(Nov. 27, 2013) Though their vote is only advisory, the Berkeley City Council last week unanimously passed a resolution urging the Alameda County Board of Supervisors to adopt California’s assisted outpatient treatment (AOT) law, known there as Laura’s Law.

A city with a strong progressive history, Berkeley has been at the fore of many emerging civil rights issues over the decades, and we commend Berkeley for taking this step to help ensure treatment for its most vulnerable citizens.

Beyond the local impact, the council vote is more evidence the view that court-ordered outpatient treatment is an abridgement of civil rights is shifting to acknowledge that the consequences of non-treatment abridge civil rights, too.

Around the country, more people are recognizing severe mental illness often affects the part of the brain that enables individuals with severe mental illness to recognize they are ill and get the help they need. They are learning that jails and prisons have replaced hospitals as the new asylums for psychiatric patients, housing far more people who are ill than psychiatric hospitals do. They are realizing that all-voluntary treatment looks good until you look at it. They are agreeing with what Dr. Drew expresses in this report from CNN’s Situation Room, which also featured Doris A. Fuller, our executive director.

We salute the Voices of Mothers Project, whose advocacy in the Berkeley area led to the city’s support. We urge all who support assisted treatment for those with the most severe mental illnesses to raise your voices, wherever you live, and work to improve treatment laws and demand that they are used to save lives and families.

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(Nov. 27, 2011) SAMHSA will present and broadcast a public-service program examining the impact of assisted outpatient treatment (AOT) on people with severe mental illness on Monday, December 2, from 9 am to 1 pm.

The public may attend the program at SAMHSA’s headquarters in Rockville, Maryland, or online through the agenda’s webcast or telephone dial-in.

Treatment Advocacy Center Policy Director Brian Stettin will participate as a panelist.

“The seminar is designed to educate and improve the understanding of assisted outpatient treatment,” according to the Substance Abuse and Mental Health Services Administration website on the event. “The presenters at this seminar will examine research findings, implications, and outcomes of AOT and topics related to persons with serious mental illnesses.”

Duke University researchers Marvin S. Swartz and Jeffrey W. Swanson will open the seminar with a review of research findings on AOT, followed by a question/answer period. Next, Stettin and two other panelists will discuss “applications and implications of assisted outpatient treatment,” followed by a second question and answer period.

Both the live and the virtual audiences will be able to submit questions to the presenters.

The full agenda for the seminar is available on the SAMHSA website. Registration is available online.

The Treatment Advocacy Center is urging the public to attend and participate in this unusual event. Seating and webcast lines are limited so immediate registration is urged.

(Nov. 25, 2013) Montana’s civil commitment laws allowed Gary Mihelish’s oldest son to begin the road to recovery after being diagnosed with schizophrenia, a journey Mihelish described this weekend on NPR’s Weekend Edition Sunday (“Caring for a schizophrenic son, worrying about the future,” NPR, Nov. 24).

Mihelish said the first sign that his son might have a mental illness was that he “began to isolate and he just withdrew into himself. We thought it might just be adolescence, an adjustment.”

The situation worsened for the Mihelish family when the young man entered his 20s and took off to California following a psychotic breakdown. “He had no money, was living on the streets,” his father said. Upon his son’s eventual return home and a mental health evaluation, he was diagnosed with schizophrenia.

Finally, things began to stabilize as a result of a civil commitment hearing. “[T]he judge told our son: ‘I want you to take your medication, and if you don’t take the medication, I’ll put you in the state hospital,’” Mihelish told NPR.

The young man followed the judge’s orders and now – nearly 30 years later – Milhelish says his son is doing “pretty darn good.”

Gary Mihelish became a lifelong advocate for mental illness treatment law reform as a result of his son’s experience. He received NAMI’s “Distinguished Service Award” in 2013 and has consistently worked with the Treatment Advocacy Center to improve his state’s treatment policies so that even more families can benefit the way his own family did.

Listen to the entire interview on NPR.

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(Nov. 22, 2013) The Creigh Deeds tragedy in Virginia sounded the national alarm bell over the United States’ shortage of psychiatric beds for people in psychiatric crisis. But what was lost in the fray was a discussion of the other tragedies that occur daily as a result of untreated mental illness.

Jails and prisons have replaced hospitals as the institutions housing the most psychiatric patients. Until we stop eliminating public psychiatric beds and start making treatment available before severely ill individuals become inmates, this will remain the case.

More people with untreated severe mental illnesses are living on America’s streets than are receiving care in hospitals. One study found that 28% of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans, and 8% used garbage cans as their primary food source.  

Untreated severe mental illness is an increasing factor in officer-involved homicides. At least half the people shot and killed by police each year are believed to have mental health problems.

Even though violence against others and sensational mass killings attract the most media attention, suicide is the number one cause of premature death among people with schizophrenia, with an estimated 10% to 13% taking their own lives every year.

The mental illness treatment system in America is a disgrace, and the non-treatment of mental illness is a growing crisis. Let’s hope the events that left Creigh Deeds injured and his son Gus, 24, dead aren’t just the next fading headline but an impetus to address all the tragedies of untreated severe mental illness.

Read our backgrounder on the consequences of nontreatment.

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(Nov. 19, 2013) Less than a day after Gus Deeds, 24, was released from an emergency hold at a Virginia hospital - reportedly because no psychiatric beds were available - the young man stabbed his father, Senator Creigh Deeds, in the head and torso before fatally shooting himself. Deeds, a former gubenatorial and attorney general candidate, is recovering.

While it remains unclear whether Gus Deeds suffered from a diagnosed mental illness, this tragedy appears to be yet another incident related to our failure as a nation to provide adequate treatment options for those in psychiatric crisis. The continuous emptying of state psychiatric hospitals for the past half-century has reduced the number of public beds for acutely or chronically ill patients by more than 90% nationwide while the US population nearly doubled. Virginia only has 37% of the beds considered necessary to meet the needs of its population, according to our study, “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals.”  

Even though most individuals with serious mental illness are not dangerous, there is a correlation between lack of treatment for mental illness and certain violent crimes, including 10% of all homicides and countless suicides.  

“The elimination of hospital beds for people who need help in a psychiatric crisis is a driving force behind a long list of terrible consequences, including preventable violent acts,” said Doris A. Fuller, executive director. “We will keep seeing tragedies until we provide sufficient inpatient beds to meet the needs of people in psychiatric crisis. If a hospital bed had been found for Gus Deeds during the limited time of a psychiatric hold in Virginia, he might be alive today, and his father would not have been grievously wounded.”

(Nov. 19, 2013) A family sits down at Maggiano's Little Italy Restaurant in California to celebrate a son’s birthday.

In the next booth a man is laughing so loudly that the son turns around. He sees that the man is by himself. There is no one eating with him or responding to his conversation. The man moves a menu across the table as if someone was sitting there. He proceeds to order two drinks and two dinners. The wait staff is polite and providing what is requested but their faces are struck with confusion.

Other patrons are trying not to look, not to notice. The man is overheard saying “Are you trying to play footsie with me?”

After paying his bill, he stands up and clicks his water glass with the knife to get everyone’s attention. As the patrons and wait staff look over at him, he proclaims that this is the happiest day of his life as he is in love. He gets down on one knee, pulls out a ring, and begins to propose to this imaginary woman. He then rises and proclaims how happy he is, he puts his arms around this imaginary woman and kisses her. Then he turns around doggy bag in hand and leaves the restaurant saying they are now headed for their honeymoon. A few patrons started clapping the rest just looked stunned.

At least 60 people observed this and did nothing. What should they have done? Many thoughts raced through their heads:

• “I bet this is a Candid Camera stunt or this guy is doing some kind of sociological study”.
• “It’s none of our business we don’t need to get involved.”
• “The poor man is crazy. He’s not hurting anyone and he is paying his bill. Leave him alone.”
• “Perhaps his girlfriend abandoned him and this is his response.”
• “What if he has a gun or could buy one.”
• “Should we do something or notify someone? Why isn’t the restaurant doing something?”
• “Should we call the police?”
• “Did this man get behind the wheel of a car and take off…where did he go?”

In this particular case, what would you advise the other diners in the restaurant to do? What would you advise the restaurant management to do? What would the consequences be for both the people who intervene and for the man?

As professionals, what would you do? What is your inclination, responsibility or obligation?

We received this post on our Facebook wall and had to share it with our readers.
What would you do?

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(Nov. 18, 2013) Of the fourteen thousand inmates in Oregon’s prisons, 4,672 needed mental health treatment in a one-month period – a number that has risen 17% in the last five years, according to data from the state Corrections Department (“Third of Ore. inmates have mental health issues,” the San Francisco Gate, Nov. 11).

It should come as no surprise to anyone that a third of inmates in the state have some sort of mental health issue. Oregon has roughly 18 psychiatric beds per 100,000 people, which is only 39% of the recommended number of beds. One of the consequences of not providing adequate long term care is that people suffering from mental illness are much more likely to end up in the criminal justice system.

In addition to not having enough psychiatric beds, only 38% the state’s population is served by crisis intervention team (CIT) policing and 54% of the population is served by mental health courts, according to our study “Prevalence of Mental Health Diversion Practices: A Survey of the States.”

Everyone talks about the inhumanity of criminalizing people with serious mental illness, but we will continue to see an influx of incarcerated mentally ill people until states make better use of their civil commitment laws and adopt policies to provide treatment to people who need it before they end up being warehoused in our jails and prisons.

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(Nov. 15, 2013) Psychiatrist Dinah Miller says it “wouldn’t be the American Psychiatric Association’s annual meeting without them.” She is referring to the anti-psychiatry protestors.

Psychiatrists “need to acknowledge that some of the points the protesters make are valid,” writes the doctor and author of Shrink Rap: Three Psychiatrists Explain Their Work.

She highlights the fact that diagnostic criteria are arrived at by consensus, rather than by biological markers, but “[the protestors] seem unaware that the values for defining diabetes and hypertension were also arrived at by consensus.”

Ultimately,“[t]reatments don’t help everyone, which is not news to any psychiatrist,” she opines on the science of treatment for mental illness.

But also.

 “We need to respond to studies showing fault with psychiatry that have been overly touted by the media and are simply wrong.”

Read all of “Responding to antipsychiatry protestors” in Clinical Psychiatric News.

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(Nov. 14, 2013) The mental health community cheered last Friday when the Obama administration announced that under the Affordable Care Act private insurers will be required to provide coverage for mental illness equal to what they provide for physical illnesses (“Rules to require equal coverage for mental ills,” the New York Times, Nov. 8).

This is a great step forward that will provide needed resources for those with psychiatric disorders who are able to voluntarily seek treatment and it’s certainly worth cheering about. But, these new regulations don’t address the population of people who need treatment the most, those who are too sick to recognize their illness.

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.

Individuals suffering from anosognosia, regardless of insurance status, won’t necessarily benefit from the new rules and they are the ones who are most likely to suffer from the consequences of untreated serious mental illness. 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.

While we have seen great strides towards equality for those suffering from mental health issues, these new regulations should only be a precursor to ensuring equal treatment for those too sick to seek it on their own.

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(Nov. 13, 2013) Celebrity and actor Richard Dreyfuss has been bravely sharing the story of his lifelong struggle with the euphoric highs and devastating lows that characterize his bipolar disorder (“Richard Dreyfuss opens up about his battle with bipolar disorder,” People Magazine, Nov. 11).

“By telling my own story, I hope to help remove the stigma. It never should be something to hide," he tells People Magazine about his decision to speak publicly about his battle.

Although he recognized extreme mood fluctuations at age 14, it appears that he lived with the symptoms of untreated bipolar disorder until 1995 when he sought treatment from a therapist for his illness in his late 40’s. “We went on a journey to find the right meds and it took four long years," he said.

“I’m able to be Richard again,” he told People. “Things are great.”

Dreyfuss is a reminder that severe mental illness is an equal-opportunity disease and an example of the positive impact treatment can have. Our hope is that by providing an avenue to treatment for those who are suffering, we will see more success stories like his.

Thanks go out to him for bravely sharing his story about living with bipolar disorder.

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