(July 28, 2015) Paul Castaway – a 35-year-old, Native American man diagnosed with schizophrenia – was shot and killed in an altercation with Colorado law enforcement earlier this month (“Paul Castaway's family disputes Denver police account of shooting,” Denver Post, July 14).

Denver Police Chief Robert White reported at the scene that one of his officers – whose name remains anonymous – shot Castaway four times in the torso after he had gotten “dangerously close” with a knife. Castaway was rushed to the hospital and died shortly upon arrival.

But surveillance video from the mobile home park where Castaway lived shows a different version of events, say witnesses and family members who are disputing police reports of Castaway’s death.

"I called the police for help, not to kill my son," said Castaway’s mother, who told media her son was experiencing a psychotic episode that evening. "They shot him while the knife was still to his own throat.”

"There was a different way to go about this," said other members of Castaway’s family. "It didn't have to end in his death."

Castaway was a Native American from the Lakota Sioux tribe. July is National Minority Mental Health Awareness Month and Castaway’s death is one more example of how minorities disproportionately interact with the criminal justice system, often with tragic results

This is also a reminder that police need better training on how to interact with a suspect in psychiatric crisis.

Read the Treatment Advocacy Center’s report “Justifiable Homicides by Law Enforcement Officers: What is the Role of Mental Illness?” to learn more.

Additionally, read our study on mental health diversion practices, which found that less than half of the United States population lives in jurisdictions where police are trained to handle people in a psychiatric crisis.

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(July 27, 2015) When John Russel Houser, 59, shot several people, killing two and injuring nine in a Louisiana movie theater, he joined the substantial list of killers with severe mental illness who were untreated.

Houser reportedly had a long history of mental illness and “erratic behavior” that included threats against his family, at least one commitment to a psychiatric hospital in Alabama and several run-ins with law enforcement. He possessed medication for his bipolar disorder but often refused to take it, according to court records cited in the media (“Gunman had mental health problems, bitter family disputes, records show,” the Washington Post, July 24).

“Louisiana has an outpatient commitment law that could have mandated treatment for Houser – someone who is too sick to recognize his own need for treatment,” said Treatment Advocacy Center Executive Director John Snook. “People with severe mental illness who are receiving treatment are no more likely than the general population to commit an act of violence.

“Louisiana must make better use of the tools that would prevent tragedies like this.”

Relevant information about Louisiana and court-ordered treatment:

• For an individual with severe mental illness to receive involuntary intervention for psychiatric crisis in Louisiana, he or she must be dangerous to self or others or meet a strictly interpreted standard for being "gravely disabled."
• Where implemented, assisted outpatient treatment (AOT) laws have been shown to reduce episodes of violence, incarceration, homelessness and repeat hospitalization among individuals with severe mental illness, such as schizophrenia and bipolar disorder.
• Louisiana earned a “C” for its use of laws that allow for intervention during a psychiatric crisis, including AOT.
• Louisiana has only 40% of the beds necessary to meet the needs of its population with severe mental illness.
• A person with severe mental illness is four times more likely to be in jail or prison than receiving treatment in a hospital.

Watch Treatment Advocacy Center Executive Director John Snook speak about the tragedy on NBC Nightly News.

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President Obama has called for extensive criminal justice reform and recommended that Congress pass legislation to reduce mass incarceration by the end of the year. His announcement was met with applause from both sides of the aisle and some of the nation’s most prominent voices on criminal justice reform.

The Treatment Advocacy Center urges lawmakers to focus on reducing the jail and prison population that suffers with severe mental illness and makes six recommendations:

• Make the reduction of mentally ill inmates in US jails and prisons a national priority. At least 1 in 5 jail and prison inmates – and as many as half in some institutions - suffers from disordered thinking caused by severe mental illness. Reducing incarceration driven by untreated mental illness will reduce inmate populations significantly.
• Foster adoption of assisted outpatient treatment (AOT) laws for people with severe mental illness who struggle with voluntary adherence to treatment. AOT provides court-ordered treatment in the community and has been shown to significantly reduce crime and violence among its target population.
• Implement evidence-based practices to divert individuals from the criminal justice system to the mental health system. Fewer than half the US population lives in jurisdictions where the most basic methods of diversion are practiced.
• Restore public psychiatric hospital beds. By 2010 (the latest year for which data is available), only 14.1 public hospital beds remained for every 100,000 US residents – the lowest total since 1850, when construction of state psychiatric hospitals began. A minimum of 50 beds per 100,000 people is a consensus target for ensuring minimally adequate availability of inpatient care.
• Promote understanding and use of civil commitment laws by funding educational programs for judges, law enforcement, school officials and others in a position to use them. Court-ordered treatment options exist to safeguard those with the most severe mental illness, their families and their communities. As long as these laws remain unfamiliar, misunderstood or overlooked, the public will remain needlessly at risk.

“If we really want to get serious about reducing mass incarceration we must focus on inmates with severe mental illness who make up 20 percent of the jail and prison population,” said John Snook, executive director of the Treatment Advocacy Center. “Ensuring treatment sooner would decrease the inmate population, improve lives and save money.”

(July 24, 2015) There are 3.5 million people in the United States with schizophrenia alone, a fate often worse than death. My son, Caleb, was diagnosed three years ago, at the age of 19. His adult life has been spent inside a living hell — literally.

The early stage was marked primarily by delusions and paranoia: there was a government conspiracy against him, Lil Wayne and Drake were writing derogatory songs about him, and pimps were trying to kill him. This was only the beginning of a downward spiral.

The first year of treatment showed only mild success. Antipsychotics are relatively fast acting, and if monitored, can be quickly adjusted or changed. But with a shortage of psychiatric beds, he was in and out of the hospital within days, still in psychosis. Further hindering recovery, he was allowed only one 30-minute psychiatric appointment per month.

It should be noted, each episode and the longer in psychosis, the more damage done to the brain resulting in increasing severity and reducing the likelihood of recovery.

This has proven true for Caleb. A year into his illness, he received a message to cut off his ear or toe or to break a leg. In the middle of the night, I awakened to his blood curdling screams. He had jumped 15 feet from a tree fracturing his back. Just prior to this feat, he attempted, unsuccessfully, to silence the commands. He branded his arm with a fork, a scar that remains today. He was admitted for psychiatric care, but released within seven days with little improvement.

Over the next two years, he was hospitalized with increasing frequency, always released within days. He is paranoid and lives in constant fear with the belief his family and friends want to kill him. He hallucinates that I say such horrific things to him as, “I’m going to chop off your head,” or “I’ll bury you alive.” He has spent nights sitting on his bed prepared to bolt if I break down the door to kill him.

Six months ago, the television told him he was Jeffrey Dahmer, and the president told him to kill me. My son isn’t violent. But statistics speak for themselves, and psychosis often leads to violent and tragic acts. It was a several-day battle to get him hospitalized, and he was released in three days in the same condition.

For a few months, his psychosis finally improved. But this rarely lasts. With his paranoia that doctors, pharmaceutical companies, and his family are trying to poison him, he often refuses medication.

He insists he is traversing. As a result, there are now two of him, or maybe three, and he doesn’t know which is the real him. He becomes confused and doesn’t know where he is and pleads with me to get him home. I try to reassure him, “you are the real Caleb, and you are safe at home.” It is heartbreaking.

But we aren’t alone. This plays out for millions of SMI people and their families day after day, week after week, and year after year as loved ones spiral further into the abyss.

KIMBERLY BLAKER 
Mother

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(July 21, 2015) Betty and her 54-year-old, schizophrenic son tell their story in an investigative series that takes an in-depth look at how the 2006 closure of Pennsylvania’s only remaining mental health hospital has been disastrous for people with serious mental illness (“From patients to prisoners,” PennLive).

Even though episodes of violence were common during his psychotic breaks, it was her son’s 48-month stay in a correctional facility that “pushed his delusions to a new level,” Betty told PennLive (“'Just a nightmare': Prison turned Harrisburg man's schizophrenia from bad to beyond control,” July 20).

"When they released him from prison it was hard to believe…that they released him in the condition that he was in," Betty said, "because he was not stable, not by any means."

Seven months into his sentence, a prison psychiatrist told Betty that her son was refusing to take his prescribed medication and was spending a considerable amount of time pacing back and forth and talking to himself in his cell.

But Betty’s son does not believe he has a mental illness; a condition known as anosognosia, not uncommon among those diagnosed with a severe mental illness.

Not surprisingly, Betty’s son was transferred to an isolation cell, as punishment for being loud and disruptive. She believes the 63 days he spent in solitary confinement accelerated his deterioration.

"Wouldn't that do something to you mentally?" Betty asks. "Even if you were sane when you went in, you'd be nuts when you came out.”

Since his release in 2013, Betty’s son has been involuntarily committed three times, become increasingly difficult to reason with and descended further into his delusions.

Betty argues that people with mental illness who are in the throes of psychosis have too much autonomy over treatment decisions.

"I think the laws should listen to the loved ones," she said. "To the people who are around them the most, so they can get their insight into what's going on."

Stories like Betty’s are far too common. “There are now 10 times more individuals with serious mental illness in prisons and jails than there are in state mental hospitals,” according to 2012 Treatment Advocacy Center data.

The elimination of psychiatric facilities, in Pennsylvania and across the country, is wreaking devastating impacts on individuals in need of treatment, their families and the communities in which they live. We will continue to see devastating consequences until we recognize the need to overhaul our ineffective mental health system.

Read the Treatment Advocacy Center report “No Room at the Inn” to learn more about the trends and consequences of closing public psychiatric hospitals.

(Photo courtesy of PennLive)

(July 20, 2015) Almost three years from the day of the July 20, 2012 Aurora theater shooting, a Colorado jury found James Holmes guilty of murder in the first degree. The jury’s verdict marks the culmination of a trial that noted a host of failures and missed opportunities by the mental health system.

Our mental health system failed the victims in the Aurora Theater shooting and their families, and it continues to fail far too many individuals affected by severe mental illness. We have not yet learned from our mistakes.

In Colorado, and across the country, the mental health system is abandoning those with the most severe mental illnesses by closing public psychiatric beds, failing to use proven interventions like assisted outpatient treatment (AOT), and limiting services almost exclusively to those well enough to volunteer for care.

Colorado maintains a shockingly insufficient number of public psychiatric beds. A 2012 Treatment Advocacy Center report found that the state eliminated 33% of its public psychiatric beds from 2005-2010, leaving just 10.3 beds per 100,000 people – far below the 50-bed standard considered necessary to provide minimally adequate mental health treatment.

As a result of these failures, a seriously mentally ill person living in Colorado is four times more likely to be behind bars than in a hospital bed.

“Too often, the lack of available treatment options in Colorado means that nothing can be done for someone in need unless that person first tries to hurt himself or someone else,” said John Snook, executive director of the Treatment Advocacy Center. “Criminalization and an overreliance on dangerousness as the standard for care are the predictable outcomes of a starved mental health system. It is a recipe for tragedy.”

The Aurora tragedy is one of the most glaring examples of the failure of our mental health system and the price we pay for that failure.

Policy Recommendations

• Restore a sufficient number of public psychiatric hospital beds to ensure individuals in crisis receive necessary medical care;
• Reform state’s civil commitment laws to reduce the reliance on dangerousness as a standard for care; and
• Provide timely, effective care, in order to reduce the consequences of non-treatment for individuals with a severe mental illness, their families and their communities.

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(July 16, 2015) For hundreds of thousands of mentally ill Americans, “help” consists of a jail cell where at least they can obtain the medications and psychiatric care they need to become stabilized.

Thanks to Wisconsin's own shortsighted rules, however, Medicaid eligibility terminates when a person is placed in custody; consequently, when the mentally ill are eventually released, they are on their own. Without access to doctors, medicines or a means to pay for them, their mental health soon deteriorates and they frequently wind up back in jail. It is a revolving door of neglect, incarceration and renewed neglect.

Chillingly, jail cells have become America’s “new asylums.” In the wake of de-institutionalization of the mentally ill, the number of people suffering serious mental illness in jails and prisons is now 10 times the number receiving treatment in state psychiatric hospitals.

In 2012, the most recent year for which data is available, there were 356,268 inmates with severe mental illness in custody, compared to just 35,000 being treated in hospitals. In 44 of the 50 states, a single jail or prison is home to more mentally ill inmates than the largest state psychiatric hospital.

At just one facility, the Dane County, Wisconsin jail, the number of inmates being administered psychotropic medications has increased by more than 55 percent just between 2013 and 2014, by which time more than 1 inmate in 3 was receiving psychiatric care.

More than just a repository where mentally ill people can be locked away and forgotten, our prisons and jails have become, by default, the only place they can receive the psychiatric care and medication they need.

Washington, however, has decreed that a poor person’s eligibility for Medicaid terminates immediately upon his or her incarceration. Although taxpayers pay the cost of an inmate’s medical care during incarceration, the practical effect of Washington’s rule is to ensure that the bills will be paid by the prison or jail instead of Medicaid.

Once the mentally ill person is released from custody, however, Medicaid ineligibility has a far more insidious effect, depriving the individual of medicines or psychiatric aftercare until he or she can successfully reapply -- if that ever happens.

Without medications or care, the individual’s mental state deteriorates and, eventually, he or she goes on to commit other offenses, often in a pathetic effort to get help.

SHERIFF DAVID MAHONEY, DANE COUNTY, WISCONSIN
JONATHAN THOMPSON, NATIONAL SHERIFFS' ASSOCIATION

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(July 15, 2015) A Washington Post story published this week details the 30-year decline of Alfred Postell – a 67-year-old, Harvard-educated man who fell from grace and landed into homelessness as a result of untreated schizophrenia (“The homeless man who went to Harvard Law with John Roberts,” the Washington Post, July 13).

During a recent court hearing, Postell, who had been accused of sleeping next to a D.C. office building, was brought before Judge Thomas Motley.

But, while Judge Motley was trying to determine if Postell posed a flight risk, a heart-rending exchange ensued, according to the Post.

"I’m a lawyer. I have to return,” Postell explained. “I passed the Bar at Catholic University, was admitted to Constitution Hall. I swore the Oath of Office as an attorney at Constitution Hall in 1979; graduated from Harvard Law School in 1979."

Taken aback, Judge Motley responded: "Mr. Postell, so did I. I remember you."

Indeed, Postell had studied law at Harvard alongside Judge Motley, as well as John Roberts, chief justice of the U.S. Supreme Court. What’s more, Postell had earned some of the highest marks in his class.

“It is an incredibly tragic and sad story,” said former classmate, Piper Kent-Marshall, “because in law school, he was one of the top students and a very, very, very bright and charming man.”

Although certainly a fascinating read, the Washington Post story fails to address the fundamental issue of why Postell - clearly brilliant and suffering from schizophrenia - had not received treatment for his illness.

It is easy to imagine how different life could have been for someone with as much potential as Postell, had his illness been treated instead of neglected.

Our mental health system has failed Alfred Postell and countless others like him who are too sick to recognize their own severe mental illness and need for treatment.

Added together, their stories provide overwhelming evidence of the need for sweeping mental health reform.

Read the Treatment Advocacy Center backgrounder on serious mental illness and homelessness to learn more.

(Photo: Terrence McCoy/The Washington Post)

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(July 14, 2015) Thus far, the discussion about Sheehan v. San Francisco has focused primarily on the 2008 police shooting of Teresa Sheehan – a then-59-year-old, mentally ill woman shot multiple times during an altercation with San Francisco law enforcement. But more attention must be paid to the ways in which the mental health system abandoned Sheehan and allowed her situation to reach boiling point (“The trials of Teresa Sheehan,” BuzzFeed, July 9).

The Sheehan family’s options in terms of helping Teresa were few.

Her sisters, Patricia and Frances, attest that Teresa did not believe she had an illness, and still does not - a common symptom of severe mental illness, known as anosognosia.

“She is so stubborn,” Patricia said. “That’s the worst trait for somebody with her illness.”

The longest Teresa has ever been in a psychiatric facility is about three weeks, the sisters said. Her involuntary psychiatric stays have mostly been within the 72-hour period allowed by California law.

But the Sheehan family could not force Teresa into longer-term care, until she proved a danger to herself or others or “gravely disabled”. With a more progressive treatment standard, Teresa could have been hospitalized much sooner.

Instead, “Teresa Sheehan’s mental health care has been a patchwork of emergency rooms and outpatient programs,” writes BuzzFeed. “She has seen countless nurses, countless doctors. She’s been prescribed, and stopped taking, countless medications. She is not wrong, in other words, to be skeptical of mental health care. ”

Frances recalls one hospital stay when a new psychiatrist wanted to talk and Teresa said, “Why should I talk to this person? They’re just going to be there a short while. Then I’ll have to start all over again.”

Even when she would get in a relatively stable situation, Teresa never received proper care. For example, the co-op for adults with mental illness where Teresa lived at the time of her encounter with police allowed her to go a year and a half without taking medication to treat her schizoaffective disorder.

Teresa Sheehan’s case serves to highlight the ways in which this country’s current mental health system fails the most severely ill time and time again.

The “Helping Families in Mental Health Crisis Act,” reintroduced last month by Representatives Tim Murphy and Eddie Bernice Johnston, gives families like the Sheehans the tools necessary to help their loved ones with severe mental illness access the treatment they need to prevent tragedy and recover their lives.

(Photo: Stephen Lam/BuzzFeed News)

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(July 13, 2015) Use of assisted outpatient treatment is expanding in Virginia, according to a new study by the University of Virginia (“Civil psychiatric commitments rose in Virginia in possible ‘Deeds effect,’” the Washington Post, July 2).

The researchers speculate that use of civil commitment is on the rise as a result of efforts to improve Virginia’s mental health system following the tragic encounter between Senator Creigh Deeds and his son, Gus , that left the younger Deeds dead.

“This might be what we call the ‘Deeds effect,’” said Richard Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the university.

Nearly two years ago, Gus was released from an emergency hold at a Virginia hospital - reportedly because no psychiatric beds were available during the short time period allowed for an emergency psychiatric evaluation. Still in the middle of a psychiatric crisis, the young man stabbed his father in the head and torso before fatally shooting himself.

In the wake of the tragedy, Senator Deeds called for and introduced major mental health reforms in Virginia, including extending the length of time a person in crisis can be held for emergency evaluation.

In the legislative session following the tragedy, and in recognition of major gaps in the mental health system, Virginia legislators voted in support of reforms that would allow better reporting requirements to track individuals on assisted outpatient treatment orders, among other important reforms.

We applaud Virginia for expanding their use of assisted outpatient treatment and ensuring a better continuity of care for residents with severe mental illness.

Read the Treatment Advocacy Center report "Mental Health Commitment Laws: A Survey of the States" to learn more.

(Photo: Ricky Carioti/The Washington Post)

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