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RESEARCH: States that Deny Best Antipsychotics to Patients Have More Mentally Ill Behind Bars

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(July 24, 2014) When Medicaid tries to save money by restricting access to the most effective antipsychotics for people with severe mental illness, more mentally ill people end up in jail, according to new research from the American Journal of Managed Care (“AJMC Study Finds Medicaid Barriers to the Right Drugs May Cause More with Schizophrenia to Land Behind Bars,” July 22).


jail barbedwiregraphicThe antipsychotics, called “atypical antipsychotics,” have been associated with lower rates of relapse in people with schizophrenia. Using data from 16,844 prison inmates, researchers found that restricting access to atypical antipsychotics – Medicaid must review the prescription before covering it – was associated with a 22 percent increase in the likelihood that a person with severe mental illness would end up behind bars.


“The United States spends $8.5 billion each year on persons with severe psychiatric disorders in jails and prisons,” the authors said in a statement. “The prison system is an expensive way to deal with mental illness, especially when many of those incarcerated are nonviolent.”

This study comes at a time when jails and prisons are facing increased scrutiny for their treatment of mentally ill prisoners and states are under pressure to enact policies that keep people with serious mental illness out of the criminal justice system.

This scrutiny makes sense. Criminalizing people with severe mental illness is a human rights violation and costs taxpayers money. An investigation by USA Today found that a 94-day incarceration cost $30,258, whereas a full year of housing, disability income, and treatment for a person with a serious mental illness was just $31,200.

“Limiting access to effective therapy may save states some Medicaid money in the short run,” said lead author Dana Goldman, director of the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California. “But the downstream consequences -- including more people in prisons and more criminal activity -- could be a bad deal for society."

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“Mental Illness Cases Swamp Criminal Justice System”

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(July 23, 2014) Police encounters with people with severe mental illness are the subject of USA Today’s latest article in a series on the human and financial costs of abandoning the seriously ill (“Mental illness cases swamp criminal justice system,” July 21). Excerpted below:

mentallyillwomanInside a cluttered downtown apartment that she shares with a cat, the 57-year-old woman is in the midst of a near-meltdown.

“There's three of them,” she tells two police officers, referring to “these predators who won't leave me alone. Those sons of bitches won't let me go.“

The police have been here before — 61 times, in fact, in the past 17 months — and the only intruders to be found are the ones apparently stalking the woman's troubled psyche.

During these episodes, she always summons the police because they are the closest thing she has to family. And no matter what, they always come.

"I didn't have any choice but to go to Jimmy,'' she said, waving the glowing end of her lighted cigarette in the direction of Officer Jimmy Winters. “I'm sorry I'm such a pain in the ass.''

In the shadow of enormous wealth, where tourists flock to view the iconic mansions along Bellevue Avenue, about 40% of all calls to police involve people who are mentally ill or have behavioral problems. It is, as Newport Chief Gary Silva described it, an "alarming'' number. Yet it only begins to assess how an overwhelmed criminal justice system has become the de facto caretaker of Americans who are mentally ill and emotionally disturbed.

From police departments and prisons to courthouses and jails, the care of those who are mentally ill weighs heaviest on law enforcement authorities, many of whom readily acknowledge that they lack both resources and expertise to deal with the crushing responsibility.

Read the entire article in USA Today.

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A Reason to Smile

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(July 21, 2014) It’s no secret that giving to others feels good. Now, Amazon is making it even easier to give to the Treatment Advocacy Center and help eliminate barriers to treatment for the most severely ill.

amazonsmileWhen you shop at amazon.com, every purchase you make can help the Treatment Advocacy Center make treatment possible for more people with severe mental illness – at no extra cost to you. That’s because the Treatment Advocacy Center is a participant in the AmazonSmile program. Every time you buy something through the AmazonSmile portal, 0.5% of your dollar goes to the Treatment Advocacy Center.

Here’s how AmazonSmile works:

To shop at AmazonSmile simply go to smile.amazon.com from the web browser on your computer or mobile device. You may also want to add a bookmark to AmazonSmile to make it even easier to return and start shopping. Select the Treatment Advocacy Center from the dropdown menu as the charity you wish to support. Once you do this, every time you shop at smile.amazon.com, a portion of your purchases will aid our organization.

The Treatment Advocacy Center is the only national nonprofit dedicated exclusively to expanding treatment access for people with the most severe mental illness. Designating us to receive your AmazonSmile dollars will help eliminate barriers to treatment for the people who need help the most.

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RESEARCH: Antipsychotics Linked to Reduction in Violent Crime

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(July 17, 2014) Antipsychotics like clozapine and mood stabilizers like lithium are a critical tool for reducing violent crime in people with severe mental illness, according to a study published in the Lancet (“Antipsychotics, mood stabilizers and risk of violent crime,” May 8).

medication taking-pillBased on data collected by Swedish national health registries from 2006 to 2009, researchers observed the effects of antipsychotics and mood stabilizers on a sample of over 80,000 patients.

The researchers found that people who take antipsychotic medication are approximately 50% less likely to commit a violent crime than those with bipolar disorder who do not take medication.

 "Patients with psychiatric disorders are at risk of perpetrating violent acts, as well as being victims,” said Dr. Seena Fazel, lead researcher on the study.

“Until now, we have not known whether antipsychotics and mood stabilizers reduce risks of violence,” she continued. “By comparing the same people when they are on medication compared to when they are not, our study provides evidence of potentially substantial reductions in risk of violence, and suggests that violence is to a large extent preventable in patients with psychiatric disorders."
 
The results of this study show that many people with serious mental illness who commit violent acts have done so as a result of untreated psychosis or other symptoms of the illness rather than malicious intent.

The authors highlight the importance of effective medication management in treating serious mental illness, specifically the use of mood stabilizers and antipsychotics to reduce violent crime among patients suffering from psychosis.

It is important to remember that most people with mental illness are not violent and are almost 4x more likely to be the victim of a crime than to perpetrate a crime. In either case, better assisted outpatient treatment (AOT) laws would facilitate effective medication management for the most severely ill.

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Mentally Ill Bear Brunt of Growing Violence at Rikers

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(July 16, 2014) Seventy-seven percent of inmates injured in attacks at Rikers had a diagnosed mental illness, report journalists Michael Winerip and Michael Schwirtz for the New York Times (“Rikers, where mental illness meets brutality in jail,” July 14).

rikersinmateThe growing number of mentally ill inmates is a major contributing factor to the escalating levels of violence at Rikers, Winerip and Schwirtz say. But Rikers is also not equipped to handle this surge of mentally ill inmates. Supervision is provided by officials who are not trained mental health professionals and “instead rely on pepper spray, take-down holds and fists to subdue them.”

Inmates with mental illness are also especially vulnerable in the harsh environment of incarceration. They are “often the weakest in a kind of war of all against all, preyed upon by correction officers and other inmates.”

“There’s lots of brutality,” said Daniel Selling, the former director of the jail’s mental health services. “Horrible brutality.”

This horrific brutality should hardly come as a surprise. With 12,200 inmates, Rikers Island Jail in New York City is the largest de facto “mental institution” in New York and prison workers “complain that they do not have the tools to properly care for inmates with mental health problems.”

Complicating the problem is that many of the inmates who need treatment the most are left untreated, according to a Treatment Advocacy Center study which found that New York is one of the most difficult places for prisoners with severe mental illness to receive involuntary treatment. Without proper treatment, systems are likely to worsen.

Until we maintain a functional public mental health treatment system, people with mental illness will continue to languish in jails and prisons with staff that are ill prepared to handle mental illness.

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