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How Suicide Risk Rises with Serious Mental Illness

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(August 14, 2014) The suicide of actor and comedian Robin Williams has brought renewed attention to the unspeakably sad and often baffling topic of suicide, a lethal act of violence against oneself. 

manic episodeToo often overlooked in discussions of mental illness and violence is the fact that the most likely victim of a violent act associated with psychiatric disease is the individual him/herself. Homicide currently takes the lives of about 15,000 people a year in the U.S., an estimated 1,500 of whose deaths are associated with untreated mental illness. In 2011, suicide took almost 40,000 lives, and NIMH Director Tom Insel has said every one of those losses is associated with mental illness.

The Treatment Advocacy Center’s recently updated backgrounder, “How many people with schizophrenia and bipolar disorder commit suicide?” looks specifically at suicide associated with schizophrenia and bipolar disorder, the disease from which Williams suffered. The top two risk factors listed are depressive symptoms and substance abuse, both of which he had suffered.

The suicide of a prominent member of society makes big headlines, but smaller headlines every day paint a grim picture of a cause of death that is preventable with appropriate and effective treatment. At Saline Memorial Hospital in Benton, Arkansas, for example, the hospital’s ambulance service answered 147 mental-health emergency calls reporting suicidal thoughts, intentions or attempts in just the first 151 days of 2014 (“Suicide, mental illness touch many in Saline County,” July 20).

Treatment Advocacy Center backgrounders are useful tools for raising awareness about mental illness and treatment issues. For a complete list of backgrounders, visit the “Reports, Studies, Backgrounders” page of our website. To see the Treatment Advocacy Center’s original research, visit our TACReports.org site.

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Robin Williams: ‘If Only You Could Grasp … It Was Not Him’

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(August 13, 2014) Comedian Robin Williams, who died of asphyxiation after hanging himself this week, has already been removed from Everyday Health’s list of 10 famous people with bipolar disorder.

robin-williamsFrom his “Mork and Mindy” days in the late ‘70s, Williams brought laughter to whole continents of people. For individuals and families living with bipolar disorder, he brought the inspiration of seeing someone who shared the disease achieve such heights.

In a reflection on the sad end to Williams’ life, blogger Elad Nehorai has made an eloquent plea for understanding Williams' death was not self-inflicted but disease-inflicted.

“Williams did not make that choice,” writes Nehorai, who says he has been suicidal himself (“Robin Williams didn’t kill himself,” PopChassid, Aug. 12). "If only you could grasp it. It was not him. It was his illness.

“It can be so hard to understand for the mentally healthy. Just as I cannot possibly comprehend what it means for someone to have AIDS or cancer, I think it can be truly hard for people to wrap their minds around the idea that for some people, a choice cannot be a choice....

“Robin Williams did not kill himself. His disease, whatever it was, killed him.”

Williams' humor and his inspiration will be sorely missed. 

Read the entire blog on PopChassid.

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Are People with Untreated Serious Mental Illness Dangerous?

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(August 12, 2014) An executive walking near a shopping mall in the posh California suburb of La Jolla was allegedly stabbed 40 times by a man whose father said is suffering from bipolar disorder the family can do nothing to help because the suspect is an adult ("Father says he tried to warn authorities about son," CBS8 San Diego, Aug. 8).

odie-miller"What I want people to know is that my son has mental illness," father Odie Miller Sr., said. His son, Odie Jr., is "bright, talented, creative and personable," according to the father. "That's on his medication - without his medication - his life becomes unmanageable."

The victim is recovering at home. Miller Jr., 20, has been charged with attempted murder.

The association between violence and serious mental illness is hotly debated in mental health circles but not in the academic or scientific worlds. There, it is almost universally acknowledged that – while most people with severe mental illness are never violent – untreated mental illness is a risk factor for committing violent acts.

"Are people with serious mental illness who are not being treated dangerous?" is one of 15 recently updated Treatment Advocacy Center backgrounders that address important issues in mental health. The paper summarizes research into the association between untreated mental illness and violence and provides references to relevant studies.

When when timely and effective intervention is not available, terrible variety of consequences befall at-risk individuals like Odie Miller Jr., their families and their communities. To raise awareness of the devastating consequences of not treating serious mental illness, including the potential for violence, share "Are people with serious mental illness who are not being treated dangerous? with your local community members, politicians and media.

For more information about mental illness treatment issues, visit the "Reports, Studies, Backgrounders" page on our website and our TACReports.org site dedicated to the Treatment Advocacy Center's original research.

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How Non-Treatment Behind Bars Can Breed Tragedy

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(August 11, 2014) Travis Fendley, 24, confessed to killing his grandmother the day after he was released from jail, but family members say non-treatment for his schizophrenia while he was incarcerated is to blame for the tragedy (“Judge: Mentally ill Fresno man will stand trial for killing grandmother,” the Fresno Bee, July 31).

travisfendleyAs a result of "bizarre" behavior, Fendley was committed to an emergency psychiatric evaluation by police following his confession. While previously in jail, he was twice hospitalized for his psychiatric symptoms because he was not psychiatrically competent to stand trial. He has now been ordered to stand trial for murder in his 78-year-old grandmother’s death.

“He was sick and he needed help,” his aunt told the Bee. She and Fendley’s defense attorney said the killing could have been prevented had Fendley received proper medication before being released from jail.

The Treatment Advocacy Center in April published “The treatment of persons with mental illness in prisons and jails,” the first national survey of mental illness treatment practices behind bars. The study found there are now 10 times more individuals with severe psychiatric disease in prisons and jails than in state psychiatric beds, and many receive no treatment.

Fendley was a key figure in a 2013 Bee investigation of treatment provided to mentally ill inmates in the county’s jails. The report found that inmates with mental illness left the jails “in worse shape than when they were taken into custody” in Fresno County. The Treatment Advocacy Center study reached the same conclusion nationwide.

Jails and prisons were never intended to be mental health facilities. As long as they are used as such, tragedies such as the Fendley family experienced will remain common.  

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Washington State Makes Psychiatric Boarding Illegal

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(Aug. 7, 2014) Sharp decreases in psychiatric beds spurred by deinstitutionalization have turned emergency rooms across the country into warehouses for people with mental illness in crisis.

hospital-bed-generic“Psychiatric boarding” is the sanitized term for keeping psych patients waiting in the ER for days, or sometimes months, because no hospital beds are available. But the Washington Supreme Court just made this practice illegal, according to the Seattle Times (State Supreme Court: Dumping mentally ill in emergency rooms illegal,” Aug. 7).

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 traumatizes thousands of mentally ill residents, wreaks havoc on hospitals, and wastes millions of taxpayer dollars,” the Seattle Times has said.

Aside from the suffering and deferred care, psychiatric boarding is expensive. One hospital lost $4 million in revenue because emergency room beds were occupied by people with mental illness who were waiting for a psych bed to open, according to a survey from the Department of Health and Human Services.

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.

Currently, the state only has 34 percent of the beds necessary to meet the needs of its population with severe mental illness. To ensure that patients in a psychiatric crisis receive proper treatment and hospitals don’t send patients back to the streets, or worse, the state must begin to restore inpatient facilities so that there are beds available for people when they need them.

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