(Jan. 5, 2016) Those who live with psychotic disorders – the individuals, their family members, caregivers and others nearby – inevitably live with the issue of medication adherence. Literature reviews on the subject typically report average rates of adherence in the 40-60% range; the NIMH estimates that approximately half the population with severe bipolar disorder or schizophrenia is not receiving treatment on any given day.

Yet medication adherence is the linchpin of improved outcomes. Antipsychotic medications are effective in controlling the hallucinations and paranoid delusions of schizophrenia and other psychotic conditions – symptoms that can severely disrupt daily living. Individuals with psychotic disorders who adhere to prescribed antipsychotics are less likely to be violent or victimized, involved with the criminal justice system, homeless, hospitalized or to experience a host of other circumstances. They also report higher quality of life.

Zachary Predmore et al. of the RAND Corporation have now added an economic dimension to the discussion of adherence. Using a financial model based on published data, the authors concluded that an annual net savings of $3.28 billion would be realized by states if patients with schizophrenia receiving public benefits adhered more completely to their antipsychotic medication prescriptions.* Despite the increase in costs for prescription drugs with higher adherence rates (projected at $462 million), net savings were estimated at $1,580 per patient. Most of the estimated savings would result from lower hospitalization rates ($2.54 billion), lower rates of criminal justice system involvement ($684 million) and lower costs for outpatient care ($514 million).

Strategies for Improving Adherence

Evidence that some interventions improve adherence to antipsychotic medications and improve outcomes exists. Stefan Priebe et al. conducted a randomized controlled trial in the United Kingdom to assess the influence of small economic incentives (under $25) on adherence to antipsychotic injections over a 12-month period. The researchers reported “significantly higher” adherence among study participants who were given a cash payment immediately after receiving their injections. On average, the financially incentivized group received 85% of their prescribed antipsychotic injections; the control group, which received no incentives, received 67% of prescribed injections. The odds of patients adhering at a rate of 95% also were significantly higher. More than one-quarter of the incentivized group achieved adherence of at least 95% compared with 5% of the controls that received no incentives.

Other intervention strategies that have produced mixed or contradictory results include replacing oral medications with long-acting injectable antipsychotics, medication management programs and the use of signs, alarms, checklists and electronic medication monitoring.

Ultimately, improving antipsychotic medication adherence – with all its attendant impacts on costs and outcomes – requires a better understanding of what influences adherent behavior. K.V. Sendt et al. conducted a tightly focused review of adherence studies published between 1980 and June 2012 involving 6,235 patients. They report that positive attitude toward medication and insight into illness were the only factors consistently associated with greater adherence. Evidence about the role of side effects – commonly blamed for non-adherence – was weak or contradictory.

* The authors do not define “adherence.” Generally, taking medication as prescribed 75-80% of the time has been considered an adequate level of compliance.

Doris A. Fuller
Chief of Research and Public Affairs

References:

• Predmore, Z. et al. (2015). Improving antipsychotic adherence among patients with schizophrenia: Savings for states. Psychiatric Services.
• Priebe, S., et al. (7 October 3013). Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: Cluster randomized controlled trial. BMJ.
• Sendt, K.V., et al. (2014) A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Research.  
  
  

Next Week: The Growing Focus on Inflammation in Schizophrenia Research

Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.

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(Jan. 4, 2016) A year-long investigation into Pennsylvania’s broken mental health system culminated last week when PennLive published the final installment in their revelatory series “From Patients to Prisoners” (11 ideas to fix Pa.’s broken mental health care system, PennLive, Dec. 30).

Throughout the series, PennLive reporter Daniel Simmons-Ritchie has raised awareness about the “transformation of Pennsylvania's jails and prisons into warehouses for the mentally ill and the gaps in the state's mental health care system that has facilitated that change.”

Previous articles in the series highlighted the difficulties that people with mental illnesses face in getting help in Pennsylvania and how, without that help, they too often end up committing petty offenses that lead them to arrest and incarceration.

Now, in the series finale, the focus shifts from raising awareness to encouraging action.

“We wanted to do something different for this story,” said Simmons-Ritchie. “We created an interactive that lists potential ways Pennsylvania could improve its mental health care system.”

PennLive presents 11 potential solutions to the criminalization of mental illness - from increasing state hospital beds to implementing assisted outpatient treatment (AOT) – and asks readers to vote for the policies they support.

VOICE YOUR SUPPORT

At the end of the article you can type in your name and your zip code and an email will automatically be sent to your state representatives, urging them to advocate for proposed solutions.

The following are some of the proposed solutions that the Treatment Advocacy Center supports:

• Commission report on state hospital beds - Assess how many psychiatric inpatient beds Pennsylvania needs.
• Broaden involuntary commitment criteria - Broaden commitment criteria to make it easier to involuntarily commit seriously mentally ill people.
• Expand assisted outpatient treatment (AOT) - Legally mandate certain at-risk mentally ill people to get treatment while living in the community.
• Restore community mental health programs - Restore funding for community mental health services to pre-2012 levels.
• Expand mental health courts - Provide incentives for counties to establish mental health courts.
• Increase state hospital beds - Expand Pennsylvania’s psychiatric inpatient hospital beds.

Pennsylvania residents: Please make sure to vote for policies that would help people with severe mental illness TODAY!

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(Dec. 29, 2015) Research Weekly did not begin arriving in mailboxes until the end of 2015, but interesting, illuminating and even hopeful mental illness research was in circulation throughout the year. Among the Treatment Advocacy Center’s staff favorites, in reverse chronological order, are the following.

• Comprehensive treatment of first-episode psychosis improved outcomes in clinical trials.
  Nearly a dozen articles in multiple publications reported on the first two years of results from RAISE (Recovery After Initial Schizophrenia Episode) projects. The mostly young-adult participants were found to be more likely to be in treatment, experiencing fewer symptoms, enjoying improved quality of life and working or going to school than non-participants. Programs based on the findings are currently being rolled out across the country. (Referenced in Research Weekly, December 2015.)
• People with untreated mental illness are 16 times more likely to be killed during a police encounter.
  Doris A. Fuller et al. conclude that untreated mental illness is so prevalent in fatal police incidents that reducing encounters between on-duty law enforcement and individuals with the most severe psychiatric disease may represent the single most immediate, practical strategy for reducing law enforcement homicides in the United States. (“Overlooked in the undercounted: The role of mental illness in fatal law enforcement encounters,” Treatment Advocacy Center, December 2015).
• Dramatic differences exist in how widely clozapine is prescribed from state to state.
  E. Fuller Torrey et al. report dramatic differences in prescription rates for the antipsychotic clozapine among the states. Clozapine (trade name Colzaril) is the only drug ever approved by the FDA for treatment-resistant schizophrenia or suicide prevention. Usage in the US dramatically trails other countries. Among the states, usage ranges from 2% in Nevada, Oregon and Louisiana to 16% in South Dakota. Usage of 10-20% in the candidate population is estimated to be appropriate. (“Clozapine for treating schizophrenia: A comparison of the states,” Treatment Advocacy Center, November 2015)
• Can a child's contact with cat litter lead to schizophrenia?
  Researcher and author Harriet A. Washington examines whether humans “catch” mental illness through viruses, prions and bacteria and argues against the “false dichotomy of mental versus physical disease.” She also proposes practical strategies for reducing psychiatric conditions such as schizophrenia, autism and OCD by making greater use of medical tools. ("Infectious madness: The surprising science of how we ‘catch’ mental illness,” Little, Brown, October 2015)
• Ex-inmates with serious mental illness are more likely to be violent.
  Zheng Chang et al. find that former prisoners with psychiatric disorders or substance abuse are “substantially more likely” to commit a violent crime after release than other prisoners. The authors estimate there could be 1 million fewer violent crimes a year in the US if prisoners with these conditions received better health care behind bars and after release to the community. (“Psychiatric disorders and violent reoffending: a national cohort study of convicted prisoners in Sweden,” The Lancet, September 2015)
• Fish oil, taken in the earliest stages of schizophrenia, may slow development of schizophrenia.
  Amminger et al. report that symptoms suggestive of later schizophrenia were reduced for more than six years among a study population that took a 12-week course of omega-3 fish oil. (“Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study,” Nature Communications, August 2015).
• Coercion during hospital admission does not hurt outcomes.
  Stephen Shannon et al. examine the impact of coercion during psychiatric admission and find it unrelated to functioning and quality of life one year after discharge. “Quality of life” was measured by factors such as employment, housing or engagement with friends.” (“Quality of life and functioning one year after experiencing accumulated coercive events during psychiatric admission,” Psychiatric Services, August 2015)
• Criminal acts, incarceration and repeat offenses among individuals with bipolar disorder.
  Thomas Fovet et al. review 35 academic articles and find criminal acts to be “common” among patients with bipolar disorder and the prevalence of bipolar among prison populations to be “high” (2%-7% of all inmates). Bipolar inmates also were found to be at higher risk for re-incarceration and suicide. The authors conclude that “many improvements should be made both within and outside prison” to improve care for individuals with bipolar disorder. (“Individuals with bipolar disorder and their relationship with the criminal justice system: A critical review,” Psychiatric Services, April 2015)
• States could generate substantial savings and human suffering could be reduced by improving adherence to antipsychotic medications among individuals with schizophrenia.
  Zachary Predmore et al. estimate annual net savings of $3.28 billion if all patients with schizophrenia took their prescribed antipsychotics. Adherence to medication is associated with lower rates of victimization, criminalization, hospitalization and other consequences of non-treatment. (“Improving antipsychotic adherence among patients with Schizophrenia: Savings for States,” in Psychiatric Services, April 2015, will be summarized in a January 2016 Research Weekly.)
• Assisted outpatient treatment (AOT) reduces net taxpayer costs.
  Health Management Associates analyzes cost data from the use of assisted outpatient treatment (AOT) in seven jurisdictions using dramatically different AOT to assess cost effectiveness of the treatment option in qualifying publications. Cost reductions in hospitalization, Medicaid and other services significantly offset the cost of the programs reviewed in New York and Ohio, resulting in net savings. (“State and community considerations for demonstrating the cost effectiveness of AOT services,” Treatment Advocacy Center, February 2015)

Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Publications cited in Research Weekly reports may require a fee or paid subscription before providing full access to the articles.

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(Dec. 23, 2015) The Treatment Advocacy Center is a leader in tracking and reporting the declining population of state psychiatric hospital beds, a vanishing breed whose numbers have shrunk by at least 95% in the last half-century. Now a team of North Carolina researchers has created a simulation model to analyze how many non-forensic beds it would take to reduce the amount of time people in psychiatric crisis currently spend waiting for a hospital bed.

The results dramatically illuminate what the authors call a “national disconnect between increasing demand for psychiatric inpatient care and decreasing supply” and what practically might be described as the size of the cracks in the inpatient mental health system.

To develop their model, Elizabeth M. La et al. studied a 25-county region of North Carolina where 3.4 million people are served by a 398-bed state psychiatric hospital. This translates into 11.7 state hospital beds per 100,000 residents, significantly fewer than the 50 beds per 100,000 people considered the minimum number for adequate public psychiatric services.

The Continuing Role of State Hospitals

In addition to the state hospital beds, the study reports that community-based crisis services in the region were providing 494 adult psychiatric beds in 14 general or private psychiatric hospitals and 66 non-hospital crisis beds in five facilities during the study period (July 1, 2010 to July 31, 2012). Though the resources increased the total number of available beds, they did not eliminate the role of the state psychiatric hospital, according to the study.

“When outpatient services are unable to help people prevent or manage crises, swift access to inpatient care in community general hospitals can be essential to ensure safety while medications are recalibrated and formal and informal supports are organized . . . ,” La et al. write in, “Increasing access to state psychiatric hospital beds: Exploring supply-side solutions.” “In contrast to community general hospitals, state psychiatric hospitals are designed and staffed to care for people with severe mental illness, including those who may become violent. Observers now believe that state hospitals will continue to serve patients whom general hospitals and private psychiatric hospitals cannot accommodate. In this respect, state psychiatric hospitals are the ultimate safety net for people with mental illness.”

What the Model Found

During the last six months of 2012, the authors found that an average of 520 adults in psychiatric crisis waited an average of approximately three days for admission to a hospital. (Not all patients on waitlists were ultimately admitted.)

Running variables through the model found that dramatic increases in state hospital beds would be needed to significantly decrease wait times for psychiatric beds and improve access to inpatient treatment. Projections included:

• Adding 24 beds increased the number of admissions by 9% (115.2 patients) and decreased average wait time by 6% (slightly less than four hours).
• Reducing average wait times to less than two days required increasing beds in the study hospital by 84%.
• Reducing average wait times to less than one day required increasing beds in the study hospital by 165%.

The model assumed unchanged demand for hospital treatment and supply of alternative psychiatric beds and intensive outpatient services in the community; a demand-side analysis would be needed to project how these service changes would affect the need for state hospital beds.

“However, many community facilities are not currently staffed to care for the most acutely ill psychiatric patients and those who become violent” the authors noted. “Thus, although buying community hospital beds may initially be less costly than adding state hospital beds, making community beds the sole solution would change community hospital staffing requirements, possibly increasing total costs for North Carolina.”

In economics, equilibrium is what occurs when supply and demand for products or services are equal. Consumers are getting the goods or services they want; sellers are selling the goods or services they produce. Demand is met, supply is consumed.

Equilibrium in psychiatric hospital beds was lost long ago. Elizabeth M. La et al. have developed a tool for mapping the disequilibrium. As grim as the map is, the authors have also demonstrated it is possible to analyze demand and project the supplies needed to meet it.

Doris A. Fuller
Chief of Research and Public Affairs

References:

• Torrey et al. (2012). No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals. Treatment Advocacy Center.
• La, E. M., et al. (1 December 2015). Increasing access to state psychiatric hospital beds: Exploring supply-side solutions. Psychiatric Services. Retrieved from http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201400570

Next Week: Top 10 Mental Illness Research Stories of 2015

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(Dec. 22, 2015) New images and video released earlier this month show the moments leading up to the deaths of four inmates while in the custody of the Alaska Department of Corrections (“DOC releases video of inmate deaths in Alaska prisons, promises change,” KTVA, Dec. 8).

One of the inmates, 20-year-old Davon Mosley, was found dead in his cell in April of 2014 after spending two weeks in segregation at the Anchorage correctional facility. Since then, Mosley’s family has been fighting to get video of how he died out to the public.

Mosley suffered from bipolar disorder and schizophrenia, but never received his medications while in jail, according to his family.

“A lot of people we’ve talked to said that Davon asked for his medications,” said Mosley’s mother, Lorraine. “[An inmate] that was next to him even asked for his medication in the hopes that they would give my son his and they didn’t; it’s like the nurses ignored him.”

Finally, at a joint Alaska House and Senate judiciary committee hearing earlier this month, the state released the disturbing images and footage revealing how Mosley and three other inmates died in separate incidents at the facility.

The state review found that Mosley was put in segregation for more than a week after trying to fight a correctional officer.

One of the videos shows Mosley’s time in solitary confinement. He was pepper spayed, left naked with nothing but a suicide blanket for several days and at one point, there was food thrown at him. His condition worsened, and he eventually died as a result of 12 ulcers.

Vernesia wonders, “What could’ve been done to change this outcome so no other family feels the pain that my family feels right now?”

Walt Monegan, DOC Interim Commissioner, apologized for the deaths and promised change.

“Good things can come out of this, out of the tragedies that we saw, which obviously should never have happened. But, I have faith that this kind of tragic event can produce a lot of great things that will forestall any kind of similar events,” said Monegan.

In Alaska, a seriously mentally ill person is 3.6 times more likely to be incarcerated in jail or prison than admitted into a psychiatric hospital.

Mosley’s story begs a question that reverberates throughout the country: Why do we continue to confine people suffering with severe mental illness within a corrections system ill-equipped to handle them, rather than the mental health system where they belong?

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(Dec. 21, 2015) “The Realities of Serious Mental Illness,” a short documentary produced by renowned psychiatrist and researcher Dr. David Pickar, is a crash-course on schizophrenia and the many devastating consequences of untreated severe mental illness.

Dr. Pickar said the following about the inspiration behind the documentary:

Schizophrenia alone is a disease that affects 1% of the population of our world making it a common illness. Unfortunately, violence has become the tragic touchstone that draws the public’s attention to serious mental illness, although the majority of individuals with serious mental illness are not violent.

Our elected officials and we as citizens of the United States and of the world owe it for the betterment of our society and to the individuals and families who suffer from these illnesses to better understand them. Only then can we offer, if not a cure, at least the humanistic support that every individual deserves. I made this documentary to help that happen.

The documentary features appearances by Dr. Thomas Insel, former Director of the National Institute of Mental Health; Representative Tim Murphy, author of the landmark Helping Families in Mental Health Crisis Act; and a family member and consumer affected by severe mental illness.

The film emphasizes that we are all affected by untreated mental illness in one way or another. Undoubtedly, everyone would benefit from taking this “crash-course” in serious mental illness. Watch “The Realities of Serious Mental Illness” now!

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(Dec. 18, 2015) Congress today approved a $1.1 trillion omnibus spending measure, including full funding for a new grant program to help local mental health systems establish and implement assisted outpatient treatment (AOT) programs nationwide.

This marks the first time Congress has funded court-ordered treatment in the community for people with severe mental illness.

AOT give courts the ability to mandate treatment in the community for severely and chronically mentally ill people who have been in and out of psychiatric hospitals or jails and who are too sick to recognize their illness.

Appropriators highlighted the role and benefits of AOT in an accompanying committee report that clarified intent for the omnibus spending: “Nearly half of individuals with schizophrenia or bipolar disorder do not recognize they have a mental illness, making it exceedingly difficult for them to follow through on a treatment regimen. AOT has been proven to reduce the imprisonment, homelessness and emergency room visit rates among this population by 70 percent.”

A recent study conducted by Health Management Associates supporting the appropriators’ conclusion about the benefits of AOT determined that the programs also reduce taxpayer costs associated with untreated serious mental illness. Costs of serving clients in AOT programs were more than offset by the reduced need for inpatient hospitalization and other high-cost services. The study found a net public savings resulted in areas where AOT was implemented.

“With this funding, Congress recognizes the value of investing in programs that focus on early intervention to improve outcomes for people with severe mental illness,” said Treatment Advocacy Center Executive Director John Snook. “AOT is a proven model for providing much needed care to those who are otherwise lost to homelessness, incarceration or an early death.”

AOT has been recognized as an evidence-based intervention by the Substance Abuse and Mental Health Services Administration and the U.S. Department of Justice.

“This money will catalyze programs to help people with severe mental illness all across the country,” the executive continued. “Congress took action today to affirm the value and benefits of AOT and the unacceptability of the status quo.”

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(Dec. 17, 2015) During the holiday season we usually think of good food, shopping and spending time with loved ones. However, it is important to remember that for the marginalized and for those on the fringes of society, the holiday season can contribute to worsening mental health conditions.

The “holiday blues” are even more dreadful for mentally ill inmates. Men and women who suffer from chronic/persistent mental illness and who are incarcerated this holiday season will miss spending time with their families. Not being present at home and enjoying the holiday season with loved ones takes a toll. These defendants face a drastic reality check when they realize they are serving time in jail – a distinctly different place in comparison to the happy families celebrating the holidays at home as seen on TV. The mentally ill are alienated and separated from society while incarcerated. Mentally ill prisoners stay longer than other prisoners so they cost states significantly more.

In Washington State prisons in 2009, the most seriously mentally ill prisoners cost $101,653 each, compared with approximately $30,000 per year for other prisoners. Often, individuals suffering from mental illness are not meant to stay behind bars for an indefinite period of time – they are held in jails to wait for a bed at the state hospital. More than 80 percent of the patients at Napa State Hospital have been referred by the criminal justice system.

Mentally ill offenders in America need help – and the Comprehensive Justice and Mental Health Act of 2015 seeks to address the problem. This piece of legislation is currently on calendar to be heard on the Senate floor. This federal bill, if passed, would reauthorize grant funding set aside in the Mentally Ill Offender Treatment and Crime Reductions Act (MIOTCRA) from 2015 through 2019 at a budget of $40 million total for mental health courts and diversion programs.

The bill also has a provision to fund specialized peace officer training concentrated on responding to the mentally ill in crisis, and ensuring the safety of both the mentally ill individual and the safety of the community. Research shows that these factors would reduce recidivism rates of mentally ill offenders within the criminal justice system. Mentally ill offenders who participated in mental health court felt that they were viewed as individuals with differing life circumstances compared with nonparticipants. Mental health courts also place emphasis on recovery and the chance for offenders to “start over.”

The bill lacks specific implementation efforts toward the creation of more community-based services to address the growing mentally ill population. Services such as residential treatment, and inpatient and assisted outpatient services would alleviate the high demand for treatment in both our jails and state psychiatric hospitals.

In spite of this, the Comprehensive Justice and Mental Health Act is a step forward in the right direction. Those with mental illness in the U.S. are stigmatized, and ill-equipped corrections facilities are taking the brunt of the responsibility of taking in more people suffering from mental illness who would benefit far more from treatment than incarceration. We should take pause at the lack of mental health resources available for those incarcerated and note that not only is the lack of treatment options costly, but also find the high number of mentally ill incarcerated alarming and disturbing.

HANNAH C. MAC DULA
AMERICAN CANYON, CALIFORNIA

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(Dec. 16, 2015) Two days before the Treatment Advocacy Center released its new study on the role of mental illness in fatal police encounters, an essay by a group of Harvard University researchers was published about the nation’s lack of reliable data on deadly law enforcement incidents.

In “Police killings and police deaths are public health data and can be counted,” the authors liken deaths that result from police encounters to other conditions that pose a preventable or treatable threat to public health. They report, for example, that the estimated 2015 civilian deaths resulting from fatal law enforcement encounters by mid-September exceeded 2015 deaths in the US for pneumonia and influenza, measles, malaria, mumps – “diseases of considerable concern,” as the authors put it – and were on a par with the national number of cases of Hepatitis A. Nancy Krieger et al. propose that “law-enforcement-related deaths be treated as a notifiable condition” and tracked by public health departments in real-time to provide “data needed to understand and prevent the problem.” Like epidemics, the authors say, police use of deadly force can “imperil communities’ social and economic well-being.”

“We have a world-class public health system that reports, nationally, in real-time, on numerous notifiable diseases and also on deaths occurring in 122 cities with populations (more than) 100,000,” Krieger wrote. “It is stunning that we in the US must turn to a UK newspaper website (The Guardian) for timely and detailed reporting on deaths due to police violence.”

Even More Stunning

What we find even more stunning is how brazenly, completely – even systemically – the US government fails to track or report the variable of severe mental illness in a host of public health and policy arenas that imperil individuals and communities far more widely than any of the diseases cited by the authors. “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Police Encounters” found that only one federal data system has ever set out to “systematically collect and publish mental health information” about victims of fatal police incidents. Operated by the Bureau of Justice Statistics, the Arrest-Related Deaths program is currently suspended because the data available for its reports “did not meet the agency’s quality standards.”

What we don’t know does hurt us. In a data-driven world, failing to quantify the real and significant impacts untreated mental illness exerts upon our public health, criminal justice, social services and other systems makes it easier to ignore those impacts and thus not seek to prevent them. From all appearances and reliable anecdote, severe mental illness is a factor in a minimum of 1 in 10 law enforcement responses, 1 in 5 incarcerations, 1 in 4 fatal police encounters, 1 in 3 solitary confinements, 1 in 3 men living homeless on the streets. “Overlooked in the Undercounted” concluded that reducing encounters between on-duty law enforcement and individuals with the most severe psychiatric diseases may represent the single most immediate, practical strategy for reducing the use of deadly force by officers in the United States. Reducing untreated mental illness might similarly reduce a host of other impacts from overcrowding in emergency rooms to homicides in families.

We need and deserve more than appearances and anecdote to understand these conditions – and prevent them.

Filling the Gaps

The Treatment Advocacy Center from its founding in 1998 has produced original research that makes use of what official data, verifiable anecdote, international research and other reasonably reliable sources are available to fill in gaps left by the neglect of mental illness as a significant public health condition. Our reports and findings to date include:

• “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Police Encounters”: individuals with untreated mental illness are 16 times more likely to die after being stopped or approached by law enforcement than other civilians.
• “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey”: the number of mentally ill persons in prisons and jails in 2012 was 10 times the number remaining in state hospitals; in 44 of the 50 states and the District of Columbia, a prison or jail in that state holds more individuals with serious mental illness than the largest remaining state psychiatric hospital.
• “Mental Health Commitment Laws: A Survey of the States”: only 18 states recognize the need for treatment as a basis for civil commitment to a hospital; in the other 32, grave disability or danger to self or others must develop before the state can order treatment for individuals too ill to seek care. 
• “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals”: public psychiatric beds for individuals with acute or chronic psychiatric disease decreased 14% from 2005 to 2010 and sunk to a per capita level not seen in the US since 1850.

Author and mental health advocate Pete Earley on Monday named the Treatment Advocacy Center the “most impactful mental health group in 2015.” Announcing the selection on his widely read blog, Earley wrote that the Treatment Advocacy Center has with its research “consistently and unrelentingly revealed flaws in our system that need repair – and it’s done it louder and often more effectively than other advocacy organizations. (It’s also done it on a yearly budget of slightly more than $1 million — that’s not much in Washington’s advocacy circles.)”

DORIS FULLER
CHIEF OF RESEARCH AND PUBLIC AFFAIRS

References:

• Krieger, N., et al. (8 December 2015). Police killings and police deaths are public health data and can be counted. PLOS Medicine. 
• Fuller, D., et al. (2015). Overlooked in the Undercounted: The Role of Mental Illness in Fatal Police Encounters. Treatment Advocacy Center.
• Torrey et al. (2014). The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Treatment Advocacy Center. 
• Stettin, B., et al. (2013). Mental Health Commitment Laws: A Survey of the States. Treatment Advocacy Center.
• Torrey et al. (2012). No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals. Treatment Advocacy Center.
• Earley, Pete. (2015). My Choice for Most Impactful Mental Health Group in 2015: Treatment Advocacy Center. Official website of Pete Earley.

Next week: The 'National Disconnect' of Disappearing Hospital Beds.

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(Dec. 15, 2015) The Treatment Advocacy Center continues to serve as a resource on the intersection of the criminal justice system and untreated severe mental illness by publishing reports that shed light on the consequences of our broken mental health system.

Following the release last Thursday of “Overlooked in the Undercounted: The Role of Mental Illness in Fatal Law Enforcement Encounters,” we have been contacted by media from coast to coast. 

Below are just a few of the top news stories on the report: 

• “People with mental illness 16 times more likely to be killed by police” – The problem stems from a lack of police training, as well as a lack of treatment for those with serious mental illness, Executive Director John Snook told USA Today. 
• "Untreated Mentally Ill 16 Times More Likely to Be Killed By Police, Study Says" – The researchers call on lawmakers to implement policies that improve the mental health system, fund reliable tracking of use of deadly force by law enforcement and ensure that mental illness in fatal police shootings is reported, noted TIME.
• "US mentally ill 16 times more likely to be killed by police, study finds" – The study comes during a U.S. debate on the use of deadly force by police, fueled by the deaths of unarmed men in New York, Missouri, South Carolina and elsewhere, reported Fox News.
• "Risk of being killed by police is 16 times greater for those with mental illness" – "People don’t stop getting sick just because you don’t have hospital beds for them, they have to go somewhere, so they go to the places that can’t say no,” John Snook told The Guardian.
• “The divide between mental health treatment and criminal justice” – Listen to the Treatment Advocacy Center discuss the role of mental illness in law enforcement encounters on WBEZ.

The Treatment Advocacy Center has published additional reports on the topic, including:

• The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey
• Prevalence of Mental Health Diversion Tactics: A Survey of the States
  

Bestselling author and mental health advocate, Pete Earley, named the Treatment Advocacy Center “the most impactful mental health group in 2015.” Earley said, “Since its creation in 1998, the organization not only has pushed its campaign to reduce barriers to treatment, it has helped set our national mental health agenda.”

This amazing work is made possible by generous donations from our supporters. We do not solicit or accept funds from pharmaceutical companies.

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