(May 14, 2014) California’s third-largest county is opting into assisted outpatient treatment (AOT) for qualifying residents with severe mental illness, and that’s a big deal. 

It’s a big deal because California is the nation’s largest state and where California leads, the rest of the nation often follows.

Like 45 other states and the District of Columbia, California has long had an AOT law on the books. Like most of those states, California has barely used its law. By voting unanimously to implement – and fund – what California calls “Laura’s Law,” the Orange County Board of Supervisors has set a course the rest of California – and the nation – would do well to follow.

“The third most populous county in California now has a critical lifeline for patients and their families that will reduce hospitalization rates, homelessness, arrests and incarceration, while saving money and lives,” said Carla Jacobs, Treatment Advocacy Center board member and a resident of Orange County. “This will be a significant improvement for people suffering with serious mental illness and their families.”

Despite this sea change for Orange County, most Americans continue to live in states where the mental health system is only accessible to those well enough to seek treatment. This puts help out of reach for the people who are most ill and most at risk to end up behind bars, hospitalized, victimized, homeless or worse. AOT has been proven to reduce these consequences of non-treatment and to save taxpayer dollars.

There are still 54 counties in California and a majority of counties nationwide where individuals with mental illness, their families and their communities are not benefiting from their AOT laws. Here’s hoping they follow Orange County’s lead and put AOT to work making treatment possible for more of their citizens who need help the most.

(May 13, 2014) USA Today has launched a series of articles of the “man-made disaster” created by “a mental health system drowning from neglect,” and it’s a don’t-miss.

"We have replaced the hospital bed with the jail cell, the homeless shelter and the coffin," Rep. Tim Murphy, author of the Helping Families in Mental Health Crisis Act, tells Szabo. "How is that compassionate?"

Coverage like this in the third most widely circulated newspaper in America will significantly raise awareness of the need to reform mental health policies and remove obstacles to treatment – and provide an easy way for you to familiarize your community and elected leaders with the consequences of non-treatment.

Once you’ve seen the story, be sure to This e-mail address is being protected from spambots. You need JavaScript enabled to view it of the devastation caused by neglecting serious mental illness. If you have a personal story to tell in a few words, include it in your letter. Letters must be 200 words or less. You can also:

SHARE the story with your friends or comment by clicking on a link from the bottom of the article, tweeting it or posting it on your Facebook page.

COMMENT on the story using the link at the end of the article.

FORWARD the article to your public officials and tell them you support mental illness treatment policies that will address these problems.

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(May 12, 2014) A person’s lack of insight into his or her own illness is the biggest barrier to treatment, not stigma, Amy Yannello writes in the San Francisco Chronicle (“Support Laura’s Law for better mental illness care,” May 8).

But events scheduled around this month’s Mental Health Awareness Month are still promising to reduce barriers to treatment by “raising awareness.”

This week in California, a one-day event with the goal of decreasing stigma promises speeches, stories of empowerment, food, a minor league baseball game – and will cost taxpayers $137,000. This is in a state where several rural or small counties have no permanent psychiatrist or psychiatric inpatient treatment beds available, according to the California Psychiatric Association.

“Apart from the thousands of lime-green ‘awareness ribbons’ that ultimately will litter the [state Capitol’s] lawn . . . it's difficult to see how this group's state-sponsored extravaganza will do anything to expand treatment options for Californians with severe and persistent mental illness,” Yannello writes.

Even worse, Yannello says, is that some from that same group have used taxpayer dollars to lobby against Laura’s Law, which would bring court-ordered treatment to a small subset of people with serious mental illness, many of whom lack insight into their illness and refuse voluntary services.

They also have spread false information about the law, Yannello continues, including the incorrect claim that Mental Health Services Act funding cannot be directed toward assisted outpatient treatment.

“By actively lobbying to ensure counties do not implement assisted outpatient treatment (AOT) programs, Laura’s Law opponents ensure that only the most high-functioning Californians with mental health issues - the ones who are able to voluntarily voice their need for services, not the most seriously ill - receive help.”

As a result of efforts to block Laura’s Law and prevent treatment options from getting to those who lack awareness of their illness, “the homeless population continues to grow, as do the number of mentally ill who cycle in and out of our emergency rooms, state hospitals, jails and prisons,” Yannello says.

In the meantime, valuable funding nominally geared towards fighting mental illness is instead spent on parties for those who oppose expanding options for the most severely ill Californians.

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(May 9, 2014) Taking psychiatric medication can greatly reduce the chances that people with serious mental illness will commit violent crimes, according to a new study published in the journal The Lancet. (“Medications Cut Violence Among Mentally Ill in Study” the Wall Street Journal, May 7).

“It’s another piece in the jigsaw puzzle that helps you think about the risks and benefits of putting and keeping [patients] on medication,” said Dr. Seena Fazel, lead author of the study.

The researchers from Oxford University and Sweden’s Karolinska Institute examined the registry records for more than 80,000 people who had been prescribed antipsychotic or mood stabilizing medication between 2006 and 2009. They found a 44 percent drop in convictions for violent crime while study participants were taking their medications as compared to times when they were not. There was also a 24 percent decrease in convictions for patients diagnosed with bipolar disorder when they used mood stabilizers.

Although the researchers did not determine medication adherence caused a reduction in violent crime, the treatment of psychotic symptoms likely reduced paranoia and decreased impulsivity, said Fazel.

The relationship between violence and mental illness includes nuances, such as that the vast majority of violence is perpetrated by individuals without mental illnesses and only a small fraction of those with mental illnesses commit violence. In fact, individuals with serious mental illnesses are more often victimized by violent acts than they commit them.

However, there is good evidence that rates of violent behavior are much higher among individuals with mental illness who are not being treated.

In cases where a person would be helped by involuntary treatment, improved commitment standards and outpatient commitment laws broaden the opportunities to intervene before tragedy.

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(May 8, 2014) Last Thursday, some of the world’s top mental illness researchers and advocates gathered at the Johns Hopkins University School of Medicine to celebrate the many achievements of Dr. E. Fuller Torrey and to applaud him towards his continuing career with a Festschrift.

Colleagues offered moving reflections on their relationships with Dr. Torrey, who has inspired, encouraged them to venture into new research and advocacy territory. Among the many topics they discussed were the accomplishments they and their teams have made as a direct result of Dr. Torrey’s leadership.

One such example is the “revolutionary” brain bank at the Stanley Medical Research Institute which has created unprecedented availability of a rare sample for brain research on schizophrenia. Another is his stature as a modern leader in investigating viral implication in schizophrenia’s cause and course, one of the most exciting and well-followed theoretical paths in studying the nature of the disease.

Dr. Torrey’s persistent questioning of traditional beliefs about schizophrenia has led to greater acknowledgment of epidemiology as an important avenue for investigating the causes and nature of the disease, said Dr. Dr. Preben Mortensen of University of Aarhaus and Sir Robin Murray of King’s College, London.

Dr. Steven Sharfstein of Sheppard Pratt Health System and others recounted the ways Dr. Torrey’s dedication to putting severe mental illness on the agendas of policy makers and service agencies has changed the landscape of mental health in the United States for the better.

Many things are clear about Dr. Torrey’s career: he has demonstrated compassion, principle, ingenuity and courage to so many – and he has mobilized a true movement towards a world where severe mental illnesses can one day be treated effectively, allowing individuals and their families and communities the resources they deserve to live free of these diseases.

But as Dr. Torrey humbly said at the event, “Our work is not done. We aren’t where we need to be,” and so onward we all must go.

Scheduled speakers included leaders in psychiatric practice and research like Drs. J. Raymond DePaulo and Robert Yolken of Johns Hopkins, Jeffrey Lieberman of Columbia University, William Carpenter of the Maryland Psychiatric Research Center, Vishwajit Nimgaonkar of University of Pittsburgh, Mark Weiser of Tel Aviv University and Maree Webster and Julie Friese of the Stanley Medical Research Institute.


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(May 7, 2014) Our neighbor Maryland has long been among the very worst states in the union for those who cannot seek or agree to essential treatment for their severe mental illness. Marylanders in this condition (and the families who love them) currently face a tragic triple whammy:

1. A hospital commitment standard requiring a finding of “danger to life or safety,” which is often interpreted to slam the hospital doors on anyone who doesn’t appear imminently violent or suicidal;

2. The notorious “Kelly Decision” of 2007, in which the Maryland Court of Appeals ruled that a patient committed to a mental hospital who refuses medication cannot be medicated over objection without evidence that the person poses a danger while in the hospital, irrespective of the danger the person would pose in the community if released in his or her current unmedicated state;

3. The lack of an assisted outpatient treatment (AOT) law to help those caught in the revolving doors of the mental health and criminal justice systems to survive safely in the community. (Only four other states share this dubious distinction.)

With the strokes of several pens yesterday morning, Maryland Governor Martin O’Malley gave hope for a brighter day ahead. The governor signed two bills championed in this year’s legislative session by the Treatment Advocacy Center and our indefatigable partners in NAMI-Maryland.

One bill, HB 592/SB 620, nullifies the Kelly decision (effective October 1) by amending the state law interpreted by the court. The new language makes explicit that a committed patient may be medicated over objection if a review panel finds the patient’s mental illness symptoms cause dangerousness in the hospital, caused the dangerousness that led to commitment, or would cause dangerousness if the person were released.

The second bill, HB1267/SB882, represents progress towards addressing the two other glaring flaws in Maryland’s treatment laws. It directs the state’s Department of Health and Mental Hygiene (DHMH) to convene a work group to examine AOT and deliver to the legislature by November 1, 2014 “a proposal for a program that … best serves individuals with mental illness who are at high risk for disruptions in the continuity of care.” It further directs DHMH to “evaluate the dangerousness standard for involuntary admissions and emergency evaluations of individuals with mental disorders, including … how the standard should be clarified[.]” (DHMH is already on record acknowledging the state’s need for both AOT and a consistent, more flexible interpretation of “danger to life or safety.”)

For now, we’ll say “one down, two to go,” with optimism that by this time next year, Maryland will stand proudly among the best states in meeting the needs of those whose anosognosia puts voluntary mental health care out of reach. We offer heartfelt thanks and kudos to the Maryland lawmakers who this year carried the mantle of this too-often-voiceless population: Senator Dolores Kelly and Delegate Dan Morhaim of Baltimore County, and Senator Mac Middleton and Delegate Peter Murphy of Charles County.

(May 6, 2014) I first came to understand mental illness through my brother’s experience.

Never understanding what mental illness was until years later, I came to know my brother’s diagnosis as severe bipolar disorder. Watching my brother struggle is similar to observing a roller coaster: he will have manic episodes where he speaks quickly and paces up and down hallways. Then he will have depressed episodes in which he will lie in bed for days with a curtain drawn. There was one incident in which my brother stole my car and disappeared for two weeks and I did not know where he was.   

Current HIPPA laws kept me from trying to help him. The HIPAA privacy rule kept me completely locked out of his care and I was powerless to help him.  The first time I encountered this roadblock was when my brother was admitted to the psychiatric hospital a few years ago. I went to visit him but he was gone. The nurse told me that she couldn’t give me any information about my sick brother’s whereabouts because of the privacy rule. So I was left to worry about where he was and what he might be doing. It was a wake-up call to realize that to help my brother, I could only count on myself and not the system.

For years I have been told by mental health professionals that my brother is an adult and can take care of himself. However, the truth of the matter is that he is not mentally capable of taking care of himself as I am now finally his caregiver.

I am my brother’s keeper.

Tracey Davis
Resident of Pennsylvania

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(May 5, 2014) Paul was a shapeshifter, a skinwalker, a Navajo witch able to spot another witch no one else could see. He had powers none of us could understand.

In actuality, a toothless 48-year-old with schizophrenia, Paul needed nebulizer treatments twice a day for his bad lungs. He also suffered from anosognosia, like many mentally ill people he didn’t really believe he was mentally ill.

But why did someone else have to be in jeopardy for Paul to be given intensive care? The bottom line was that the state had a timetable and the social workers had followed it, without letting us know about it. The decision to give him more freedom seemed to be disconnected from any evaluation of his connection to reality. Unless he was a danger to himself or others, he was a free man.

He’d never been able to hold down any sort of job. And his hygiene was certainly terrible. Even with the rules at the halfway house, he sometimes arrived at family gatherings smelling so bad we had to send him to the shower.

As I drove to his apartment for the first time, I tried to imagine treating another kind of neurological disorder this way. Tell someone with a spinal cord injury that they’ve been in a wheelchair long enough. Time for you to walk! someone says, and the wheelchair is whisked away.

Or imagine telling someone who suffers from Alzheimer’s, enough of this hanging around doing nothing. You’ve been in this nursing home for six months now. We can’t look after you forever. From now on you’ll have to take care of yourself.

Absurd.

Excerpted from Shot in the Head: A Sister’s Memoir, A Brother’s Struggle
Katherine Flannery Dering.

In the book, Flannery details her life with her younger brother. “My younger brother Paul was more than a schizophrenic,” the author says. “He was a brother, a son and above all, a person that my eight siblings and I loved.” Meet the author.

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(May 2, 2014) One day our happy 14-year-old boy disappeared and in his place was a paranoid person who heard voices and believed the FBI was out to get him, Ed Kelley tells NPR host Robert Sullivan (“Effort to force treatment on severely mentally ill meets resistance,” May 1).

That is why Kelley supports the Helping Families in Mental Health Crisis Act,introduced by Rep. Tim Murphy (R-PA) last December and co-sponsored by more than 70 members of both parties in Congress.

The bill, among other things, would lower or remove some of the barriers to treatment that commonly prevent people with severe mental illness from getting the treatment they need.

Kelley believes his son would never harm anyone, and a majority of people with mental illness never become violent. But a small subset of people with severe mental illness can be prone to violent acts, or other consequences of non-treatment when untreated. It is this subset of people the bill intends to help.

“I hope that the people who are shouting and keeping the families from having their loved ones treated properly, I pray they never have the experiences that our family or other families have had because it would change their perspective,” Kelley tells Sullivan.

Listen to the interview.

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The annual observance of Mental Health Month will not be cause for celebration as long as Americans with the most severe mental illnesses don’t receive the treatment they need to stay of out jails and prisons, off the streets and on the road to recovery.