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When Police Are Mental Health Providers

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(April 24, 2014) My son ended up dead because a police officer wasn’t trained to handle a person with mental illness, Mary Wilsey told Al Jazeera America about the death of her son last January (“How lack of police training can be deadly for the  mentally ill,” April 23).

cit_trainingWilsey’s son, Keith, was 18-years old and diagnosed with schizophrenia. He had a long history of trying to hurt himself, but Wilsey says every morning he would ask her if she wanted a cup of hot chocolate and at night he would tell her he loved her.

Sometimes, with the help of local police, Wilsey was able to have him involuntarily committed for treatment at a psychiatric hospital. That was why she called the police on the night of her son’s death, she said.

The first two police responders were able to speak calmly to Keith, despite his psychotic state, Wilsey told Al Jazeera.  “Then a third officer showed up and escalated the situation . . . Then I heard the gun go off and saw my son start bleeding.”

Keith died in the ambulance on the way to the hospital.

Stories with similarly tragic endings were the subject of our recent report, “Justifiable Homicides by Law Enforcement Officers: What is the Role of Mental Illness?,” in which the authors found that the responsibility of law enforcement officers for seriously mentally ill persons has increased sharply in recent years and is continuing to increase.

Many of these officers are ill equipped to handle such confrontations, and as a result, untreated mental illness is an increasing factor in officer-involved homicides.

Wilsey is now an advocate of crisis intervention team (CIT) policing, which consists of specially training officers who respond to calls involving mental illness.  

“Train them so they can handle the population that they deal with every day,” Wilsey said. “My goal is to prevent another family from going through a terrible tragedy that has ruined our lives.”

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“Why Must the Sufferer be Compelled to Suffer On?”

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(April 22, 2014) Our recent report on the treatment of inmates with serious mental illness shows that 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 and are not trained to do it; and yet are held responsible when things go wrong, as they inevitably do under such circumstances.

jail studyDr. Walter Kempster, a psychiatrist and former superintendent of the Winnebago Mental Health Institute in Wisconsin, decried the placement of people with serious mental illness in jails and prisons in the Marquette Law Review over a decade ago.

"Who can think of the number of unfortunate beings now confined in the receptacles of the different counties of the state, and realize in the most remote degree, the sorrowing hearts their misfortunes have created; of hopes once bright now dashed; of the ambitions that lured beyond strength; of life's work begun but left unfinished; of affections ripened only to be blasted--who can consider these calamities of our fellow mortals, rendered insane by perhaps no act of their own, unwittingly thrown upon the charity of the state, bound by the unyielding fetters of a terrible disease......who can think of these things, of the measureless calamity of insanity, and turn idly away, closing eye and hand, withholding that which is known to be required to make life comfortable?

“We can conceive of no argument, economical or humanitarian, that can be adduced to show why aid should be postponed; why the sufferer must be compelled to suffer on (The Marquette Law Review, 1999).”

We agree. There are now 10 times more mentally ill in jails and prisons than mental hospitals. We also want to know why "the sufferer must be compelled to suffer on."

Read or download “The Treatment of Persons with Mental Illness in Prison and Jails: A State Survey.”

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Kendra’s Law a Lifeline for Patients, Families

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(April 21, 2014) Amid the complex and polarizing questions raised by the recent shooting of James Boyd by Albuquerque police, at least one thing should be clear to all observers: The deadly confrontation in the Sandia foothills would almost certainly have been avoided if Boyd had been receiving the treatment for severe mental illness he desperately needed.

albuquerqueTragedies of this nature are on the rise nationally. At least in part, they are a predictable consequence of our abandonment of those whose inability to recognize their own mental illness and need for treatment – a condition known to clinicians as “anosognosia” – prevents them from taking control of their spiraling lives.

With timely and adequate treatment, people with severe mental illness are no more likely to be violent than the general public. But for those whose illness is complicated by anosognosia, the challenge of securing that treatment is magnified.

Because they don’t believe they are ill, they often reject treatment, deteriorate psychiatrically and get trapped in the revolving doors of the mental health and criminal justice systems. Their risk of committing a violent act triples; their risk of being victimized increases eleven fold.

There are several things New Mexico can and must do help these individuals maintain safety and sanity.

An obvious place to start is to pass a law allowing “assisted outpatient treatment” (AOT) in the state.

Sometimes referred to as “Kendra’s Law,” this measure would authorize a civil court judge to order a person with severe mental illness and a history of bad outcomes caused by treatment non-adherence to comply with an approved treatment plan as a condition of remaining in the community.

Just as importantly, it would hold the treatment system responsible for careful monitoring of the person and for delivering the services outlined in the court-approved plan.

The idea is to keep people like James Boyd from falling through the cracks.

In states that have such laws and use them, results have been impressive.

Studies in New York show AOT has led to sharp declines in rates of hospitalization, arrest, incarceration and treatment disengagement. The law has also been found to be a boon for New York taxpayers, with reductions in spending on jail and hospital days far exceeding the up-front costs of providing AOT.

New Mexico is currently one of only five states without an AOT law on the books, but not for lack of trying.

Read the entire op-ed by Brian Stettin, policy director for the Treatment Advocacy Center in the Albuquerque Journal. The piece originally appeared on April 20, 2014.

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Onlookers Guess About Amanda Bynes' Diagnosis

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(April 18, 2014) Amanda Bynes is back in the headlines, or more specifically, statements by Amanda Bynes’ mother and her attorney are in the news. 

amanda_bynes"Amanda currently is on zero medication . . . . She's devoted to living her life as healthy as possible . . . . She's never had a history of abusing alcohol or hard drugs, and she's proud to say she's been marijuana-free for the past nine months . . . . Amanda does not have schizophrenia, nor has she ever been diagnosed with it,” said her attorney Tamar Arminak (“Amanda Bynes doesn’t have schizophrenia, lawyer reveals,” April 9).

 “Amanda has no mental illness whatsoever.  She has never been diagnosed as schizophrenic or bipolar,” Bynes’ mother, Lynn, has also said.  Instead, her mother attributes the unusual behavior that resulted in Bynes’ hospitalization to her daughter’s use of marijuana.

While mental health groups are all taking turns diagnosing Bynes or questioning whether the young star does in fact have a mental health diagnosis, we do know that Bynes has had several very public incidents involving unusual and sometimes dangerous behavior.  

We know that Bynes has spent some time involuntarily committed to a psychiatric hospital. We know that Lynn Bynes petitioned for and was appointed as her daughter’s LPS Conservator, a mental health conservatorship.

We also know that the civil commitment laws in California allowed the Bynes family to help their daughter get the treatment that she needed, even if Amanda didn’t believe that she needed the help.

Even though we don’t know Amanda’s psychiatric diagnosis or her medication regime or lack thereof, we don’t need to know.

We respect Amanda Bynes’ privacy, and we support her and the Bynes’ family in her recovery. 

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“Mental Health Care in the U.S. Needs a Check-Up”

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(April 17, 2014) The Washington Post became the second national newspaper to come out in support of the “Helping Families in Mental Health Crisis Act” in an April 17 editorial that says the changes in Rep. Tim Murphy’s bill “would help relieve a lot of suffering that does not make the front page.”

tim_murphy“Mental illness usually is not as dangerous or dramatic. Nearly 23 million Americans live with schizophrenia, bipolar disorder or major depressive disorder, according to the National Institute of Mental Health. Very few of these men and women are potential mass-murderers; they need help for their own well-being and for that of their families. A few, though, need services that will keep them from harming themselves or others. The nation’s health system needs to do better at treating all types.

“The Affordable Care Act has significantly increased insurance coverage for mental health care. But that may not be enough to expand access to sparse mental-health-care resources. Besides, the government is already spending billions on mental illness treatment; it has an interest in making sure taxpayers get results.

“Rep. Tim Murphy (R-Pa.) has a bill that would do so. The Helping Families in Mental Health Crisis Act is more comprehensive than other recent efforts to reform the system and perhaps has the brightest prospects in a divided Congress. The bill would reorganize the billions the federal government pours into mental health services, prioritizing initiatives backed by solid evidence and tracking their success. It would change the way Medicaid pays — or, in this case, underpays — for certain mental health treatments. It would fund mental health clinics that meet certain medical standards. And it would push states to adopt policies that allow judges to order some severely mentally ill people to undergo treatment.”

Read the entire editorial about Rep. Murphy’s landmark federal legislation.

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