(July 20, 2013) One year ago today, 12 people died and 70 more were wounded in an Aurora, Colorado, movie theater when a young man diagnosed with schizophrenia opened fire on an audience at the midnight opening of The Dark Knight.

In the months that followed, additional mass killings associated with mental illness took lives in Michigan, Texas, California and – at the end of the year at Sandy Hook Elementary School – in Connecticut.

In the collective national grief that followed, state and federal lawmakers focused more attention on mental illness treatment issues than they had in the half-century since passage of the Mental Health Act of 1963.

In Nevada, a law was enacted so that Nevadans trapped in the revolving door of non-treatment consequences at last would have the option of court-ordered outpatient treatment (AOT) to help them live safely in the community.  In Colorado, New York, Texas, Montana, Indiana, Washington and elsewhere, treatment law improvements were made that will assist more people who struggle to stay in treatment. Bills to make improvements are pending in states where legislatures are still in session, including California and Pennsylvania.

Meanwhile, on Capitol Hill, policymakers like Rep. Tim Murphy (R-PA) turned a spotlight to federal policies that create barriers to treatment for those with the most severe mental illness –holding hearings, grilling federal officials and at least talking about change.

All this attention and the reforms that have resulted are welcome – but they are not enough.

Millions of Americans live with untreated severe mental illness every single day. Hundreds of thousands are behind bars or living on the streets because of their symptoms. Tens of thousands are victimized or kill themselves every single year.

On behalf of them all – and of the past and future victims of preventable tragedies like the one in Aurora – we must not rest on a year of milestones. As long as barriers to treatment remain, the drive must continue to improve and use the laws that exist to help those too ill to help themselves must continue.

In the meantime, we continue to mourn with the rest of the nation the lives lost and hurt that treatment before tragedy might have spared.

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(July 18, 2013) Los Angeles County officials – worried about the feds cracking down on the deplorable conditions for inmates with mental illness – have come up with a $1 billion-plus solution: build a bigger jail (“LA Supervisors agree to act on billion-dollar jail renovation,” Los Angeles Times, July 16).

The Board of Supervisors this week voted unanimously to renovate the Los Angeles Men’s Central Jail to reduce crowding and increase mental-health services for prisoners. The number of jail beds will not be changed.

Sheriff Lee Baca has said for decades that he runs the nation’s largest mental hospital – the Los Angeles County jail. In his related story, Times columnist Steve Lopez describes inmates with mental illness who’ve been jailed there so many times they’ve lost count (“It's a crime to house the mentally ill this way,” Los Angeles Times, July 17).

 In 2004, LA County implemented Laura’s Law (California's assisted outpatient treatment/AOT law) on a limited basis. The program has already produced a 78% reduction in incarcerations among the participants.

LA County should expand its pilot program to help more of its mentally ill citizens avoid re-arrest and re-incarceration. The focus should be on treating those suffering from severe mental illness rather than expanding jail space to warehouse them better.

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(July 17, 2013) The public cost of services to individuals with severe mental illness doubles when they get arrested and enter the criminal justice system, according to the first comprehensive estimates of the criminal justice costs associated with providing services to people with mental illness.

“Costs of criminal justice involvement among persons with serious mental illness in Connecticut ” by Jeffrey W. Swanson et al. reports on a study of 25,133 adults with schizophrenia or bipolar disorder who were served by Connecticut’s Department of Mental Health and Addiction Services during the fiscal years 2006 and 2007 (Psychiatric Services, July 2013). The study found that one in four of the subjects became involved with the justice system during the two-year period.

“The justice-involved group incurred costs approximately double those of the group with no involvement - $48,980 compared with $24,728 per person,” the study found. Costs were shared by several state agencies and Medicaid.

Individuals who ended up in the criminal justice system were “significantly younger” and more likely to be male and African American than the non-involved persons with mental illness. They also were “far more likely” to have a co-occurring substance abuse issue than their counterparts who were non-involved (65% vs. 28%) and more likely to have bipolar disorder (63% of those “justice-involved) than schizophrenia (37%).

The research also found that individuals who received a greater number of short, acute hospital admissions were more likely to become justice involved than those who had fewer but longer admissions to a hospital.

The authors paint a bleak picture of combining criminal justice involvement with mental illness including negative impacts on “long-term chances for stable housing, employment, income, marriage and community ties, and general well-being over the life course.”

The Treatment Advocacy Center always says that treatment works. But early and effective treatment also pays. Public officials who blame budget woes when they shut down psychiatric hospitals, reject court-ordered outpatient treatment options and fail to use mandated treatment for those too ill to seek treatment for themselves need to look at the numbers.

Swanson and his fellow researchers conclude, “By applying (Connecticut’s) per-person cost estimates to analogous service populations and agencies, other states should be able to plan, coordinate, and deliver more cost-effective services to individuals with serious mental illness….”

If you agree, forward or mail “Costs of criminal justice involvement among persons with serious mental illness in Connecticut ” to the elected leaders or public officials in your community who are in a position to improve your treatment laws and see that they are used to provide treatment before criminalization.

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(July 16, 2013) In 2011, at the age of 23, my son was diagnosed with schizophrenia after a very serious psychotic breakdown. He spent three months in the Yale Psychiatric Hospital. He was discharged three times and readmitted twice because of suicidal thoughts and an attempted suicide.

But I had been trying to get my son help since he was a teenager.

When I first noticed his strange behavior, I thought this might be just be a period that teenagers go through.

My son was a gifted artist so I attributed some of his behavior to that of a “creative genius.” I knew there was a problem when he started sleeping all day and taking drives at night. He was also spending a great deal of time in the basement doing what I saw as strange things. He was slowly retreating into isolation. Looking back I understand that he was becoming delusional, that he had delusions of grandeur. During this time he thought people he would see where he worked were speaking to him when they were not. Not being familiar with mental illness, I was at a loss as to what was happening. I also knew I could do nothing due to his age.

Each time the psychiatrist would spend a short time with him, diagnose him with depression or social anxiety and prescribe medication, which he never wanted to take.

Once he turned 18, that was the end of me being able to help him even though he lived with me and was financially dependent on me. I couldn’t even get him an appointment with a psychiatrist. I remember trying to make an appointment, crying over the phone and pleading. But, no, they said that my son needed to call. He wouldn’t call.

When my son’s psychotic break came to a head, it was severe. He “knew” he was going to die a painful death. He looked at me and said, “You are never going to see me again.” He thought a person on Craigslist was going to kill him so he decided to do it himself.

Thankfully he did not succeed.

The sad truth seems to be that people with severe mental illness do not get the help they need until there is a crisis. Can this be changed? I would like to see restrictions lifted on parents for children over the age of 18 so that people who are clearly in crisis get the help that they need.

SUSAN GALLAGHER
CONNECTICUT

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(July 15, 2013) We are very sorry to announce the death of Ms. Vada Stanley July 13 from cancer. Vada is the reason why the Treatment Advocacy Center exists.

 In 1998, she called me after reading Out of the Shadows and asked: “Isn’t there something we can do to help people who need treatment for their serious mental illness?”

Vada was especially distressed by the number of such individuals who were ending up on the streets and in jails. After discussing the problem at length, we agreed that changing state laws to make it easier to get treatment for individuals with serious mental illness – especially those who were not aware of their illness – had the potential to improve things. Vada and her husband, Ted, then committed funds to get the Treatment Advocacy Center started.

Vada Stanley was the kindest and most caring person I have ever known. Whatever success the Treatment Advocacy Center has had in improving treatment for mentally ill persons is a testament to Vada, and she was proud of its accomplishments.

The most important thing we can do to honor Vada is to work even harder to carry on her wishes and improve the treatment system.

E. Fuller Torrey, MD
Founder and board member, Treatment Advocacy Center 

More information about this remarkable woman and champion for mental illness treatment is available in her obituary.

 

 

 

 

 

 

(Jul 11, 2013) Three stories about psychosis and severe mental illness are told in Voices, a powerful forthcoming documentary that seeks to put a human face on a disease too often consigned to the margins by fear and dread.

Sharon, a Vietnamese immigrant, was diagnosed with schizophrenia shortly after her arrival in the U.S., when she began hearing voices and showing signs of paranoia and depression. Sharon’s story is a testament to the determination of one family to secure desperately-needed treatment for their loved one.

Thomas is a homeless man who has been living on the streets of San Francisco for 20 years. He no longer speaks with his family in Ohio, and does not receive any community services or treatment for his illness. His friendliness and outward good cheer mask feelings of isolation and distress.

As a young boy, Aaron was active and athletic, but in his teens he began showing signs of unusual behavior and slowly started isolating himself from his friends and family. Eventually, despite his father’s best efforts to get him into treatment, Aaron walked into the woods and never came back.

The directors, Hiroshi Hara and Gary Tsai, credit their motivation for the film to the “belief that personal stories have the power to decrease the stigma commonly attached to those living with psychotic conditions.” They maintain that “[w]hile focusing on the positive is important, … it is [also] critical to tell a fuller spectrum of stories.”

Voices is currently being prepared for film festival screenings.

Watch the trailer here.

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(July 10, 2013) Fifteen years ago this week, Seminole County Deputy Sheriff Eugene Gregory was shot and killed by a man with untreated severe mental illness. Two other deputies were wounded before the gunman was himself shot and killed by officers after a 13-hour standoff. The shooter, Alan Singletary, 43, had been diagnosed with paranoid schizophrenia. His family had tried for years to get him treatment, without success.

After Gregory’s death, Seminole County Sheriff Donald Eslinger created a Mental Health Task Force to recommend changes to Florida’s mental health and substance abuse services and laws. The deputy sheriff’s widow Linda Gregory and the shooter’s sister Alice Petree and the Treatment advocacy Center joined Eslinger’s campaign for reform.

Six years later, the Florida legislature passed and then-Gov. Jeb Bush signed into law a bill known as the Baker Act Reform, which included authorization of assisted outpatient treatment (AOT, known in Florida as “involuntary outpatient placement”). For their efforts to make it happen, the trio of Sheriff Eslinger, Ms. Gregory and Ms. Petree were honored by the Florida House of Representatives.

But on this 15th anniversary of the deaths that were the catalyst for change, the jury is still out on the effectiveness of the Baker Act Reform. Like too many other states, Florida has a good AOT law that isn’t widely used.

It’s past time for that to change, not just in Florida but in Arizona, Colorado, Louisiana, Maine, Ohio, among others. Coast to coast, family members and communities must increase the pressure on public officials to provide treatment before tragedy.

See our tips for effective advocacy for ways to make a difference.

(July 9, 2013) U.S. spending on the consequences of untreated mental illness is skyrocketing. The 11.5 million American adults who suffer from mental illness cost the country a half a trillion dollars annually, according to the New York Times Magazine (“The Half-Trillion -Dollar Depression,” July 2).

Policymakers are struggling to find ways to combat the hidden costs associated with mental illness, which include reduced earnings, unemployment, homelessness and incarceration.

The Times Magazine article notes that people with mental illness are at “higher risk of poverty than their peers, which subsequently increases their need for other public safety-net services like food stamps and subsidized housing.” One recent estimate puts the cost of these services to taxpayers at $140 billion to $160 billion a year. That means cumulative mental-health issues — depression, schizophrenia and bipolar disorder, among others — are costing the U.S. economy more than the government spent on all of Medicare during the last fiscal year.

If policymakers want to reduce these costs, they should spend a bit on the front end to ensure meaningful access to treatment. This must include using assisted outpatient treatment (AOT) for those who struggle with treatment adherence and making sure there are enough hospital beds to allow people in psychiatric crisis to fully stabilize before release.

“Economists refer to this as the cost offset, and it’s sort of like a return on an investment that comes from helping mentally ill people become more productive and less dependent on taxpayers,” the Times Magazine explains.

Ultimately, if we ensure access to treatment for severe mental illness today, we will reduce the economic impact of untreated severe mental illness tomorrow. 

Read more about the consequences of untreated severe mental illness.

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(July 8, 2013) When you work at an organization dedicated to getting people treatment for severe mental illness, you learn a lot about failure.

Failure of the mental health system to help those who need help the most. Failure of medications to fully control symptoms or to do it without grim side effects. Failure of states to provide enough public psychiatric beds for the acutely ill people who need it to set them on the road to recovery. Failure of counties to use their states’ court-ordered outpatient treatment (AOT) laws.

But in a blessedly cool restaurant on San Antonio’s sizzling Riverwalk last week, Policy Director Brian Stettin and I were treated to a feast of success while we were in town for the 2013 NAMI National Convention.

Eric Smith was fresh from his assisted outpatient treatment order (AOT, or “court-ordered outpatient mental health services” in Texas) when he was featured in our 2011 documentary video, “Stopping the Revolving Door.”

Now 30, Eric and his proud parents – Nancy and Brad Smith – described the recovery that AOT has made possible for him, including his plans to major in biology at the University of Texas San Antonio, where he’s been accepted and starts in the fall.

Over and again, Brian and I thanked Eric and his parents for opening their home and their lives to our effort to show “a civil approach to treating severe mental illness” in the video.    

No, they said over and again. AOT saved Eric and their family life, and the video turned out to be a tool they used to educate Eric’s medical providers.

No dessert could have been as sweet as seeing Eric’s success – or as encouraging for any of us living or working with mental illness.

Doris A. Fuller
Executive Director

PS – If you have a NAMI affiliate, community group, judge, mental health department or other viewers who would benefit from learning more about how AOT can stop the revolving door of untreated mental illness, email us at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it , and we’ll send you a DVD. The video is also available from our Media Library.  

(July 4, 2013) As we wish you and yours a happy Fourth of July, we at the Treatment Advocacy Center continue working to promote policies and practices that make treatment – and the independence it can bring – available to everyone who needs it. This includes –

• People suffering from anosognosia, which robs them of awareness they are ill. Assisted treatment can give them access to treatment they wouldn’t seek on their own.
• People at risk for “revolving-door” consequences of non-treatment, such as homelessness, arrest, incarceration and hospitalization. Treatment can help them escape the revolving door and live safely in the community.
• People in acute psychiatric crisis, who need the specialized intervention that psychiatric hospitalization provides.Treatment can help them stabilize sufficiently to return to their homes and communities.

Have a safe and happy Fourth!

Your team at the Treatment Advocacy Center

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