(April 30, 2014) Virginia Governor Terry McAuliffe signed legislation on Monday to reform the state’s mental health system with Sen. Creigh Deeds seated at his side (“McAuliffe signs ‘first step’ to reforming Virginia’s mental health system,” the Washington Post, April 28).

Last November, less than a day after Sen. Deeds’ son, Gus , was released from an emergency hold at a Virginia hospital - reportedly because no psychiatric beds were available - the young man stabbed his father in the head and torso before fatally shooting himself.

Just two months after losing his son, Sen. Deeds returned to the Virginia capital determined to turn personal loss into public gain by changing the laws that hindered access to treatment for his son.

On Monday McAuliffe and Deeds traveled to the same hospital that treated Deeds’ son to ceremonially sign SB 260, spearheaded by Deeds, which increases the duration of emergency psychiatric holds from 4 hours – currently the shortest in the nation – to 12, with a safety net clause that state mental health hospitals are required to accept patients for temporary detention after 8 hours. The bill also extends the time period that a person can be held involuntarily under a temporary detention order from 48 hours to 72 hours.

“It’s an important first step,” McAuliffe said. “Let us be crystal clear: We have a long, long way to go.”

While every improvement is worth celebrating, Gov. McAuliffe is correct, there is much more work to do.

Virginia remains the nation's extreme outlier on providing enough time for a mental health examiner to be called, to get to wherever the patient is being held because of psychiatric symptoms and to conduct an evaluation (48-72 hours is much more common).

What's more, some individuals - especially suicide risks – do not stabilize sufficiently during the emergency hold to leave the hospital safely. This is far more likely when the hold exceeds just a few hours.

The new law will go into effect on July 1.

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(April 29, 2014) “Bruce Williams couldn’t sleep. It was after midnight and quiet in his Portsmouth apartment complex,” write Janie Bryant and Joanne Kimberlin in Hampton Roads. “Quiet, except for the voices in his head. He'd told people about them – the way they shrieked for violence, his fear they'd win. Those voices had led him to kill before (“Pilot Investigation: Part 1, Can’t hold him,” April 27).”

Through the story of Williams, a middle-aged man with schizophrenia, Bryant and Kimberlin provide a glimpse into America’s mental illness treatment system and its many victims. The journalists describe a fragmented mental health care delivery model where people with severe mental illness, like Williams, are “patched up in hospitals and sent back into the community,” regardless of whether or not they are able to live successfully on their own.

In the case of Williams, he wasn’t.

On that same quiet night in Portsmouth, he walked into his neighbor’s home, number 433, searched for knives while she was sleeping and “moments later…left, covered in her blood.”

This wasn’t his first murder and it wasn’t his first contact with the mental health system. In 1989, after being released from his first stay at a psychiatric hospital, he crossed paths with a young woman in Virginia, an encounter that ultimately ended with her death.

Williams served nearly 18 years in prison but prison records leave little doubt as to his mental illness, Bryant and Kimberlin report. “He also left [prison] in the same condition he was in when he arrived: seriously mentally ill.”

Following his release from jail, Williams was in and out of psychiatric hospitals for several years, often set free before he was ready. In December 2008, Williams told doctors at a Norfolk hospital that voices were “laughing at him, calling him worthless and telling him to hit people or kill himself.” He was admitted and released 12 days later, despite his previous murder conviction.

On February 25, 2010, he walked into apartment 433 and murdered Linda Gay Carroll, a 64-year-old resident of his housing complex.

“If I am a danger to myself and to others, why would they put me on the street with [no] medication or after care,” he had written in his journal.

The writers wonder why stories like those of Bruce Williams don’t make national headlines and compel policy makers to change laws. “Unlike a Seung-Hui Cho or an Adam Lanza, Bruce Williams killed one person at a time. Unlike a Gus Deeds, he’s a nobody who attacked unknowns.”

Even though the majority of people with severe mental illness are not violent, it shouldn’t take a mass murder, or even one murder to compel policy makers to change laws that facilitate access to treatment.

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(April 24, 2014) My son ended up dead because a police officer wasn’t trained to handle a person with mental illness, Mary Wilsey told Al Jazeera America about the death of her son last January (“How lack of police training can be deadly for the  mentally ill,” April 23).

Wilsey’s son, Keith, was 18-years old and diagnosed with schizophrenia. He had a long history of trying to hurt himself, but Wilsey says every morning he would ask her if she wanted a cup of hot chocolate and at night he would tell her he loved her.

Sometimes, with the help of local police, Wilsey was able to have him involuntarily committed for treatment at a psychiatric hospital. That was why she called the police on the night of her son’s death, she said.

The first two police responders were able to speak calmly to Keith, despite his psychotic state, Wilsey told Al Jazeera.  “Then a third officer showed up and escalated the situation . . . Then I heard the gun go off and saw my son start bleeding.”

Keith died in the ambulance on the way to the hospital.

Stories with similarly tragic endings were the subject of our recent report, “Justifiable Homicides by Law Enforcement Officers: What is the Role of Mental Illness?,” in which the authors found that the responsibility of law enforcement officers for seriously mentally ill persons has increased sharply in recent years and is continuing to increase.

Many of these officers are ill equipped to handle such confrontations, and as a result, untreated mental illness is an increasing factor in officer-involved homicides.

Wilsey is now an advocate of crisis intervention team (CIT) policing, which consists of specially training officers who respond to calls involving mental illness.  

“Train them so they can handle the population that they deal with every day,” Wilsey said. “My goal is to prevent another family from going through a terrible tragedy that has ruined our lives.”

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(April 22, 2014) Our recent report on the treatment of inmates with serious mental illness shows that 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 and are not trained to do it; and yet are held responsible when things go wrong, as they inevitably do under such circumstances.

Dr. Walter Kempster, a psychiatrist and former superintendent of the Winnebago Mental Health Institute in Wisconsin, decried the placement of people with serious mental illness in jails and prisons in the Marquette Law Review over a decade ago.

"Who can think of the number of unfortunate beings now confined in the receptacles of the different counties of the state, and realize in the most remote degree, the sorrowing hearts their misfortunes have created; of hopes once bright now dashed; of the ambitions that lured beyond strength; of life's work begun but left unfinished; of affections ripened only to be blasted--who can consider these calamities of our fellow mortals, rendered insane by perhaps no act of their own, unwittingly thrown upon the charity of the state, bound by the unyielding fetters of a terrible disease......who can think of these things, of the measureless calamity of insanity, and turn idly away, closing eye and hand, withholding that which is known to be required to make life comfortable?

“We can conceive of no argument, economical or humanitarian, that can be adduced to show why aid should be postponed; why the sufferer must be compelled to suffer on (The Marquette Law Review, 1999).”

We agree. There are now 10 times more mentally ill in jails and prisons than mental hospitals. We also want to know why "the sufferer must be compelled to suffer on."

Read or download “The Treatment of Persons with Mental Illness in Prison and Jails: A State Survey.”

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(April 21, 2014) Amid the complex and polarizing questions raised by the recent shooting of James Boyd by Albuquerque police, at least one thing should be clear to all observers: The deadly confrontation in the Sandia foothills would almost certainly have been avoided if Boyd had been receiving the treatment for severe mental illness he desperately needed.

Tragedies of this nature are on the rise nationally. At least in part, they are a predictable consequence of our abandonment of those whose inability to recognize their own mental illness and need for treatment – a condition known to clinicians as “anosognosia” – prevents them from taking control of their spiraling lives.

With timely and adequate treatment, people with severe mental illness are no more likely to be violent than the general public. But for those whose illness is complicated by anosognosia, the challenge of securing that treatment is magnified.

Because they don’t believe they are ill, they often reject treatment, deteriorate psychiatrically and get trapped in the revolving doors of the mental health and criminal justice systems. Their risk of committing a violent act triples; their risk of being victimized increases eleven fold.

There are several things New Mexico can and must do help these individuals maintain safety and sanity.

An obvious place to start is to pass a law allowing “assisted outpatient treatment” (AOT) in the state.

Sometimes referred to as “Kendra’s Law,” this measure would authorize a civil court judge to order a person with severe mental illness and a history of bad outcomes caused by treatment non-adherence to comply with an approved treatment plan as a condition of remaining in the community.

Just as importantly, it would hold the treatment system responsible for careful monitoring of the person and for delivering the services outlined in the court-approved plan.

The idea is to keep people like James Boyd from falling through the cracks.

In states that have such laws and use them, results have been impressive.

Studies in New York show AOT has led to sharp declines in rates of hospitalization, arrest, incarceration and treatment disengagement. The law has also been found to be a boon for New York taxpayers, with reductions in spending on jail and hospital days far exceeding the up-front costs of providing AOT.

New Mexico is currently one of only five states without an AOT law on the books, but not for lack of trying.

Read the entire op-ed by Brian Stettin, policy director for the Treatment Advocacy Center in the Albuquerque Journal. The piece originally appeared on April 20, 2014.

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(April 18, 2014) Amanda Bynes is back in the headlines, or more specifically, statements by Amanda Bynes’ mother and her attorney are in the news. 

"Amanda currently is on zero medication . . . . She's devoted to living her life as healthy as possible . . . . She's never had a history of abusing alcohol or hard drugs, and she's proud to say she's been marijuana-free for the past nine months . . . . Amanda does not have schizophrenia, nor has she ever been diagnosed with it,” said her attorney Tamar Arminak (“Amanda Bynes doesn’t have schizophrenia, lawyer reveals,” April 9).

 “Amanda has no mental illness whatsoever.  She has never been diagnosed as schizophrenic or bipolar,” Bynes’ mother, Lynn, has also said.  Instead, her mother attributes the unusual behavior that resulted in Bynes’ hospitalization to her daughter’s use of marijuana.

While mental health groups are all taking turns diagnosing Bynes or questioning whether the young star does in fact have a mental health diagnosis, we do know that Bynes has had several very public incidents involving unusual and sometimes dangerous behavior.  

We know that Bynes has spent some time involuntarily committed to a psychiatric hospital. We know that Lynn Bynes petitioned for and was appointed as her daughter’s LPS Conservator, a mental health conservatorship.

We also know that the civil commitment laws in California allowed the Bynes family to help their daughter get the treatment that she needed, even if Amanda didn’t believe that she needed the help.

Even though we don’t know Amanda’s psychiatric diagnosis or her medication regime or lack thereof, we don’t need to know.

We respect Amanda Bynes’ privacy, and we support her and the Bynes’ family in her recovery. 

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(April 17, 2014) The Washington Post became the second national newspaper to come out in support of the “Helping Families in Mental Health Crisis Act” in an April 17 editorial that says the changes in Rep. Tim Murphy’s bill “would help relieve a lot of suffering that does not make the front page.”

“Mental illness usually is not as dangerous or dramatic. Nearly 23 million Americans live with schizophrenia, bipolar disorder or major depressive disorder, according to the National Institute of Mental Health. Very few of these men and women are potential mass-murderers; they need help for their own well-being and for that of their families. A few, though, need services that will keep them from harming themselves or others. The nation’s health system needs to do better at treating all types.

“The Affordable Care Act has significantly increased insurance coverage for mental health care. But that may not be enough to expand access to sparse mental-health-care resources. Besides, the government is already spending billions on mental illness treatment; it has an interest in making sure taxpayers get results.

“Rep. Tim Murphy (R-Pa.) has a bill that would do so. The Helping Families in Mental Health Crisis Act is more comprehensive than other recent efforts to reform the system and perhaps has the brightest prospects in a divided Congress. The bill would reorganize the billions the federal government pours into mental health services, prioritizing initiatives backed by solid evidence and tracking their success. It would change the way Medicaid pays — or, in this case, underpays — for certain mental health treatments. It would fund mental health clinics that meet certain medical standards. And it would push states to adopt policies that allow judges to order some severely mentally ill people to undergo treatment.”

Read the entire editorial about Rep. Murphy’s landmark federal legislation.

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(April 15, 2014) When Bill O’Quin called the police to warn them that his 41-year-old paranoid schizophrenic son, David, was wandering the streets one night in February 2013, he had no idea the arrest would ultimately lead to David’s death in a Louisiana prison.

Yet “thirteen days later David Jackson O’Quin lay lifeless on a jail cell floor after being shackled to a restraint chair for nearly 170 hours during 10 days of often violent behavior,” reports the Advocate (“Dad hopes suit over mentally ill son’s death in jail will spur change,” April 14).

An artist, David O’Quin was fluent in Spanish and graduated from the University of Texas with a degree in studio art. Shortly thereafter, he moved to Los Angeles to further his art studies at UCLA.

What originally appeared to be the quirky behavior of an artist became more alarming when David moved to the west coast. “Helicopters and birds followed David around Los Angeles,” Bill O’Quin tells the Advocate. “Intelligence officials implanted listening devices in his brain . . . He often stripped naked in public.”

When he landed in the East Baton Rouge Parish Prison on that February night, David was suffering from serious psychosis, according to a medical report from a prison nurse. “Recognizing he was mentally unstable, intake workers kept him apart from the general population of inmates.”

On his sixth day in jail, “David spent 24 hours strapped to his chair, screaming for at least six of those hours, and he refused to eat.” Days later, David was “shot with a stun gun and had a spit mask pulled over his face.” Much of David’s last few days were spent restrained to the chair.

On his last night alive in prison, after being released from the chair but too weak to move, “David ate dinner lying on a mat on the floor of his jail cell . . . At about 5 a.m. a deputy yelled for him, but he didn’t’ budge. . .  At 7 a.m. a guard poked the motionless man through the bars with a broom.”

David was dead.

Officials with the Emergency Medical Services declined to comment to the Advocate about the causes surrounding David’s death. The autopsy report indicates that David died after blood clots in his legs dislodged and settled in his lungs.

Bill is suing the prison to facilitate changes in how jails and prisons treat people with mental illness.

While it is unknown whether significant efforts were made to treat David’s psychosis during his incarceration, our study, “The Treatment of Persons with Mental Illness in Prisons and Jails,” found that Louisiana is one of 13 states where involuntary treatment is significantly more difficult because it requires a court order or appointment of a guardian by the court.

David O’Quin is one more casualty in our nation’s failure to adequately provide treatment for inmates with serious mental illness who are in the throes of psychosis. As our report notes, the consequences of failing to treat mentally ill inmates are “usually harmful and sometimes tragic.”

In this case, the consequences were tragic.

Read or download “The Treatment of Persons with Mental Illness in Prisons and Jails.”

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(April 14, 2014) My 39-year-old son was diagnosed with schizophrenia 13 years ago. It started with various pains throughout his body.

After his first psychotic break we took him to the hospital where he was prescribed medication, but we realized a year later that he had never taken it. He even cheated the nurse who was sent to observe him comply with his prescription.

He has anosognosia. There have been many times when he does not believe he has an illness. When he goes off his meds, he decompensates. He becomes delusional, his thoughts race and I fear for him and others around him.  

Because of this he is a classic example of the revolving door of mental illness. He has been hospitalized about 11 times over the course of his illness, usually staying about six weeks. Once he leaves the hospital, though, he stops taking his prescribed antipsychotics.

In Connecticut, we don’t have an assisted outpatient treatment (AOT) law so as long as he doesn’t believe he is sick, he won’t take his medication. People like my son are thrown back and forth in and out of hospitals and jails. 

The lawmakers don't get it. It is hard for me to believe that even after the Newtown tragedy, they still can’t find a way to pass court-ordered treatment for the most severely mentally ill.  Our son is high functioning when he takes his meds.

An AOT law would help people like him by lowering the rate of crimes and victimization. It would prevent the cycling of my son in and out of hospitals.

All we are looking for is a law that helps people with severe mental illness who need guidance when they stop taking their medication and start to decompensate.

We know that the most severely ill patients aren’t a harm to anyone until they harm someone and end up in jail, or worse.

The mother of a a man with schizophrenia
Connecticut

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(April 11, 2014) Given the large number of seriously mentally ill individuals in our prisons and jails and the associated, the question becomes how these individuals can be treated for mental illness.

Many of the seriously mentally ill inmates will accept medication voluntarily. Others, especially those who are not aware of their own illness (in other words, those who have anosognosia), will not accept medication voluntarily because they think there is nothing wrong with them.

Just as inmates should be treated for tuberculosis, diabetes, and hypertension, so also should they be treated for schizophrenia, bipolar disorder, and major depression.

The consequences of failing to treat mentally ill inmates are “usually harmful and sometimes tragic,” according to the report, which represents the first compilation of state laws and practices governing such treatment. Without intervention, symptoms worsen, leading inmates to behave in disruptive and bizarre ways and become vulnerable to being beaten, raped or otherwise victimized, to mutilating themselves or committing suicide.

All recommendations for improving the situation begin with the general premise that individuals with severe mental disorders who are in need of treatment belong in hospitals, not in prisons and jails.

The ultimate solutions to the problems presented in this report include having an adequate number of public psychiatric beds for the stabilization of mentally ill individuals and involve a fundamental realignment of the public mental illness treatment system in which public mental health officials at the state and county level are held responsible for any failure of the treatment system. Until that is done, the following are some interim recommendations.

1. Provide appropriate treatment for prison and jail inmates with serious mental illness
2. Implement and promote jail diversion programs
3. Promote the use of assisted outpatient treatment (AOT)
4. Encourage cost studies
5. Establish careful intake screening
6. Mandate release planning

Excerpted from “The Treatment of Persons with Mental Illness in Prisons and Jails.” Read or download the complete report from our TACReports.org website.

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