard, said Brian Davis, executive director of the Mental Health Center of Madison County.

While waiting for an evaluation, “at some point that person is going to stabilize and no longer meet the criteria that is in the commitment law,” he continued. “This is a classic case of a gap in the system because once a person is stable and is discharged from , it is the choice of the person suffering from the illness to agree to continue treatment.”

In our survey of state civil commitment laws, Alabama was awarded an “F” for making it incredibly difficult for people in the midst of a psychiatric crisis to receive treatment. This means people, like this Huntsville man, who desperately need help, are unlikely to receive it and police officers in Alabama will continue to serve as de facto mental health workers.

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(June 6, 2014) The deadly rampage by Elliot Rodger that left seven dead and 13 injured in Isla Vista over Memorial Day weekend is just one of several mass tragedies the country has suffered related to untreated mental illness in the last several years.

At Sandy Hook, Adam Lanza murdered 26 people. James Holmes was the perpetrator of a movie-theater shooting that left 12 dead in Colorado. Jared Loughner has been ordered to serve seven consecutive life terms plus 140 years for killing six people and wounding 13 others in Arizona. Thirty-two were killed at Virginia Tech by Seung-Hui Cho.

When mass killings occur, everyone searches for answers. 

The Treatment Advocacy Center’s newly updated backgrounder, “Are mass killings associated with untreated mental illness increasing?” explores research on the role untreated mental illness may have in these atrocities.

Specifically, the backgrounder summarizes four attempts that have been made to answer the questions:

1)      Whether mass killings are increasing and;

2)      What proportion of them are attributable to persons with severe mental illnesses.

The surveys the backgrounder looks at, published between 1999 and 2012, suggest that mass killings are increasing in incidence and that individuals with severe mental illness are probably responsible for approximately half of these killings.

While mass killings are horrific events that appear to be associated with untreated severe mental illness, the reasons for improving involuntary treatment standards and programs are broader than those related to violence. The consequences of non-treatment are vast and include, in addition to risks of violence committed by untreated individuals, their increased vulnerability to victimization and homelessness.

Our backgrounder offers clarification on a timely and controversial issue that unfortunately reappears each time our country experiences the tragedy of a mass killing. It is important that advocates for reform to mental health treatment be equipped with resources and knowledge about these issues and for there to be accurate summaries to provide to policy makers, media and officials at all levels of the community.

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 5, 2014) Warren Pennick, 56, was found dead in his cell early Tuesday morning nearly a month after being transferred from a mental health facility to a prison in Camp Hill, Pennsylvania. The inmate’s death was ruled as a “passive” suicide hanging using a bed sheet (“Mentally ill Lansdale mom-killer commits suicide,” the Intelligencer, June 5).

Pennick, who had been diagnosed with paranoid schizophrenia, was serving a 20- to 40-year prison sentence for stabbing his mother to death in 2012. His diagnosis allowed him to receive treatment at a psychiatric hospital rather than at the prison.

But in late April, Pennick was transferred back to the prison “once his mental illness was under control,” said his defense attorney, Robert Adshead. “Unfortunately, the prison system is just not set up to deal with someone so seriously mentally ill no matter how much the illness may seem under control.”

While the deaths of Pennick and his mother are tragedies, they are certainly not surprising.

There are approximately 1,000 homicides – among the estimated 20,000 total homicides in the US committed each year by people with untreated severe mental illness. But it is even more likely that a person with schizophrenia will commit suicide, with an estimated 10 to 13 percent committing the act each year. Add incarceration to the mix and a deadly outcome is even more likely.

Stories like these remind us that as people with psychiatric disease are left untreated they will increasingly fill our jails and prisons due to violent crime or small misdemeanors, and corrections officials will be forced to assume responsibility for their mental health care, despite the fact that they are not trained to do so.

The mental health system is broken and one need look no further than the criminal justice system to see just how badly.

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(June 4, 2014) Individuals with schizophrenia are more likely to kill themselves, die prematurely or commit a violent crime today than they were 38 years ago at the outset of deinstitutionalization, according to a study of 25,000 Swedish hospital patients published today in the Lancet Psychiatry.

The study led by Seena Fazel of Oxford University compared “adverse outcomes” for people with a diagnosis of schizophrenia or psychotic disorders without a mood component to both the general population and unaffected siblings. The first study of its kind, the report found:

• At the end of five years after first being diagnosed, 10.7% of men and 2.7% of women had been convicted of a violent offense. This was defined to include homicide, attempted homicide, assault, robbery, arson, any sexual offense, or illegal threats or intimidation.
• The rate of violent offense among patients with schizophrenia and related disease was 4.8 times higher than among their siblings and 6.6 times higher than matched individuals in the general population.
• Three risk factors were found that predicted future violence, and these risk factors were present in all three groups (those with schizophrenia, their siblings and the general population): past violent behavior, substance abuse and past attempts at self-harm.
• The incidence of violent offenses increased as hospitalization of the patients decreased, i.e., as patients spent less time in the hospital as a result of deinstitutionalizing psychiatric patients in Sweden, the incidence of violent offenses increased.

“It is important to remember that most individuals with schizophrenia and related disorders are not violent,” said E. Fuller Torrey, MD, founder of the Treatment Advocacy Center. “However, a small number of them, if not treated, do become violent because of the symptoms of their illness."

“This study shows that such violent behavior increased in Sweden over 38 years as the patients were being deinstitutionalized" Torrey continued. "The most disturbing thing about this study is that this level of violent behavior is taking place in Sweden, where psychiatric outpatient services are much better than in the United States, where the overall rate of violence is lower and also where deinstitutionalization has not progressed as far. This suggests that the level of violent behavior is quite likely even worse in the United States.”

The study looked at 24,297 patients in Sweden with these diagnoses discharged from hospitals between 1972 and 2009. It compared them with 26,357 of their siblings and with 485,940 matched individuals in the general population.

Read the abstract in the Lancet Psychiatry.

(June 3, 2014) Even when tragedies involving untreated severe mental illness are not making national headlines, reliance on the Treatment Advocacy Center as the only expert source of information on the consequences of our broken mental health system continues. Here are a few of the latest headlines:

“Debate over forced treatment of the severely mentally ill” – Dr. E. Fuller Torrey tells host Diane Rehm that unless we begin focusing on the severely mentally ill, we won’t be able to fix the system. Rep. Tim Murphy and family member G.G. Burns are also guests– National Public Radio

“US mental health system” – Most mental health funding is not targeted to those who need help the most and we must overhaul our system of care, Doris A. Fuller tells Washington Journal host Steven Scully – C-SPAN

“Speak up more on red flags” – Therapists are reluctant to break patient confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) gives them an excuse not to do so, Dr. E. Fuller Torrey writes in Room for Debate – New York Times

“American jails have become the new mental asylums – and you’re paying the bill” – “While some of the mentally ill population in our jail has been charged with violent crimes, the majority has been charged with non-violent, lesser offenses such as retail theft, trespassing and drug possession. These inmates end up staying because they can't afford to post bail – or because they have nowhere to go,” Sheriff Thomas Dart, who oversees the Cook County Jail in Illinois writes – The Guardian

If one of these stories or a report in your own community provides an opportunity to share why mental illness treatment reform is important to you, please submit a letter to the editor, online comment or op-ed to advocate for improved laws and more complete use of them wherever you live. You'll find advocacy tips here.

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(June 1, 2014) The wife of a man with severe mental illness shares how she lost faith in the mental health system on author Pete Earley’s blog.

“My husband Joe and I enjoyed 18 wonderful years together. We had a beautiful daughter and our lives were filled with love, laughter, joy, hard work and exciting plans for the future.

“That was before he got sick, before he was diagnosed with a mental illness. The first sign came in December 2003 two weeks after Joe got laid off from a company where he had worked for 20 years.

“During the next six years, it took over our lives. We lived from crisis to crisis.  Our family became unsettled. Nothing was predictable. Thankfully, Joe was never physically abusive to me nor did he self-medicate with alcohol or drugs. But when he became manic, he would go on spending sprees, buying items we couldn’t possibly afford, such as an expensive boat.

“I completely lost faith in the way our mental health system cares for someone so ill.  I was caring for him alone while trying to work a full-time job. I was overwhelmed.

“I asked him if he would try the medication the doctors prescribed for his bipolar and was surprised when he agreed. And then after a few weeks something amazing happened — the old Joe began to return. He was literally transformed by the medication. For three months I had my Joe. He died at home from cancer.

“The cause of death were complications caused by his cancer. That’s what everyone said, but I knew better. It was his mental illness. His denial of reality was part of his mental illness and it was as much his untreated bipolar disorder as it was the cancer that killed him.

“I am speaking out today because individuals with mental illness and their families need help. It is hard to believe what happened to my family, but it did happen and I know it is happening to other families — more than we are willing to admit.   Families caring for a loved one who has a severe mental illness need help and support. The role of caregiver is so under-recognized in our society, especially while caring for a loved one with a severe mental illness. It can be a frustrating, lonely and isolating experience. It was for me.”

Read the entire piece on Pete Earley’s blog.

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