GET HELP: When Mental Illness Leads to Criminal Justice Involvement


(August 20, 2014) More than 40% of individuals with severe mental illness end up behind bars at some point in their lives.

gavelAs a resource to family members whose loved ones become involved in the criminal justice system, the Treatment Advocacy Center has created a web page of steps caregivers can take both before and after a family member or friend becomes involved with law enforcement, the criminal justice system or both.

For example, if a loved one is untreated and has a pattern of unpredictable behavior, visiting your local zone or police precinct station during business hours and explaining the circumstances with the community resource or other officer may help officers be better prepared to respond appropriately if a psychiatric crisis erupts.

If your family member is arrested and charged with a crime, determining whether his or her charges would merit consideration for mental health court will equip you to be more effective in advocating for jail diversion.

Links are provided to Treatment Advocacy Center reports that will help you determine what mental health diversion programs exist where you live.

For more resources for use in a mental health crisis, visit the Get Help section of our website.

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RESEARCH: Minorities Less Likely to Get Care After Hospitalization

(August 19, 2014) National Minority Mental Health Month is over, but the dual discrimination against minorities with severe mental illness goes on.
In the July issue of Psychiatric Services, a team of researchers looked at outpatient follow-up after hospitalization for mental health crisis and found that “blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge” (“Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups”).

“Hospitalization serves a crucial function in mental health systems by providing treatment for individuals with acute psychiatric needs,” the authors wrote. Timely follow-up after hospitalization can reduce the duration of disability and, for certain conditions, the likelihood of rehospitalization.”

Rates of follow-up (defined as being seen in a follow-up appointment within 30 days of hospital discharge) were abysmal for the whole population: Less than 26% of hospital dischargees – an extremely fragile population considering how difficult it is to get into a hospital in the first place – received follow-up treatment, the study found.

After adjustment for need and socioeconomic status, the analyses found that blacks were “significantly less likely than whites” to receive follow-up with 30 days and “also less likely to receive adequate care beginning within 30 days of discharge.”

Bias against minority patients by their providers was found to heighten barriers to recovery.

“When patients from racial-ethnic minority groups perceive provider discrimination or bias during inpatient treatment, the negative impacts on mental health and follow-up can be profound and potentially debilitating,” the researchers said.

Their results “reassert the need for interventions to improve continuity of care for all acuity levels of mental health services, especially for black patients,” they concluded.

Read an abstract of “Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups” here.

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The Brain on Antipsychotic Drugs: What Happens?

(August 18, 2014) Antipsychotics like clozapine and mood stabilizers like lithium are a part of recovery for people with severe mental illness, and they also cut violent crime, according to a study published in the Lancet (“Antipsychotics cut violent crime, study finds.” May 8).

antipsychoticsAntipsychotic drugs are an important part of the picture in most people’s journey to recovery from serious mental illness. They are also a complex piece of an approach to address the biology of these illnesses. The Treatment Advocacy Center’s backgrounder, "Do antipsychotic drugs change brain structure? ” updated in April 2014, demystifies the way these drugs act on the brain.

As the backgrounder explains, “changes in brain structure are caused both by the disease process of schizophrenia and bipolar disorder and by the antipsychotic drugs used to treat these diseases.”  Moreover, that these drugs produce changes to the structure of the brain should not surprise anyone. The backgrounder describes the following structural brain changes the drugs cause:
  • Decreased brain volume with associated increased volume of the ventricles;
  • Increase in size of the striatum; and
  • Increased density of glial cells in the prefrontal cortex.

It is important to apply an informed perspective to understanding treatment for serious mental illnesses like schizophrenia and bipolar disorder. One area of controversy remains the safety and impact of antipsychotic drugs – and with justification. However, not all criticisms are created equally, and as we know, antipsychotic drugs both require careful monitoring by physicians and have the potential to help change lives for the better for those experiencing psychosis.

The backgrounder can be an important tool towards informing community members, politicians, and media about antipsychotic medications, along with education about the many devastating consequences of non-treatment of serious mental illness.

For access to more of our backgrounders, which summarize information about severe mental illness, policies and programs related to its treatment, and the consequences of lack of treatment, visit the “Reports, Studies, Backgrounders” page on our website.


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If I Could Turn Back Time – personally speaking

(August 15, 2014) I am a member of our community who lives with anxiety, sadness, fear, exhaustion, frustration, grief and society blames me for not doing enough for my son. When I drive my son to the hospital there is no one there to answer my questions or offer emotional support and when I come home, there is no consoling or casseroles waiting from friends. There will be no fundraisers to help with hospital bills.

ninamcdanielpart1I grieve and reminisce for the son I once raised by love and support the new child before me now. If my son had a heart attack, cancer or was in a car accident, my life would be different. My name is Nina McDaniel and I am the proud mother and advocate to my 32-year-old son, Michael, who has schizoaffective disorder.

Michael was a hard worker from a young age. Even though Michael was awkward and enjoyed being alone, he always showed a huge heart and always helped others in need. His smile warms your heart and his affection is contagious.

His downward spiral began in July 2007. He began wearing sunglasses all the time, even to bed. He also became paranoid over secret messages on the radio, helicopters flying overhead and thought his sister and her husband were part of a conspiracy.

We filed our first petition for commitment also in July 2007. This commitment resulted in only three days in the psychiatric unit. We filed another petition for commitment in August that resulted in five days of treatment in a psychiatric unit. That time he was rapidly losing weight by starving himself. Even though we were trying to save Michael’s life, this began the endless cycling through the mental health system in order to attain help.

Things only got worse. In 2008, we rushed Michael to the emergency room after he tried to end his life by consuming a large amount of alcohol. The hospital just dismissed him as an alcoholic.

At one point we received a call from our daughter, who cried, “Michael swallowed a handful of my medicine, come quick!” We called the crisis unit, but nothing was done because Michael refused to voluntarily speak with them. Under the law, he still had the right to refuse treatment and remain psychotic.

After one terrifying episode that included verbal threats and a potential weapon, I was able to get Michael committed for 20 days. After the 20 days we decided as a family that we could not bring Michael home, he needed to remain in the mental health system. But that is not what happened. The hospital declined my request to have Michael placed in an intensive program. It ultimately became clear that if we did not take him home, the alternative would have been a homeless shelter and we were not going to leave him homeless.

My beautiful son deserves to receive help in his life and a chance for happiness. But instead, we feel like second class citizens, neglected by friends, neighbors and law makers who slash funding and block access to care.

Nina McDaniel
Mother of Michael
Part II of Nina and Michael’s story will run next week.


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How Suicide Risk Rises with Serious Mental Illness


(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 site.

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