Live from the Kennedy Forum
(Oct. 24, 2013) Treatment Advocacy Center Executive Director Doris A. Fuller has been in Boston this week for the Kennedy Forum on mental health organized by former Congressman Patrick Kennedy.
The stated goal of the forum is to unite the community of mental health. Among the attendees were Vice President Joe Biden, Kathleen Sebelius, Chelsea Clinton, Chris Matthews, Dr. Steve Sharfstein and many more.
Doris has been tweeting live! So make sure to follow us on Twitter, we are @TreatmentAdvCtr. Here are just a few of her tweets:
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Massachusetts Hearing Is a Sign of the Times
(Oct. 23, 2013) For the eleventh time in many years, Massachusetts heard testimony yesterday on an assisted outpatient treatment (AOT) bill. Ten years ago the room was almost completely empty, but on Tuesday the standing-room-only hearing before the Joint Committee on Mental Health and Substance Abuse was a sign that after the spate of high-profile tragedies involving severe mental illness, people are becoming increasingly passionate about how we treat people tormented by psychosis.
 The committee members heard testimonies from twelve people in support of mandatory outpatient treatment for Massachusetts’ most vulnerable residents.
Here’s what they said:
“Families, loved ones, employers, healthcare providers and law enforcement witness and struggle with serious mental health issues every day…and this state, one of only 5 without AOT, needs to take this issue more seriously. . . Will it take a Navy Yard event before Massachusetts takes this more seriously?”
Robert Martel, Family member and advocate
“I work at Pine Street Inn, one of the state’s largest resources for homeless men and women. Forty-seven percent of people we saw last year had some sort of mental health condition. Some of these individuals stay in our shelter, many live on the street. This legislation would give us, as well as other providers, a valuable treatment option that does not exist.”
Aimee Coolidge, Social Worker
“While adequate funding and functioning of a community mental health system are necessary, they are not sufficient to meet the needs of some. Why? The reason is anosognosia (lack of insight). Having a lack of awareness raises the risk of treatment and service nonadherence. From their point of view, why should they go to appointments or engage in therapy?”
Jeffrey Geller, MD, MPH, Director of Public Sector Psychiatry and Professor of Psychiatry at the University of Massachusetts Medical School
“If Massachusetts were to pass a law allowing for assisted outpatient treatment and to use it effectively, it would help those most in need, and it would mitigate the strains that untreated mental illness are exerting on families, law enforcement officers, your jails and prisons and your hospital ERs.”
Kathryn Cohen, legislative and policy counsel at the Treatment Advocacy Center
Help us support those who are calling for AOT in Massachusetts:
Massachusetts is Failing People With Serious Mental Illness
(Oct. 22, 2013) The Commonwealth of Massachusetts consistently fails most measures of providing access to treatment for its population with severe mental illness, according to our report released today.
“Massachusetts: An Assessment on the Commonwealth’s Access to Treatment for Persons with Severe Mental Illness” examines public policies that create access to treatment for the small but costly segment of the population suffering from untreated severe mental illness and unable or unwilling to seek treatment.
The report found that current legal provisions and lack of diversion practices restrict access to treatment for people with severe mental illness until they enter the criminal justice system or fall victim to other consequences of non-treatment.
Key Findings:
- The untreated population with schizophrenia in Massachusetts is 37,284
- The untreated population with severe bipolar disorder in Massachusetts is 58,486
- The estimated number of homeless people with severe mental illness is 4,999
- The number of people incarcerated with severe mental illness is 7.26% of the male inmate population and 24.9% of the female inmate population
The report recommends three strategies for increasing access to treatment for Massachusetts most vulnerable individuals:
- Pass House Bill 1792/Senate Bill 906 introduced by Representative Kay Khan and Senator Ken Donnelly to create an assisted outpatient treatment (AOT) law in Massachusetts.
- Provide an adequate number of psychiatric beds. An estimated 50 public psychiatric beds per 100,000 people are needed to provide minimally adequate inpatient psychiatric care to Massachusetts’ population. As of 2010 Massachusetts only had 10.6 beds per 100,000 people.
- Use mental health courts and Crisis Intervention Team (CIT) policing to divert people with severe mental illness from the criminal justice system
The failure to provide treatment for individuals with serious mental illness has turned into one of the greatest social disasters for Massachusetts. If the state were to reform its mental health treatment laws it would mitigate the strain that untreated mental illness exerts on families, jails and prisons, and the ill themselves.
Some People Slip Through the Cracks; Others Are Shoved
(Oct. 21, 2013) Matthew Herrera could be a poster boy for the price of protecting the right to insanity.
 Herrara, of Sacramento, California, has revolved in and out of locked psychiatric wards, jails and prisons for 13 years, since he was 13, Sacramento Bee reporter Dan Morain reports in “Mental health system a safety net in name only” (Oct. 21).
His latest outing ended when he was released from Sacramento County jail and dumped in downtown Sacramento at 1 o’clock in the morning. Mere hours later, Herrera “lay on a gurney at UC Davis Medical Center mumbling. He had been deemed a danger to himself and others, again.”
Herrera’s experience shows “that while many mentally ill people slip through gaps in the safety net, others are shoved,” Morain writes.
“They’re setting him up for failure,” his mother Karen Herrera told Morain. “It’s no different than letting a 3-year-old run out to the street. Adults should intervene. But they don’t until mentally ill people commit crimes. Even when they are in custody, authorities are solicitous of their rights.”
When Herrera arrived at the UC Davis Medical Center he was placed on anti-psychotic meds and the next day was “lucid enough to play cards with his mother.”
“There are different Matthews when the medication kicks in,” his mother said.
Herrera “is part of that small segment of mentally ill people who can’t care for themselves and become our responsibility,” Morain writes. “We don’t do well by them.”
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Requiring Dangerousness to Receive Treatment is Dangerous
(Oct. 17, 2013) As Dr. E. Fuller Torrey has said, "Waiting to treat those affected with severe mental illnesses until they become dangerous to themselves or others ensures that many will become exactly that."
 No one has to tell that to the nurse at Thomas B. Finan Hospital Center in Cumberland, Maryland, who was struck by a patient in the head with a seven-inch metal spike. The patient, a fifty-year-old man had been threatening to kill staff and had been refusing his medication (“Patient charged with stabbing nurse with spike in Western Maryland hospital,” the Washington post, Oct. 15).
Maryland requires that a patient demonstrate dangerousness, either to self or others, during a hospitalization in order to receive medications over objection as a result of the decision in Dep't of Health & Mental Hygiene v. Kelly (Md. 2007). It does not matter that the person has already demonstrated dangerousness, as is the only basis for inpatient civil commitment in Maryland in order to be admitted to the hospital in the first place. The person must demonstrate an additional episode of dangerousness while in the hospital in order to be medicated over objection.
The mother of the patient who stabbed the nurse stated that “he’s not violent unless he’s off his medicine for a long time. As long as he was on his medicine, he would give you the shirt off his back and help you in any way. If he wasn’t on his medicine, something should’ve been done to get him on his medicine. That’s why he was there, to be treated.”
Maryland, however, often continues to allow people to remain unmedicated in their severe mental illness until they become dangerous…even after they have been found dangerousness enough to be committed to a hospital.
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RESEARCH: Lithium’s Neuroprotective Effects
(Oct. 16, 2013) Lithium and some other medications may help preserve cognitive function in people with bipolar disorder and possibly those with Alzheimer disease, according to a report in Psychiatric Times (“Lithium’s neuroprotective effects,” Aug 21).
 An association between bipolar and impairment in executive function, verbal memory and information processing has been identified in more than 75 studies and other research, the report said. The impairment exists even during periods when no symptoms of mania or depression are present and appears in first-degree relatives who don’t have the disease.
Findings in these studies indicate that lithium, quetiapine (Seroquel) and valproate (Depakote) have “very positive effects” on the brain abnormalities common in people with bipolar disorder and specifically in preventing the onset of Alzheimers.
One researcher told the American Psychiatric Association meeting in San Francisco this year that his study of patients who had taken lithium for a decade or more had found “significantly lower” abnormalities associated with the disease and decreased risk of dementia and Alzheimer disease later in life.
“Lithium had been slipping into American obscurity in the past 10 years, but it is making a well-deserved comeback as a therapeutic substance that may have numerous uses. Not only is it the best mood stabilizer, but . . . it may have protective effects on the central nervous system.”
Read “Lithium’s neuroprotective effects” in Psychiatric Times.
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How Mental Health Can Foster Physical Health
(Oct. 15, 2013) “Diagnosed with Type 1 diabetes when he was 14, CC began to tell family and friends in 2010 that he was hearing the voice of God in his mind,” reports the Associated Press. Shortly thereafter, CC stopped taking the insulin that was necessary for managing his diabetes.
 CC also refused to take medication for his bipolar disorder. When his parents tried to intervene he said it was the “work of the devil.”
"(God) said, 'Just eat anything. You still have diabetes, but I'm going to sustain it, so it doesn't affect your blood — your nerves or your organs,’” CC told his psychiatrist. "So I said, 'Okay, Lord.'"
When he was civilly committed for bipolar treatment, CC appealed the district court’s order.
CC’s inability to take care of his medical needs is not uncommon among people with severe mental illness. A team of researchers at Johns Hopkins University examined the connection between antipsychotic adherence and life expectancy and found that people who adhere to medication schedules 90% of the time are 25% less likely to die than those who adhere 10% of the time. “If people are taking their medications, they usually have fewer symptoms and are able to be more organized in other areas of their lives," said Dr. Bernadette Cullen, lead researcher on the study.
"We believe they are then more likely to make appointments with their primary care doctors, to stay on top of other illnesses they may have and to regularly take diabetes, blood pressure or cholesterol medication that they may require to stay healthy,” Cullen continued. “We also believe that they are more likely to be socially engaged and have a healthier lifestyle."
Ultimately, the Oregon Court of Appeals affirmed a lower court’s decision to commit CC to a psychiatric hospital for bipolar treatment “despite his insistence that God will protect him from the consequences of refusing to take his medication.” Though he wasn’t committed for treatment of his metabolic condition, restoring his mental health was good for his physical health, too.
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Homeland and Girls Tackle Mental Illness
(Oct. 14, 2013) “Convinced that her medication for bipolar disorder clouded her judgment, Homeland’s protagonist began the show’s third season self-medicating with exercise and alternative therapies. And doctors say that decision, along with others Carrie Mathison has made concerning her condition, are influencing the way real patients are approaching the mental illness.
 “Once a taboo topic, mental illness is an increasingly prominent plot line on television, not just on Homeland but on Girls, where Lena Dunham’s Hannah depicts life with Obsessive Compulsive Disorder (OCD) (when stressed, she organizes everything in a series of eights). The portrayals can be a double-edged sword, however, as they raise awareness of the realities of living with mental illness while frequently focusing on some of the more extreme symptoms and therapies….
“Mathison experiences a variety of symptoms associated with bipolar disorder, including impulsivity and engaging in risky behaviors, including sexual promiscuity (her character slept with potential terrorist Nicholas Brody and a stranger from a liquor store).
“Aside from helping those unfamiliar with mental illnesses to have a more realistic and unbiased view of psychiatric disorders, the depictions may help patients struggling with mental illness as well.
“Normalizing mental illness can de-stigmatize having a disorder and help patients to accept the need for taking medications. And as Mathison’s story shows, the experiences of these characters struggling with their symptoms can also make compelling material for television shows and movies.
“It’s a win-win for both patients and the entertainment industry alike.”
Read Homeland and bipolar disorder: How TV characters are changing the way we view mental illness (TIME, Oct. 8).
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Prisons Are a Very Poor Place to Treat the Mentally Ill
(Oct. 10, 2013) Yes, jails are America's "new asylums." Thousands of people with treatable mental illness who once might have been patients getting treatment are instead inmates essentially getting punished for being sick.
 The front-page charts in your outstanding article provide a perfect snapshot of the plunging availability of public hospital beds, where desperately ill people once received intensive treatment they needed to begin recovering.
The complete picture would also chart the explosion of homelessness, suicide, homicide and victimization associated with untreated mental illness that has taken place at the same time. Public policies recognizing the need to provide treatment for individuals with the most severe mental illnesses could stem the criminalization of mental illness and reduce the many other incalculable personal and public costs of nontreatment. For those policies to change, there needs to be some collective agreement that the conditions you describe are no longer acceptable. That consensus doesn't currently exist. Until it does, the picture will only get darker.
Doris A. Fuller
Executive Director, Treatment Advocacy Center
Giselle Stolper, president and CEO of Mental Health Association of New York City, also weighed in with a published letter, calling the criminalization of people with mental illness, “cruel … ineffective public policy and a gross waste of tax dollars.” Deborah Bennett of Staatsburg, New York, wrote, “We need a serious national conversation about our obligations to those truly incapable of fending for themselves….”
These letters originally appeared in the Wall Street Journal on Oct. 8 and were written in response to “Jails Swell With Mentally Ill,” page one, Sept 26.
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What People Are Saying About American Psychosis
(Oct. 9, 2013) The causes and consequences of deinstitutionalization are the subject of Dr. E. Fuller Torrey’s scathing new book, American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System.
 Here’s what people are saying:
“Torrey is the conscience of the country and its most articulate spokesperson when it comes to public mental health care.” – JEFFREY A. LEIBERMAN, President, American Psychiatric Association
“The first time I heard Torrey speak at a meeting of psychiatrists I was so offended I got up and left. Five years later I realized everything he said was true. This book will, I believe, offend many people; hopefully it will take them less time to recognize the truth of what Torrey has written.” – ALAN A. STONE, MD, Professor of Law and Psychiatry at Harvard University
Torrey’s superb new book is a devastating indictment of America’s mental health ‘system,’ a story of good intentions gone disastrously awry.” – STUART M. BUTLER, Distinguished Fellow and Director, Center for Policy Innovation, The Heritage Foundation
“With persuasive facts and gripping, tragic examples, Torrey documents what state psychiatric hospitals, community mental health centers and jails have in common: millions of seriously mentally ill people treated inhumanely and inadequately.” – SIDNEY M. WOLFE, MD, Public Citizen Health Research Group
Read an excerpt from American Psychosis.
Purchase a copy of the book here. All royalties from American Psychosis have been assigned to the Treatment Advocacy Center.
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