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We Must Focus Resources on the Most Seriously Ill, Urge Prominent Members of the APA

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(Sept. 29, 2014) Two prominent members of the American Psychiatric Association called for major reforms to the mental illness treatment system in an editorial in JAMA Psychiatry (“Fixing the troubled mental health system,” Sept. 24).

sharfstein“The first step in reform is to focus attention and resources on the most severely ill, high-need, high-cost patients,” wrote Lloyd Sederer, MD, and Steven Sharfstein, MD. “We have to have the right structure for the delivery of care.”

Sederer is medical director of the New York State Office of Mental Health and was director of APA’s Division of Clinical Services from 2000 to 2002. Sharfstein is CEO and medical director of the Sheppard Pratt Health System and was president of APA from 2005 to 2006.

“Federal and state governments should prioritize the move of patients from the criminal justice system to the treatment system,” they urged. “Some of the neediest people who would have been institutionalized are now in the criminal justice system. This is an absolute disgrace. We need to provide incentives for people to be treated in the community and to avoid jail and prison.”

In an interview with Psychiatric News, Sharfstein argued that the Helping Families in Mental Health Crisis Act (HR 3717) has the potential to offer some relief to the suffering of the most severely ill, their families and their communities. “In my view it tackles head-on some of the major impediments to access to care for a critical subset of individuals who are high cost and very difficult to retain in treatment, in large part because they don’t recognize they are sick,” he said.

Even though the some of the nation’s leading psychiatrists are calling for more resources and attention for the most high-need patients, the plan put forth by the leading federal agency dedicated to improving mental health efforts, the Substance Abuse and Mental Health Services Administration, falls short, said the current president of the APA, Paul Summergrad, MD, in this month’s issue of Psychiatric News (“SAMHSA strategic plan falls short on serious mental illness,” September).

The plan leaves out “a focus on the appropriate medical care of patients with serious mental illness,” Summergrad said.

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Role of Untreated Severe Mental Illness Missing From New FBI Report

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(Sept. 26, 2014) “Active shooter incidents” have more than doubled over the last 14 years, according to a report released by the FBI Wednesday.  While the FBI did not collect data on the cause of such incidents, previous studies of mass shootings suggest approximately half are related to untreated severe mental illness

police carAn average of six shooting incidents occurred in the first seven years that were studied, the FBI’s report shows. That average rose to more than 16 per year in the last seven years of the study, including high-profile tragedies in Newtown, Aurora, Tucson and last year’s massacre at the Navy Yard in Washington, DC – all involving severe mental illness. (The report excluded domestic violence, drug and gang-related shootings).

“At the heart of the problem is the sheer number of people being failed by our nation’s mental illness treatment system and left untreated,” said Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center and a leading research psychiatrist focusing on schizophrenia and bipolar disorder.

Previous studies of mass shootings show:

•    A 1999 University of North Texas study identified 30 mass killings for which extensive information was available. Even though the killings took place over a 50-year period, 70% took place in the 22 years before the study was conducted. Twenty of the 30 perpetrators had definite or probable psychosis.

•    A 2000 New York Times survey of 100 “rampage killings” between 1949 and 1999 found that 73 occurred in the nine years before the newspaper conducted its study. Half the killers had histories of serious mental illness.  

•    A 2012 Mother Jones survey found that nearly half of the mass shootings from 1982-2012 (29 of 62) took place in the most recent nine years. Seven of the killings took place in 2012 alone. According to their research and analysis, “at least 38 of the perpetrators displayed signs of possible mental health problems prior to the killings.”

(Read the backgrounder, “Are Mass Killings Associated with Untreated Mental Illness Increasing?”)

“Mass killings by individuals with severe mental illness are just one tragic symptom of a much larger problem,” Torrey continued. “Other tragedies occur daily. People with mental illness comprise one-third of the homeless population and there are now 10 times more people with a psychiatric disease in jail or prison than receiving treatment in a hospital.”

“This is preventable," the founder said. "Removing legal and other barriers to treatment will pay dividends for people living with untreated severe mental illness and their communities. As long as these barriers remain, tragedy in all its many forms will continue.”


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IMD Exclusion Forces Patients to Seek Care Far From Home

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(Sept. 25, 2014) Next time Maria Cepeda tries to kill herself, she will succeed, she told the Press Democrat (“Mental health patients forced to seek treatment outside of Sonoma County,” Sept. 23).

maria“My last way, my final out, will be a hanging,” said Cepeda. “There will be no more suicide attempts. There will be one more and I will succeed.”

Cepeda, who has been diagnosed with severe depression and bipolar disorder, has checked herself into psychiatric hospitals over a dozen times in just as many years.

But because she is on Medicaid, she is not eligible to stay at Aurora Santa Rosa Hospital, a 95-bed, inpatient-psychiatric hospital. For Cepeda, and many low-income people with a mental illness, Medicaid is essentially meaningless when it comes to getting treatment in a psychiatric hospital.

The federal government's Institution for Mental Diseases (IMD) exclusion bans Medicaid from paying for psychiatric hospitalizations in facilities with more than 16 beds. Because Aurora Santa Rosa Hospital has 95 beds, Medicaid recipients with mental illness in Sonoma County, like Cepeda, have nowhere to go. (Read about the IMD exclusion). “The IMD exclusion ensures that adult, low-income patients will usually be sent out of the county,” according to the Press Democrat.

Ken Meibert, Aurora’s CEO, said the IMD exclusion amounts to discrimination. “Just because they have a different type of insurance should not preclude them from the type of care everybody else gets,” he said.

Some states are beginning to apply for a waiver to sidestep the IMD exclusion. In mid-September, Washington received approval to allow reimbursement for 30-day psychiatric hospital stays in facilities with more than 16 beds.

We can only hope, for Cepeda’s sake, that other states follow suit.

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Los Angeles to Offer Treatment Instead of Jail for Mentally Ill Offenders

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(Sept. 24, 2014) Los Angeles County has announced a plan to help low-level offenders with serious mental illness obtain alternative sentencing, allowing for treatment instead of prison time (“Mental Illness program could transform LA county justice system,” the Los Angeles Times, Sept. 17).

jail barbedwiregraphic“It is time to stop to stop bouncing people who are mentally ill and genuinely sick between the streets and our jails,” said District Attorney Jackie Lacey. “This is an unconscionable waste of human life and money.”

This project has the potential to not only reduce recidivism rates and encourage humane treatment for the mentally ill, but also set a precedent for the criminal justice system throughout the country, reports the Los Angeles Times.

Measures include providing transitional housing, treatment and assistance for finding jobs to the mentally ill who would benefit from alternative sentencing. The initial plan will start in Van Nuys, a neighborhood in Los Angeles, and spread throughout the county with the help of $756,000 in funding.  

This initiative is a crucial step in helping offenders with serious mental illness, according to advocates. "Los Angeles County has a real problem with people with mental health issues in the jail system," said Karen Tamis of the Vera Institute of Justice. "This could have a very significant impact on the jail population as a whole."

Beyond getting the seriously mentally ill out of jails, this plan will allow criminal charges to be cleared from their records with the successful completion of treatment and a probation period. Courts that specialize in sentencing mentally ill offenders will push these measures, along with a variety of other courtrooms throughout the county.

Los Angeles County should be lauded for the attention it has given to the plight of people with mental illness and their families this year. In July, the LA County Board of Supervisors voted to unanimously implement Laura’s Law, making it the third major California county – and the largest – to embrace court-ordered outpatient treatment as a tool for helping the most seriously ill.

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Relatives Say White House Trespassers Needed Treatment, Not Incarceration

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(Sept. 23, 2014) With more than 800 rounds of ammunition and a machete, Omar Gonzalez, a war veteran, jumped the fence at the White House, entered the building and made his way toward the North Portico before being arrested by Secret Service last Friday.

secretserviceGonzalez, 42, was diagnosed with paranoid schizophrenia, among other mental illnesses, according to his ex-wife Samantha Bell (Ex-wife of White House intruder Omar Gonzalez says he needs help,” NBC News, Sept. 23).

Gonzalez told a Secret Service agent that “the atmosphere was collapsing and he needed to get the information to the president of the United States so that he could get the word out to the people," according to an affidavit obtained by NBC News.

“There were telltale signs that he did need help,” said Sergeant Haslach, who described himself as one of Gonzalez’s closest friends (“Omar Gonzalez recalled as a good, if troubled neighbor,” the New York Times, Sept. 23).

“He needs proper care. He needs proper treatment and throwing him in jail is not going to do anything for him,” said his ex-wife. “He is beyond that.”

Shockingly, or not shocking at all, Gonzalez wasn’t the first White House trespasser who reportedly suffered from mental illness this month.

Earlier in September, 26-year-old Jeffrey Grossman was arrested after jumping the White House fence in attempt to talk to the president about how mental illness is treated. Grossman has reportedly suffered from mental illness for “sometime” and was recently turned away from an out-of-state hospital because he lacked insurance coverage (“White House trespasser was seeking better mental healthcare,” examiner.com, Sept. 18).

My son’s arrest is another testament to the nation’s failure to deal with mental illness, Grossman’s mother said. “He’s not a threat to anyone. I want to see him get help.”

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