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Long ER Waits for People in Psych Crisis in California

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(Oct. 28, 2014) Marty Naftel once spent nine hours in the emergency room waiting for a psychiatric bed to open up but was ultimately sent home without treatment for his bipolar disorder (“Psych patients pack emergency rooms," Orange County Register,” Oct. 25).

martynaftelNaftel’s experience is not uncommon. Sharp decreases in psychiatric beds spurred by deinstitutionalization have turned emergency rooms across the country into warehouses for people with mental illness in crisis.

The practice, called “psychiatric boarding” is the santitized term for keeping psych patients waiting in the ER for days, or sometimes months.

“I’m hearing from all over the state about ERs being overrun by psych patients,” says Randall Hagar, director of government relations at the California Psychiatric Association in Sacramento. “I’ve heard stories many times about the difficulty of finding placement for individuals. They can be kept in the ER three, four, five, even up to seven days.”

Warehousing patients like this has had far reaching consequences, leaving fewer ER beds available for the public while psychiatric patients do not get the timely and necessary medical care they would have received in a treatment facility.

The practice is so contentious that Washington recently made boarding illegal. While Washington’s decision that patients cannot be warehoused in ER rooms is a humanitarian one, but it also means that authorities will have to find a suitable treatment facility for people in a psychiatric crisis.

While California isn't considering making the practice illegal, the state should still provide suitable treatment facilities for people like Naftel.

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Mental Illness Makes Families Sick – personally speaking

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(Oct. 27, 2014) Before my brother got sick, really sick, I had started taking masters level psychology classes and what I learned has come in handy over the past few years. Even when he hasn’t wanted it, I’ve been able to help my sick brother. I’ve been able to help my sick family navigate the confusing, frightening, and very tumultuous seas that are mental illness.  

brotherandsisterThat’s something I’ve realized, just now in this moment: serious mental illness doesn’t just impact the person who is sick, but it effects and infects those closest to that sick person, making them sick too, in a very real way.  

Mental illness makes mothers cry. It makes siblings fight. It makes fathers afraid in their own homes, afraid of loved ones who refuse to keep psychiatrist appointments and who refuse to take meds.

Mental illness leaves pits in the stomachs of those who aren’t ill – those who listen to the delusions; who watch the abnormal behavior; those who care; those who want to heal every part of the broken brain that turns water into poison that twists memories into horrible misrepresentations of the truth.  

Mental illness sucks.  

It sucks the color and order from this beautiful intricate life of ours and replaces it with a black and white jigsaw puzzle missing dozens of very important pieces.  In other words, mental illness is no fun at all.  Did I mention that it sucks?  

My brother is very sick right now.  My parents are with him in his college town 10-hours away, taking turns in the ER while they wait for a bed in the psych unit.  
We are lucky this is happening in Nevada, where the laws are more balanced and allow family members and concerned doctors provide treatment to people like my brother.  

This is not the case in our county in California, where you have to commit a crime before they’ll take your severe mental illness seriously.  

My poor parents are exhausted. My poor brother is chasing his tale around a cage of paranoia and anger and fear. And all I can do from here, hundreds of miles away is research treatment centers and blog and pray.

You know how we all want to cure cancer? Parkinsons? Lou Gehrig disease?  Clearly there are lots of things we all want to cure.  Well, I’d like to add one more to the list: can we please find a cure for mental illness too?  Please.

Stephanie Mignon
Family Member and Advocate

 

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“My Son Tried to Enter the White House” – guest column

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(Oct. 24, 2014) My adult son suffered from severe bipolar disorder. During his first manic episode in January 1994, while he lived in northern Virginia, he became psychotic, paranoid, and lost touch with reality. He developed an unhealthy fixation for the president and made many attempts to get into the White House for what he actually thought were scheduled meetings with President Bill Clinton.

dottiepacharis3But he was in denial that anything was wrong with him. It took the assault of a police officer to get him committed. He spent his 27th birthday in a padded cell in the psychiatric ward at a Virginia hospital. He was diagnosed with bipolar disorder and transferred to a mental hospital where, after six weeks of involuntary commitment and forced meds, he recovered and resumed his life. Six years later, when he stopped taking his meds, he suffered a second psychotic break, this time fixating on President George W. Bush.

He claimed he was in possession of very important information for both these presidents and he needed to share it. As seems to be the case with the two alleged White House fence-jumpers this month, Dominic Adesayana and Omar Gonzalez, his sickness propelled him there.

After 9/11, my son told his family he had obtained a top secret security clearance at the White House, that the FBI had issued him a special gun permit, and that he was exercising his constitutional right to purchase a gun. Several days later, he showed up at the White House and told the Secret Service he was there for his scheduled appointment with Bush.

State laws vary, but all states set strict controls on involuntary hospitalization, limiting it to circumstances when a person is an imminent danger to self or others, or likely to become so. These laws give people with severe mental illness the right to decide when, where, how, or even if they will receive treatment.

Today’s laws, although well intended, were mostly written decades ago, in response to an era when doctors and hospitals had broad control over patients’ lives. Mental institutions, as they were called then, became a dumping ground not only for the mentally ill, but for the disabled, the handicapped, and the elderly. Eventually a public outcry led to laws forbidding the state from forcing treatment or medications on mentally ill people. Once you turn 18, you have a civil right to refuse treatment and remain mentally ill.

Yet some serious mental illnesses make it difficult for sick people to assess their own need for treatment. Families watch their loved ones descend, sometimes slowly, into Code Red territory, but current laws do not allow them to push help onto a deteriorating person until he or she reaches crisis stage. Only when a sick person becomes a danger, as determined by a judge at a commitment hearing, can he or she be committed.

But by this time, it is sometimes too late.

When patient rights exceed necessary protections, individuals with severe untreated mental illness can die because we’ve protected their civil liberties to remain mentally ill and refuse treatment. Many—like my son, who committed suicide on his third attempt in 2007—do die. Sometimes they harm others along the way.

Mental illness is not going away. We must find a balance between protecting the rights of mentally ill people and also getting them the treatment they require to recover and not be a threat to society.

Rep. Tim Murphy has introduced a bill, the “Helping Families in Mental Health Crisis Act,” that does just that. It would require states to have commitment criteria broader than “dangerousness” in order to receive Community Mental Health Services Block Grant funds. It would clarify HIPPA to assure caregivers are able to receive protected health information when necessary to safeguard the well-being of a patient or the safety of another. It would require states to have “assisted outpatient treatment” laws. AOT is for a small segment of the most seriously mentally ill individuals who have accumulated multiple episodes of homelessness, hospitalization, arrest, or violence associated with not taking their medications. AOT allows judges to order them to stay in six months of mandated and monitored treatment while living in the community. My son would have been a perfect candidate.

Sometimes the best way to neutralize a threat (and prevent a tragedy) is to preempt it.

Dottie Pacharis
Author of "Mind on the Run - A Bipolar Chronicle"

Read Dottie's entire article in the Washington Post.

 

Left Alone and Untreated, A Young Mother Hangs Herself in Jail Cell

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(Oct. 23, 2014) Two hours after entering jail, young mother Kathryn Schneider was found hanging in her cell following an apparent suicide. Her history of mental illness and suicide attempts were well known to the Koochiching County jailers ("Koochiching County jail suicide highlights lapses in care of mentally ill,” Oct. 14).

youngmotherDespite her known history of mental illness and suicide attempts, Kathryn was not screened for medical or mental health problems on the night of her death - checks that could have been instrumental in saving her life.

“I feel betrayed by law enforcement. Katie had put herself in an environment where she was supposed to be kept safe,” Schneider’s sister stated in the aftermath of Kathryn’s death.

Video footage shows “a woman who methodically prepared to end her own life” and that nobody tried to stop her.

“It is apparent that facility staff needs significant retraining,” said a senior Corrections Department inspector. “This includes holding supervisors and line staff accountable.”

But Kathryn’s suicide reflects problems not only in Minnesota jails but also in the prison system at large. Most county and federal prisons are poorly equipped to treat patients with mental illness. Prison and jail officials are being asked to assume responsibility for the nation’s most seriously mentally ill individuals, despite the fact that the officials did not sign up to do this job; are not trained to do it and face severe legal restrictions in their ability to provide treatment for such individuals.

What’s more is that people with mental illness should not be landing in jails and prisons in the first place. Today, there are ten times more patients in jail instead of in a psychiatric hospital, according to our study "The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey."

There is clearly something wrong with a system when people with a psychiatric disease end up behind bars rather than in treatment. 

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Homelessness Is Not a Human Right

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(Oct. 21, 2014) Diagnosed with paranoid schizophrenia, 68-year-old Nancy Wenzel has spent the last two decades cycling in and out of psychiatric hospitals, homeless shelters or living on the streets.

josephparkerWhen Joseph Parker, Wenzel’s son, reunited with her after nearly two decades earlier this month, Wenzel was sleeping on a cement slab next to an abandoned restaurant. Parker determined he would get his mother into treatment (“A son fights to save mother from Fitchburg streets,” Telegram and Gazette, Oct. 20).

He did not know how difficult that would be in Massachusetts.

Parker tried to bring his mother to the local hospital in attempt to get her back onto medication, but she refused treatment.

“The mental health program is not for me,” she said. She also accused Parker of posing as her family.

Parker was told by hospital staff that if he tried to get his mother to stay against her will the hospital would call the police and Wenzel could press charges against her son for kidnapping.

“They said it is all about human rights, but it is not a human right for her to go homeless, refuse medications and treatment and kill herself,” Parker told the Telegram and Gazette. “I think I have a human right to intervene with my mom and not watch her die on the streets."

But in order for someone with severe mental illness, like Wenzel, to qualify for court-ordered treatment in a hospital in Massachusetts, she would need to be a danger to herself or to someone else.

"I cannot fathom for the life of me how difficult it is to help your loved ones," Parker said. "How a man-made law on the books trumps my human right to help my mother. There has to be a better way.”

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