(Oct. 7, 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.

Published by Oxford University Press, the book details the forces that led to the Community Mental Health Centers Act of 1956 (CMHCA), the last bill President John F. Kennedy Jr. signed before his assassination. The CMHCA was designed to initiate a grand new era of small, caring community centers in place of the state psychiatric hospital system inspired by Dorothea Dix and other reformers. Instead, the law ultimately dismantled the treatment system for those with the most serious mental illnesses without ever replacing it.

“On staff at the National Institute of Mental Health when the program was being developed and implemented, Torrey draws on his own first-hand account of the creation and launch of the program, extensive research, one-on-one interviews with people involved, and recently unearthed audiotapes of interviews with major figures involved in the legislation” amazon.com says in its description of the book. “As such, this book provides historical material previously unavailable to the public.”

The book was released in October to coincide with the 50th anniversary of the CMHCA, which Kennedy signed on Halloween day.

“Many now wonder why public mental illness services are so ineffective,” amazon.com says. “At least one-third of the homeless are seriously mentally ill, jails and prisons are grossly overcrowded, largely because the seriously mentally ill constitute 20 percent of prisoners, and public facilities are overrun by untreated individuals. As Torrey argues, it is imperative to understand how we got here in order to move forward towards providing better care for the most vulnerable.”

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.

(Oct. 7, 2013) Nearly a year before the car chase that led to her death in the nation’s Capital last week, Miriam Carey told police she was a prophet and that President Obama would “place the city of Stamford under a ‘lockdown’ and that he had her and her residence under electronic surveillance,” (Miriam Carey, identified as Capitol Hill car chase driver, was taken for mental-health evaluation,” CBS News, Oct. 5).

Another news report said, "Authorities searching the home of a Connecticut woman who rammed barricades and led police on a chase near the U.S. Capitol found discharge papers from a 2012 mental health evaluation that listed prescriptions to treat schizophrenia and other mental disorders” (“Source: Mental health paperwork found at home of Miriam Carey after Capitol chase,” CNN, Oct. 4). 

Carey’s death occurred the day after the Treatment Advocacy Center and National Sheriffs’ Association published our latest joint study, “Justifiable Homicides: What is the Role of Mental Illness?” In it, we report that, while the use of deadly force in the line of duty has declined over the last 30 years, its use after a law enforcement agent is attacked has risen 67%.

We don’t yet know the precise role of mental illness in Carey’s death. We do know she was shot by law enforcement after she rammed barricades and police cruisers, injuring two officers, and that multiple people who knew her said she struggled with post-partum mental health issues after her daughter’s birth last year.

“Unfortunately, if someone does have a crisis, a moment of instability, how do people put in place to protect, how do they help you,” Carey’s sister, Ann Carey-Jones told Grio. “{H]ow can they contain the situation and give you the help that you deserve?” (“Family of Miriam Carey: ‘Shooting was not justified,’” Oct. 5).

That’s the question we work to answer every day.

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(Oct. 4, 2013) I write the way I speak. The way I speak these days is with impatience at the hesitancy to implement or fully use involuntary treatment laws in every state.

I wasn't always this way. When my daughter had her second psychotic break, I went to our urgent psychiatric center to fill out the involuntary petition and found myself sitting in the chair unable to speak or write due to crying uncontrollably at the thought that I was there quite literally begging for my 19 year old to get the medical care she desperately needed.

And beg I would. I would have done anything. But they accepted that petition and the other three I have had to fill out during the course of her now almost 10-year battle with serious mental illness.

Getting the care she needed still didn't stop me from being curled up in the fetal position the third time we had to go through the same process worrying about how my precious girl was supposed to survive in a world that prefers to incarcerate her or leave her on the streets.

My daughter's illness included a lack of insight, which means she was too sick to know she was sick. I have never needed studies or medical expertise to explain to me that her illness affects her brain, therefore her ill brain may not allow her understand she is sick. Common sense told me that.

But due to the fact that she was allowed access via our involuntary program to the medical care she needed for almost eight years, her illness relented and she now has insight. For the last year and two months, she has been receiving care voluntarily.

I still worry though. She is still mentally ill. There are no guarantees the symptoms of her illness won't rear their ugly heads again. And she still lives in a world that would prefer to incarcerate her or leave her on the street.

But I am grateful she has made it this far. I no longer find myself curled up in a ball sobbing.

Now I'm just impatient waiting for everyone to have access to medical care, including those with brain disorders rendering them too sick to ask for it on their own.

- The mother of a young woman who benefited from Arizona’s assisted outpatient treatment (AOT) law.

(Oct. 3, 2013) Glenn Broadnax told police he wanted to commit suicide as he walked in and out of cars in Times Square last month. Police shot at Broadnax after they say he reached in pocket, but the bullets hit two bystanders instead.

Law enforcement officers in New York City get limited training about how to deal with people in a psychiatric crisis and the incident in Times Square “highlights the fact that when police and the mentally ill come face to face, the situation can quickly become deadly,” reports Julia Dahl for CBSNews (“Times Square Shooting: Experts say police need better training to deal with the mentally ill,” Sept. 16).

Ironically, a group of advocates met the day before to discuss bringing police Crisis Intervention Training (CIT) to New York City.  The timing of these recent events in Times Square seems like proof that the City Council needs to listen. 

New York has been a leader with assisted outpatient treatment (AOT) with Kendra’s Law, but it lags behind in training its police to work with those with severe mental illness. CIT teams are comprised of officers who have received substantial training in working with people with mental illness in the community. The Treatment Advocacy Center found CIT teams are only available to 5% of the population in New York State. (Read the complete study “Mental Health Diversion Practices: A Survey of States”). 

Employing a CIT team in New York City could potentially have prevented last month’s gunshots in Times Square, but getting Broadnax into treatment before a crisis would have been the best solution.

The two bystanders who were shot in Times Square survived, but too often encounters between people with untreated serious mental illness and police have deadly consequences. Read our study “Justifiable Homicides: What is the Role of Mental Illness?,” in which we review incidents where an individual with severe mental illness is killed by a law enforcement officer in the line of duty.

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(Oct. 2, 2013) Jonathan Meline, 29, was released from Western State Hospital in Washington last October. But upon his release, Jonathan’s parents had no legal access to his treatment records and no way of knowing that his delusions were still active, and he still thought about killing his parents.

Now, his father, Robert, is dead, killed by Jonathan during a psychotic episode. His mother Kim wants to know why her son was released and who made the decision.

Due to HIPAA (“Health Insurance Portability and Accountability Act”) privacy laws, she has no way to access his treatment records and find out whether anyone involved in her son’s treatment did something incorrectly. As a result, she is suing her son for access to his medical records.     

“Suppose your mentally ill son killed your husband with a hatchet. You might want to know whether anyone involved in his treatment screwed up beforehand,” Tacoma News Tribune reporter Sean Robinson writes about Kim Meline’s struggle with HIPAA (“Tacoma mother forced to sue for medical records of mentally ill son,” Sept. 28). “When a patient with a mental illness commits a violent crime, tracking is far harder — almost impossible. Privacy laws governing mental-health records cover all the footsteps.” 

The Treatment Advocacy Center routinely receives phone calls from patients and family members frustrated that privacy laws prevent them from helping desperately ill loved ones get appropriate treatment and keep them from being aware of safety issues. 

Knowing the law may help family members convince providers to share vital information about loved ones. Read our HIPAA at a Glance chart to learn how to navigate HIPAA 

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(Oct. 1, 2013) I had a heart attack this past January. The symptoms were mild, and I reacted to warning signs without delay. I knew something was wrong, and I sought help. On the other hand, tens of thousands of people with a major mental illness have literally no idea that they have a mental illness impairing their ability to function, interact, and behave within the expectations of society. Their world is a jumble of bizarre thoughts, beliefs, and perceptions.

They attract our attention and evoke pity, but they scare and repel us. Sometimes they make us laugh when they do silly things, but it is a tragedy nonetheless. Seventy years ago they would have languished in an asylum, filthy with urine, unbathed, poorly clothed if at all. Forty years ago they would have lived in an institution in a pastoral setting, removed from the general population, likely overmedicated but bathed, fed and clothed for the most part. Now they live on the streets, smelling of urine, unbathed, poorly clothed if at all, and eating from trash cans. Progress?

They are out there because the policies have changed over the years, reacting to the poor treatment in institutions in the early part of the twentieth century. State hospitals have reduced their censuses dramatically over the past 40 years. Don’t get me wrong, many people have benefited from the changes. Community services have expanded over the same period. Medicine available to treat psychotic disorders has improved dramatically over the last 40 years. Many people, who could not live independently in the past, now can. But not all people respond well to medicine, and a subset of people with mental illness also have a condition known as anosognosia, which prevents them from understanding that the intrusive thoughts, voices, and paranoia they are experiencing are not real. They are the majority that ends up on our streets due to mental illness. They are the homeless problem that will probably not go away until we change some of the policies and make it easier to intervene.

Please stand up for homeless people with serious mental illness. Please demand a review of policies that allow people to languish on the street without care.

The problem as I see it is:

• Not enough quality housing. There is a waiting list.
• Not enough emergency care. The hospitals are rewarded for discharging people in a week whether or not they are better.
• A system that has become jaded over the years by laws and policies that hamstring it, including impossible caseloads an documentation requirements that leave the case worker working on reports more than seeing people.
• Most important, a system that has to rely on voluntary compliance from people who do not understand that they need help.

Gunther Stern
Georgetown Ministry Center

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(Sept. 30, 2013) The CBS news magazine 60 Minutes devoted one of its season premiere segments to an examination of schizophrenia and the consequences of not treating it.

“Imminent Danger” was in production for nearly 10 months and featured Treatment Advocacy Center founder E. Fuller Torrey, MD, and others, including two young men living with treated schizophrenia and video of a third man whose schizophrenia is untreated.

From the program:

60 Minutes correspondent Steve Kroft:  “The mass shooting at the Navy Yard two weeks ago that resulted in the deaths of 13 people, including the gunman was the 23^rd such shooting in seven years.  It is getting harder and harder to ignore the fact that many of the people pulling the triggers have been severely mentally ill, not in control of their faculties and not receiving treatment.”

Dr. Torrey: “Every person I have taken care of  . . . had a very good reason for doing what looked to be crazy behavior, but in their mind it wasn’t crazy behavior it was in response to something that was very logical that their voices were telling them..

Jacob Bowen, living with schizophrenia: “Basically all my voices I have are just voices telling me to harm myself of others . . . and that’s why I think I need to get on medication because I don’t want to hurt anyone.”  

Jeffrey Lieberman, MD, president of the American Psychiatric Association: “You could be the most popular student, you can be the valedictorian of your class and if you develop schizophrenia it will change the functioning of your brain and change the nature of your behavior.  Usually it’s multiple voices. . . .When they are at the worst, the person cannot distinguish the voices from the illness.”

Cook County Sheriff Tom Dart: “I have 2500 people with severe mental illness in my jail today. This is a population that people don’t care about, so as result there are no resources for them.”

Sheriff Dart and the Cook County Jail also were featured in a recent front-page Wall Street Journal story, “The new asylums: Jails swell with mentally ill” (Sept. 26). “Society was horrified to warehouse people in state hospitals, but we have no problem with warehousing them in jails and prisons,” he told the Journal in a story that is behind a pay wall but may be accessed by subscribers.  

Watch “Imminent Danger” on CBS.com.

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(Sept. 27, 2013) Last week was a remarkable week in Washington.

On Monday, September 16, Aaron Alexis, a 34-year old former Navy reservist, opened fire at the Washington Navy Yard, killing 12 people and injuring eight others. Five weeks before the shooting, Alexis had complained to the police in Rhode Island that people had been following him and “sending vibrations to his body” using a “microwave machine” to keep him awake. He was profoundly delusional – hearing voices that seemed to come through the walls, floor and ceiling of his hotel room. On the barrel of the gun he used for the shooting he engraved “My ELF machine,” referring to the extremely low frequency (ELF) electromagnetic radio waves, used by the Navy to communicate with submarines and which Alexis apparently thought the Navy was using to persecute him.

On Wednesday, September 18, Oscar Ortega-Hernandez pleaded guilty in federal court to having fired eight rounds from an assault rifle at the second and third floor of the White House in November 2011. One bullet hit a window but was stopped by the bulletproof glass. Another bullet narrowly missed a secret service agent on the White House roof. Mr. Ortega-Hernandez was a 21-year-old with a young son who came to Washington from Idaho Falls, Idaho. He had recently been telling people he was “the modern-day Jesus Christ that you all have been waiting for” and that President Obama had to be killed because he was “the Antichrist.” Ortega-Hernandez also believed that “the federal government was seeking to control Americans by implanting global positioning chips in children.” He will be sentenced on January 10 and faces up to 27 years in prison.

On Thursday, September 19, Floyd Lee Corkins, a 29-year old man from Herndon, Virginia, was sentenced to 25 years in prison in a U.S. District Court. Corkins had been convicted of shooting an unarmed security guard in August, 2012, at the Family Research Council in downtown Washington. Corkins had gone there to kill “as many people as possible” because he disagreed with the politics of the organization. Six months before the shooting, Corkins had been hospitalized for auditory hallucinations and “thoughts of killing his parents and conservative right-wing Christians.” He had been diagnosed with major depressive disorder with psychotic features and been started on antipsychotic medication but had not followed up with his most recent appointment.

The vast majority of people with serious mental illness do not become violent. Indeed, studies have repeatedly found they are no more dangerous than the general population.

However, a small subset of the estimated 7.7 million people living with the most severe mental illnesses is at risk for committing violence, most often to themselves by suicide but also to others. Once this happens, we find out – as we have about Alexis – that they had been hoisting red flags for weeks, months, even years. Time and again, we also learn that the warning signs were overlooked, ignored or inadequate to overcome the barriers to mental illness treatment that stood between them and recovery.

Perhaps the most remarkable thing about last week in Washington is that it is no longer remarkable. If we want fewer weeks like them, we must become more willing and able to recognize the red flags of untreated severe mental illness and remove the legal and other barriers that prevent us from acting on them. 

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(Sept. 26, 2013) “Inevitably, news that the shooter in the Navy Yard rampage killings had called Newport police in a delusional state barely a month before the rampage that left 13 dead in Washington raised the question: ‘Were the Rhode Island police to blame?’” the Treatment Advocacy Center asks in a Providence Journal op-ed (“Navy Yard shooting reveals flaw in RI law,” Sept. 25).

The answer, we conclude, is “No.”

“Police officers are not mental health workers, and forcing them into that role is illogical, unfair and implicitly dangerous,” we say.

What is the role of mental illness in the 67% increase of “justifiable homicides” resulting from an attack on a law enforcement officer – commonly involving a person with untreated mental illness – we ask in our latest study, “Justifiable Homicides by Law Enforcement Officers,” issued this week with the National Sheriffs’ Association.

“The transfer of responsibility for persons with mental illness from mental health professionals to law enforcement officers … harms both the patients and the officers,” we conclude.

How many Americans live in communities where law enforcement officers likely to be pressed into duty as first-responders in psychiatric crisis get specialized Crisis Intervention Team (CIT) education and training to handle these emergencies? Less than half, our state survey, “Prevalence of Mental Health Diversion Practices,” reported in August.

A Canadian law enforcement official recently summed up the problem nicely. “We went from the agency of last resort to the mental-health service agency of first resort,” Jim Chu, president of the Canadian Association of Chiefs of Police, told the National Post in Canada. “And that’s wrong. That’s failing those who are mentally ill and who deserve better care” (“Police should not be front-line on mental health” (August 21).

They do deserve better care. But as long as we continue leaving their care to law enforcement, we will continue failing them – and are in no position to blame the police.

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(Sept. 24, 2013) Since it is state – not federal – government that regulates who can be court-ordered into treatment and under what circumstances, the laws and standards of no two states are exactly alike. That’s why Navy Yard gunman Aaron Alexis could have been hospitalized for a psychiatric evaluation in some states but not in Rhode Island, where he called police in a delusional state.

The Treatment Advocacy Center works to promote the passage and use of standards that recognize someone like Alexis should have access to emergency intervention even if he is not dangerous and/or not self-aware enough to recognize he needs help.

To find out whether your state has a need-for-treatment standard, use the map on every page of our website to navigate to your state’s page. For general information about how states define the need for treatment, visit our updated Better Treatment Standards page. You can find a link to your state's civil commitment standards here.

Also, our psych crisis app includes resources for help in a psychiatric crisis. In it you will find state-specific standards for emergency hospitalization and for who can initiate treatment; inpatient and outpatient commitment criteria by state; tips on navigating the Health Insurance Portability and Accountability Act (HIPAA); and information on responding to specific kinds of psychiatric emergencies such as suicide or assault danger.

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