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Public Policies Render People with Serious Mental Illness ‘Invisible’

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(Oct. 17, 2014) People with serious mental illness are often rendered invisible, writes Liza Long in the Idaho Statesman (“Guest Opinion: Ignoring the mentally ill won’t make them go away,” Oct. 10).

homeless photoLong drew her observations after speaking with members of her community who live with severe mental illness at a lunch in her hometown of Boise, Idaho.

“They just want to sweep us under the rug. We are invisible. People want to pretend we don’t exist,” said David who spoke up about his struggles. Another attendee said he could barely afford the cost of medications he needs to manage his mental illness.

Stories like these highlight the destitution the most severely ill often face, frequently further complicated by insurance issues.

A large majority of people with severe mental illness are underinsured, covered by Medicaid or not insured at all.

Medicaid is now the single largest payer of mental health care in the United States, and psychiatrists, including those in community-based hospitals and clinics, academic medical centers, and private practice, play a central role in treating Medicaid beneficiaries with serious mental illness.

“Medicaid expansion would go a long way to helping adults who have mental illness,” Long said. But in states choosing not to expand Medicaid, things will likely only get worse for people with SMI.

Idaho, which has chosen to reject the expansion, will likely see a substantial loss of funding for state hospitals and additional psychiatric bed loss.

The flip side of rejection could mean more people in psychiatric crisis will fill emergency departments, end up in jail or prison or among the homeless population.

“Mental illness is not a personal choice or a character flaw,” wrote Long.

Our public policies need to reflect that.

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Mental Health System 'Utterly Useless' for Massachusetts Man

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(Oct. 16, 2014) Bodio Hutchinson stabbed two park rangers several times after they responded to calls that he was threatening passersby with a knife at the Boston Common in Boston, Massachusetts.

bodiohutchinsonHutchinson, a homeless man diagnosed with paranoid schizophrenia, has a long and sordid history of violent and bizarre behavior, including unprovoked attacks on strangers. He punched a woman in Newtown Square and bit the man who came to her aid last year. In total, he has over 17 convictions.

When one of his convictions led to jail time at Nashua Street Jail in 2010, it took nine officers to restrain him during a violent outburst.

But “perhaps the worst part of this is that through it all, our court and mental health systems have been utterly useless — unable to save Hutchinson from himself, or to protect us from him,” writes Adrian Walker for the Boston Globe (“Why couldn’t anyone stop Bodio Hutchinson?” Oct. 16).

Hutchinson’s lawyers say he struggles to understand reality and that he has no memory of the attack.

“That’s tragic,” says Walker. “But his daily struggle shouldn’t imperil anyone who happens to cross his path. Plainly our mental health system doesn’t seem to be up to the challenge posted by a 290-pound paranoid schizophrenic.”

Walker wonders why our mental health system is failing people like Hutchinson. He implores legislative candidates to stop paying lip-service to mental illness treatment issues and actually take action.

In Massachusetts, where there is no assisted outpatient treatment (AOT) law and a high threshold for inpatient treatment, passage of AOT and less restrictive inpatient treatment criteria would be a great place to start.

 

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"The Suicide Crisis"

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(Oct. 15, 2014) Kevin Briggs recalls the day in 2007 when he was unable to talk a jumper back from the ledge of the Golden Gate Bridge in an interview with Gregg Zoroya for USA Today (“The cost of not caring: The suicide crisis,” Oct. 9).

goldengatebridgeBriggs, a California Highway Patrol officer, has talked many potential jumpers back from the ledge of San Francisco’s most famous bridge and is one of the searing stories presented in USA Today’s examination of suicide as a consequence of letting people with mental illness fall through the cracks of our fragmented treatment system.

The lifetime risk of suicide among individuals with schizophrenia is about five percent and about 10 to 15 percent for people with bipolar disorder, according to a Treatment Advocacy Center backgrounder.

“The country seems almost complacent with this staggering death toll,” writes Zoroya. “But the suicide rate keeps climbing.”

My son would be alive today if there had been a way to keep him medicated, Pat Milam said. Milam’s son killed himself in 2011 with a homemade explosive and frequently refused treatment for his mental illness.

But most lawmakers are not interested public policies that would provide treatment for people at risk for suicide. “If the public doesn’t think you can do anything about it, they won’t support it,” said Alex Crosby, a CDC epidemiologist. (HR 3717 does provide a glimmer of hope for the most severely ill).

“The nation must find a way to treat despair before the only resort is a police officer begging someone not to jump,” Briggs told USA Today.

We couldn’t agree more.

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Family Suffers Heartbreaking Loss After Mental Health System Fails

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(Oct. 10, 2014) Keith Wrubel, 30, died of poisoning last month after a nearly 10-year battle with paranoid schizophrenia, and his family blames the laws in Michigan (“Mentally ill man dies after family says pleas were ignored by Michigan’s failed mental health system,” ABC News, Oct. 8).

keithwrubel“I feel like I failed him,” said his sister Amber Guerrero. “That I wasn’t able to get him help.”

“But what actually let Keith down wasn’t his family, but the system that was supposed to keep him well,” said reporter Ross Jones for ABC News.

Nearly four years ago, after an attempt to take his life, Wrubel was admitted into a hospital. But he was discharged after 3 days. He would be committed to the hospital three more times over the course of the next several years. Each time, he was released too soon, said his family.

Medication helped Keith, his family said. But like many people with severe mental illness, Wrubel believed he didn’t need to take his medication and self-medicated with toxic substances instead.

Then, after a night of self-medicating, he overdosed.

Part of the problem was that there was no system in place to make sure that the young man stayed on his treatment course after he was released from the hospital, his family said.

Families and mental health professionals alike say Michigan’s mental health system is not working for people like Keith.

Even though the state has Kevin’s Law, an assisted outpatient treatment (AOT), law that would allow a judge to order outpatient treatment for people with severe mental illness, it is rarely used.

Lieutenant Governor Brian Calley has convened a task force to examine why the mandatory outpatient treatment law isn’t used and how the state can improve treatment for its most seriously ill.

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Family Members Plead for Assisted Outpatient Treatment in Contra Costa

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(Oct. 9, 2014) Stories of homelessness, addiction, violence and suicide attempts were told by nearly three dozen speakers who have a loved one with severe mental illness in Contra Costa, California, earlier this week.

homelessness-feetMany of the family members spoke of loved ones who are too sick to recognize their own illness and requested tools to help the mentally ill into treatment (“Helping the severely mentally ill who don't realize they need to be helped,” Contra Costa Times, Oct. 8).

The pleas for help were directed toward the county supervisors, who were considering implementing Laura’s Law to allow assisted outpatient treatment (AOT) for the most severely ill.

If Laura’s Law had existed three years ago, my son would not be charged with a murder he doesn’t understand he committed, said the mother of a man diagnosed with paranoid schizophrenia.

Another mother told the story of her son, “who refuses to see doctors, take medication or accept counseling,” she said. “For three years he’s been in and out of police cars, ambulances, emergency rooms, psychiatric wards and back onto the streets.”

Even though all five supervisors said Laura’s Law has value, only two supervisors voted in support of implementation and the decision was extended for an additional 90 days while the board waits for a cost analysis.

"We need to help those who don't realize they need a treatment plan,” said Mary Piepho, one of the supervisors who voted in favor of implementing the court-ordered outpatient treatment program. “The point is to prevent crisis before it occurs."

Contra Costa shouldn’t wait too long to offer this life-saving tool to its most severely ill. In May, Orange County supervisors voted unanimously to adopt Laura’s Law and July saw San Francisco and Los Angeles vote to fully implement the program – covering more than 14.5 million Californians and making the state a better place to live.

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