(June 5, 2015) The Treatment Advocacy Center applauds Representatives Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX) for their reintroduction of the landmark “Helping Families in Mental Health Crisis Act.”

“Our mental health treatment system is broken and families have suffered long enough,” said John Snook, executive director of the Treatment Advocacy Center. “This bill gives families the tools necessary to help their loved ones with severe mental illness access the treatment they need to prevent tragedy and recover their lives.”

Among many important provisions, the reintroduced “Helping Families in Mental Health Crisis Act” would reorganize the way the federal government funds mental health services by identifying and prioritizing programs that have a proven track record of success. The bill would also provide nearly five million dollars in funding to help states use assisted outpatient treatment (AOT), a lifesaving program for people who are too sick to maintain treatment themselves.

“The recognition of AOT in this legislation follows its inclusion into the National Registry of Evidence-Based Programs and the announcement by the U.S. Department of Justice Office of Justice Programs that AOT is an effective and evidence-based practice for reducing crime and violence.” Snook said. “It is now clear that implementing and using AOT has become a public-health priority.”

Other changes to the mental health system include adjustments to the HIPAA Privacy Rule so caretakers of the severely mentally ill can access information in times of crisis and provisions to expand access to inpatient psychiatric care in appropriate settings.

“This country’s inadequate mental health system needs a checkup,” the executive continued. “This bill will help the government better serve the people who are most likely to suffer the consequences of untreated severe mental illness.”

Congressman Tim Murphy was chosen in 2014 to receive the Treatment Advocacy Center’s highest honor, the Torrey Advocacy Commendation, in recognition of his courageous efforts to make treatment possible for more people with severe mental illness.

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(June 4, 2015) I spent yesterday morning in an Oakland courtroom waiting for my 37-year old mentally ill son to appear before a judge for fighting with Berkeley police. He spent four nights in jail and was still in custody with bail set at over $10,000.

I hadn’t seen Sean for five months, since I finally took out a restraining order to prevent him from coming to my house (usually around midnight) demanding money or to move in with me (my cottage is 900 sq. ft).

We tried that living arrangement a few years ago and I ended up calling the Oakland Police several times when Sean went into abusive rages. It would take the Oakland PD over three hours to arrive by which time Sean had left the house temporarily. Eventually, I rented him a room elsewhere and changed the locks on my doors. I’ve offered him help to get medical insurance and see a doctor, but Sean has drifted since then and became homeless last year. He kept up his demands for money from me and said if I didn’t help him, I had no reason to be alive. I finally got the restraining order five months ago.

He insists he’s fine. He’s self-medicating and the street drugs and delay in treatment will just cause more brain damage over time. I don’t believe psych meds always help everyone, but from support groups I’ve been attending for years, I’ve never heard of a patient getting any better without drugs and/or treatment.

So yesterday, I sat for four hours in a chaotic courtroom until the judge—switching her focus from cases of DUI and petty theft on her left to cases of prisoners-in-custody on her right—called my son’s name. Sean was brought out in prison clothes.

He looked rough but wasn’t beaten up or comatose, and his nose hadn’t been broken again. He was asking the judge and public defender semi-coherent questions. Watching him showed me how bright and charming he can be when he is desperate. He has a university degree, medical training, and two kids he can’t see because of a restraining order. He’s homeless and can’t keep a job and he still won’t admit to being ill.

Like so many of the mentally ill, my son has a condition called anosognia or “lack of insight” by which some mechanism or chemistry in the decision-making frontal lobe area won’t allow him to see that there’s something wrong with him. People unfamiliar with the mentally ill, including my son’s estranged father, might call it denial or defiance. This condition of anosognia is often a symptom of schizophrenia.

Sean is my beloved only child and yet because he is an adult, I can’t get him a diagnosis or treatment without his full cooperation. As the laws stand today, Sean must request treatment (and I would gladly pay for it), or commit a felony to even be psychologically evaluated. My son’s arrest, confinement, and public defense must have cost thousands of dollars. And at this point, I don’t know how many times he’s been arrested.

Sean can figure out how to apply for and get accepted to nursing school, but he can’t see the one thing that is making his life a living hell--his illness. He will take street drugs with who-knows-what in them, but won’t even consider taking prescribed psychiatric drugs or mood stabilizers (he calls them “crazy pills”) that might make his life manageable and far less dangerous.

LINDSAY AIKMAN
BERKELEY, CALIFORNIA

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Photo: Andrew and Hobbes/Flickr)

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(June 3, 2015) Our latest Catalyst newsletter is online now.

In this issue, we share the results of our most recent study which found that assisted outpatient treatment saves more money than it costs. “If states and counties look at what they are spending in every budget area touched by untreated mental illness– crisis intervention, law enforcement, jails, homeless shelters and more – they will find they can’t afford not to use this treatment option,” the Treatment Advocacy Center said.

We also highlight our 2014 Torrey Advocacy Commendation winner, Representative Tim Murphy, who was awarded our highest honor for his courageous efforts to make treatment possible for people with severe mental illness with his “Helping Families in Mental Health Crisis Act.”

Read our spring Catalyst.

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(June 2, 2015) Ohio Governor John Kasich recently expressed outrage at the number of people with mental illness in prison, calling it “a disgrace” (“John Kasich: Number of mentally ill in prison is 'a disgrace',” Buzzfeed News, Jun. 2).

“We have 10,000 people in our prisons with mental illness,” Gov. Kasich said, speaking at a luncheon last week.

“Now I don’t know how many of you know people who struggle with these illnesses, but if you’ve got a problem with schizophrenia you find yourself in a prison? It’s a disgrace in this country,” he continued.

Kasich’s administration has taken steps to address this issue. The Governor released a budget earlier this year designed to encourage judges to put first-time, nonviolent offenders in community programs instead of prison. Kasich also signed a bill clarifying the right of judges to order outpatient treatments for adults with mental illness.

Governor Kasich is right; the way we treat people with mental illness is indeed a national disgrace.

Prisons and jails have become America’s de facto mental asylums. According to Treatment Advocacy Center data, there are now ten times as many individuals with serious mental illness behind bars than in state psychiatric hospitals.

Read the Treatment Advocacy Center report on “The Treatment of Persons with Mental Illness in Prisons and Jails” to learn more.

(Photo: Michael Vadon/Flickr)

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(June 1, 2015) Diagnosed with schizophrenia, Shannon King sits in a jail cell in South Dakota awaiting trial on charges of burglary and assaulting his mother, Suzy, last April (“Mother: My son needs treatment, not jail time,” Argus Leader, May 26).

Suzy said her son attacked her during a schizophrenic episode at their home, and then dragged her eight blocks away across gravel to a local beauty salon. Once there, King kicked in the salon’s door, pulled Suzy inside, lay down on the floor, and went to sleep.

But Suzy blames the attack on the illness, not her son.

"How do you punish a person like that?" Suzy said. "He doesn't even understand what he's done."

Advocates say King’s case further highlights the need for change in the way the courts handle criminal cases involving defendants with mental illness.

"We are long overdue for a mental health court in our state and community," said Phyllis Arends, executive director of the National Alliance on Mental Illness in Sioux Falls.

Many mentally ill defendants like King find themselves in a cycle of entering and exiting jails and prisons, without ever being fully stabilized and rehabilitated, Arends said.

Mental health courts offer one possible solution. They are designed to get treatment for those who might otherwise land behind bars, and possibly help them regain their lives.

"I think there is beginning to be a consensus that there needs to be a better way to deal with this specific group," said Judge Hoffman of Sioux Falls Second Circuit. Hoffman is working to build support for “an alternative court that would focus on rehabilitating mentally ill defendants rather than locking them up.”

Hoffman is headed in the right direction. Read the Treatment Advocacy Center’s study on the prevalence of mental health diversion practices to learn more about ways to provide treatment before a person with severe mental illness ends up in the criminal justice system.

(Photo: Joe Ahlquist/Argus Leader)

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(May 29, 2015) Since the deaths of Michael Brown, Tamir Rice, Eric Garner, Walter Scott and Freddie Gray, confrontations between citizens and law enforcement, and the fatalities that result from them have come under intense media scrutiny as the public demands answers.

But much less attention has been paid to the deaths of people with mental illness at the hands of police, even though untreated severe mental illness is an increasing factor in officer-involved homicides.

Tanisha Anderson, a mentally ill woman, who died shortly after being taken into police custody in Cleveland, Ohio, last November has been all but ignored by the media. Few details of the case had been made public until Mother Jones examined the case earlier this week (“A Mentally Ill Black Woman's ‘Sudden Death’ at the Hands of Cleveland Police,” May 28).

According to official reports, police were called by Anderson’s family, and Anderson agreed to be escorted to the hospital for a psychiatric evaluation.

But as the group approached the police vehicle waiting to escort Anderson, she “began actively resisting the officers.” Following the struggle, Anderson appeared to “go limp.” She was pronounced dead at the hospital less than an hour later. It is unclear how she died.

The public should be commended for demanding answers for the deaths of Brown, Rice, Garner, Scott and Grey, but we shouldn’t forget about the Andersons of the world – people with mental illness.

One way to start is to mandate that every law enforcement officer receive crisis intervention training on how to respond to people in a psychiatric crisis. It’s unclear whether the officers involved in Anderson’s death received the training.

The country also needs to demand that the Department of Justice collect better data on the use of police force against people with mental illness. These cases are so poorly monitored that there is no precise accounting of how many citizens are killed, much less their psychiatric diagnosis or other crucial details.

We must also recognize that the responsibility of law enforcement officers for seriously mentally ill people has increased sharply in recent years and is continuing to increase. Inevitably, the increasing number of confrontations between law enforcement officers and persons with serious mental illness leads to some unfortunate and often tragic outcomes.

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(May 28, 2015) “Mental illness is not something people choose, and if it is found to have contributed to their actions—no matter how heinous they may have been—it would be unconscionably callous to make them pay the ultimate penalty,” argued an editorial in the Plain Dealer (“Death penalty should not apply to the seriously mentally ill: editorial,” May 27).

There is no outright ban on executing people with mental illness. While the Supreme Court has barred the execution of the intellectually disabled and of juveniles, populations it deems so vulnerable that their execution would constitute cruel and unusual punishment, there has been no such ban for people with mental illness.

The editorial calls for support for bipartisan legislation recently introduced in the Ohio Senate that would prohibit using the death penalty for people with serious mental illness who are convicted of murder.

The legislation reasons that someone who is “significantly impaired” as a direct result of their psychiatric illness is unable to understand what they are doing at the time of a criminal act.

But it shouldn’t have to come to this. Untreated severe mental illness is a factor in an estimated 10% of all the homicide deaths committed in the United States every year. Effective treatments for severe mental illness exist that would reduce the number of homicide victims and - by extension - the capital cases that result from them.

As long as mental health policy and systems fail to recognize and address mental illness with timely and effective treatment, homicide victims and their killers alike will continue dying as a consequence of non-treatment.

(Photo: Ken Plorkowski/Flickr)

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(May 27, 2015) Policymakers have another clear signal that passing and implementing assisted outpatient treatment (AOT) programs is a reasonable means of improving outcomes for people with severe mental illness.

The Agency for Healthcare Research and Quality (AHRQ) issued a report this month that added the practice, also known as court-ordered outpatient treatment, to a list of programs that would reduce costly psychiatric hospital readmissions.

“These programs improve adherence and outpatient treatment . . . and lead to significantly fewer emergency commitments, hospital admissions as well as a reduction in arrests and violent behavior,” the report said.

As casualties of a failed mental health system, people with serious mental illness cycle through hospitals that often don’t have enough room to treat patients, pushing them back into the community before they are ready.

“The goal is to ensure that individuals with mental illness with a history of repeat hospitalizations participate in community-based mental health services with the ultimate objective of keeping them out of inpatient settings,” the report concluded.

AHRQ’s endorsement adds to the growing list of organizations throwing their weight behind mandatory outpatient treatment.

Earlier this month, SAMHSA added AOT to the National Registry of Evidence-Based Programs (NREPP) after deeming the program an effective way to reduce the negative outcomes associated with untreated severe mental illness.

This impartial assessment adds further weight to the voices of advocates across the country seeking to implement AOT laws to save lives. Far too many communities face tragic outcomes because of a failure to effectively use this common-sense solution to serve those who are most severely mentally-ill.

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(May 26, 2015) Legislation aimed at increasing access to mental health treatment for mentally ill inmates is making progress in California, according to an editorial by the Sacramento Bee (“Confronting a cost of mental illness,” Sacramento Bee, May 25).

The act would give the court the ability to consider mental illness in the sentencing of a mentally ill offender who has committed a petty, nonviolent crime. The bill is sponsored by Assemblyman Marc Levine and called the “Mental Health Justice Act,” or AB 1006.

If implemented, the legislation would expand treatment for petty offenders with mental illness, and combat the criminalization of serious mental illness.

The numbers suggest this would be a good move for California. It costs approximately $51,000 a year to house an inmate in jail or prison. Comparatively, it costs about $20,412 to house and treat a person with mental illness.

But the need for a bill like AB 1006 highlights a fundamental issue: Jails and prisons have become this country’s de facto mental health hospitals. There are now 10 times more people with serious mental illness in jails and prisons than there are in state mental hospitals.

To cut prison populations and costs, we must stop criminalizing mental illness. AB 1006 is a step in the right direction towards this goal.

Read the Treatment Advocacy Center report “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey” to learn more.

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(May 21, 2015) Nneka Jones Tapia, a clinical psychologist, will soon be appointed as the new executive director of Cook County Jail, the second-largest jail in the country, Sheriff Tom Dart announced on Tuesday (“Psychologist to head Chicago jail, nation’s second largest,” Reuters, May. 19).
Tapia has overseen mental health strategy for the Cook County sheriff's office since 2013, and she is the first mental health professional to be appointed to head a large jail.

"I think I can bring a wealth of knowledge to the staff in understanding the inmates," Tapia said.

Sheriff Dart said choosing a mental health professional to head the jail made sense, calling it the “final piece of the puzzle” in addressing mental illness behind bars.

"When a third of your population is mentally ill, you sure as heck better have someone who understands that at the top," said Dart.

Cook County Jail houses approximately 9,000 inmates daily, of which 25-35 percent suffer from mental illness. 

Unfortunately, this is not unique. Across the country, there are now 10 times as many people with severe mental illness in our jails and prisons than receiving treatment in a psychiatric hospital.

Appointing a mental health professional to a leadership position is a great step forward for Cook County. But the focus must shift towards ensuring access to treatment and recovery, so that individuals with mental illness will be less likely to have such an overwhelming presence in our correctional systems.

Read the Treatment Advocacy Center report “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey” to learn more.

Watch Nneka Jones Tapia, Pete Earley and Treatment Advocacy Center executive director John Snook discuss the current state of mental health in our prison system in an interview with Huffpost Live.

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