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Victimization: A Tragic Consequence of Untreated Serious Mental Illness

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(June 20, 2014) Individuals with untreated serious mental illness, especially women, are extremely vulnerable to being victimized. A recently updated Treatment Advocacy Center backgrounder reviews existing studies on this association and offers summaries of them.

victimizationVictimization of persons with severe psychiatric disorders, the backgrounder says, “frequently involves acts such as theft of clothing or money but also includes assault, rape, or being killed.” These disturbing acts are unfortunately quite common, according to research on the subject. Some of the key research findings the background refers to are:

1. A 2014 analysis of five American studies of victimization among adults with mental illness that found that 31 percent of study participants had experienced at least one episode of physical violence;

 

2. A 2012 meta-analysis of victimization studies that found that 24 percent of mentally ill individuals had been victimized; and

 

3. A 2009 review of victimization studies that found victimization to occur more frequently among individuals who were also abusing drugs and/or alcohol and among those with the most severe symptoms.


Also of particular note is a 2002 North Carolina study that showed that individuals with severe psychiatric disorders were victimized only half as often when on outpatient commitment orders as compared to their peers who were not participating in outpatient commitment.

The victimization of individuals with serious mental illnesses is a disgraceful consequence of the failure to provide these individuals with timely treatment that could reduce their vulnerability. Our backgrounder, “How often are individuals with serious mental illness victimized?” can help advocates to educate stakeholders in their communities about one of the biggest reasons to support better treatment standards and assisted outpatient treatment laws.

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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California Reaches Tipping Point for Laura’s Law

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(June 18, 2014) San Francisco must move forward and adopt Laura’s Law to allow court-ordered outpatient treatment for people with serious mental illness, Fred Martin writes in the San Francisco Chronicle (“Mentally ill individuals need care and treatment not jail,” June 17).

mental illness jails“Adopting Laura's Law is about public safety. It is about whether we offer treatment for those with serious mental illness or abandon them to the streets or jail,” Martin says. “It is a means to help individuals avoid being forcibly hospitalized or jailed. It may help someone with severe psychosis avoid a violent confrontation."

As the chairman of the Committee on Mental Illness of the Episcopal Diocese of California, which works closely with homeless and incarcerated populations, Martin witnesses firsthand how America’s mental health system struggles to help the most severely ill among us.

With a shortage of public psychiatric beds and community-based treatment available only to those who seek it voluntarily, the consequences of untreated severe mental illness are apparent on the streets of San Francisco.

Bringing the law to the city will save taxpayers money. Laura’s Law can vastly reduce overall costs of tax-supported services associated with severe mental illness by reducing expensive hospitalizations, arrests and incarcerations. Nevada County, which implemented Laura’s Law in 2008, estimates it saves $1.81 for every $1 invested.

Last month, Orange County voted to bring this lifeline to treatment to its most vulnerable citizens and their families.

Next Monday morning, residents of San Francisco will have the opportunity to publicly voice their support for Laura’s Law to the Rules Committee in Room 263 at the San Francisco City Hall.

It’s time to bring Laura’s Law to San Francisco.

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When a Call for Help Turns Deadly

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(June 16, 2014) Responding to a mother’s 911 call for medical help for her son, the police instead shot and killed Jason Harrison, a 38-year old who suffered from severe mental illness. Harrison’s mother had asked law enforcement for help getting her son to a hospital for treatment (“2 Dallas police officers on leave after mentally ill man shot, killed,” June 15).

police carHarrison reportedly suffered from bipolar disorder, paranoia and schizophrenia. At the time of the shooting, he was carrying a screwdriver which he refused to drop. “In my eyes, it looked like the police overreacted,” said Harrison’s older brother, David.

Harrison’s family was unable to get him into treatment because he never appeared to be a danger to himself or anyone else, they said. “I just really wish that he could have got the help that we had really been trying to get for him so that maybe it could have had a different outcome,” Harrison’s brother said. “We'll never know.”

Deaths like these are unsurprising tragedies. Over the last half century, the responsibility of law enforcement officers for seriously mentally ill people has increased sharply. In fact, untreated severe mental illness is an increasing factor in officer-involved homicides, according to our study “Justifiable Homicides: What is the Role of Mental Illness?.”

Inevitably, the increasing number of confrontations between law enforcement officers and persons with serious mental illness leads to some unfortunate outcomes. Among the most tragic are officer-related shootings ofmentally ill individuals, many of which are fatal.

Until we return the responsibility for the care of people with mental illness back to mental health agencies, we will continue to see these types of preventable tragedies.

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Why I Support the Helping Families in Mental Health Crisis Act - personally speaking

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(June 10, 2014) In early April of 2012, my son announced he was crippled and went to bed in the middle of the day. His ankle was pulverized. He had a brain tumor.  His back was broken in three places. He promised to get up when he healed.  I asked him, When will that be? He said that he wasn’t sure, but probably not soon. I left his bedroom and closed his door.

laurapsonIn the next two weeks, he quit eating and drinking. He couldn’t trust anyone to bring him food. He saw poison being pumped into the water supply. He could only use the rest room with assistance. He smelled; his clothes were turning black. His lips were crusted and cracked, his hair matted.  I sat by his bed, putting ice chips in his mouth and wiping his face, begging him to make a good decision for himself and see a doctor.

Two weeks later, police crept up the stairs to his room and helped him, shaking, weak, and filthy, into a squad car to go to the hospital.

If you think that’s an odd series of events, it’s because I left something important out. My son is severely mentally ill. He has schizophrenia, a thought disorder that includes hallucinations, delusions, and paranoia.  Before the April events, he had quit taking a medicine called Clozapine, used for hard-to-treat cases.  Between February and March, he quit bathing and changing his clothes. He became disorganized and missed work, then got fired. He began sitting in the living room all day, not speaking, and staring at a television that wasn’t turned on.  He made no phone calls, saw no friends, made no attempts to engage in any activity. He couldn’t answer questions, even when they were direct.

As he degenerated, his doctor and I had many conversations—why was he deteriorating so dramatically? Was he under medicated, over medicated or wrongly medicated?  On the day my son went to bed, he announced there would be no more doctor visits and weekly labs—required by law to get meds dispensed—and no more pills. By the end of March, it was clear—whatever the reason, he was floridly psychotic. He was sicker than he’d ever been. He really, really needed to get to a hospital.

In early April, I phoned Crisis Intervention teams, both county and city, three times, but no one would come. Finally, I went to the local courthouse and begged a judge for an emergency petition. In Maryland, it’s a legal remedy to bring a person who is a danger to himself or others in for an evaluation. The police served it the next morning. His bed was waiting at Johns Hopkins, but the law requires transporting to the nearest hospital, one that has no psych unit.  He was transferred to Hopkins where he refused medication.

On April 16th, he lost a hearing on his competency. He was still in a wheelchair, still in his same clothes, and unmedicated. A week later, he lost a medical panel convened to decide if medication was warranted. He was still in a wheelchair, in the same filthy clothes, but was now mute and catatonic. After a 48-hour appeal process, he finally received an injection of an antipsychotic. This was his 9th hospitalization in four years. He was unmedicated overall approximately three months and lost forty pounds.

He was discharged from the hospital nearly two months after he was admitted. He walked his sister down the aisle at her wedding on July 28th.

I support the bipartisan mental health reforms in the Helping Families in Mental Health Crises Act (HR 3717), to help young men like my son have a chance to recover. There was a legal remedy in our case and we used it: my son’s refusal to eat while paranoid made him a danger to himself.

I support HR 3717 because it closes the legal gaps that prevent parents like me, a caretaker of a severely ill adult child, from getting our children to care. It provides real medical parity for our sick children. It ensures that federal funds awarded into the billions of dollars each year are truly earmarked, with proper oversight, toward care for those like my son, who is sometimes too sick to know he’s sick.

HR 3717 gives parents the rights as caregivers that are essential for assisting our children and ensuring their continued health. It marks funds for an assisted outpatient treatment (AOT) model that has proven results in reducing failures of the mentally ill to function in the community, and greatly reduces incidents of violence and incarceration among those most affected.

This legislation rectifies the many, many wrongs we’ve committed as a wealthy, compassionate country—that the mentally ill have been rotting in jail cells and under our cities’ bridges for almost forty years as a lifestyle choice.

If you oppose HR 3717, I want to ask you: What should I have done as a mother, when my son went to bed and tried to starve himself to death? One of the absurdities of our situation is that if my son had any other brain dysfunction, I would be legally negligent and abusive in not seeking medical help, but with the same injured brain, in a different disability, I am “supporting a choice” he makes to starve himself while delusional.  Today, he is living in an apartment with a friend, going to therapy daily, planning for work and school. I’m sure he is not sorry that I violated his rights, or fought to give him his life back.

Reread my story, and think about just the impact of that single absurdity on a family struggling to help stabilize a young adult with a severe mental illness. The promises of community health care are bereft of meaning—a clear 40% never receive any care in the community. Parents like me know that without real reform, our children will languish, suffer and too many times, die of illnesses that are treatable.

HR 3717 will ensure that children like my son can all have a better future because there will be remedies in place to get quality, continuous, appropriate medical care for our children.  If the reforms seem drastic, it’s because there is so very much to fix, so very much broken, in our mental health system.  

In the end, as a mother, I know that passing HR 3717 is the humane answer to helping us help our children.

Laura Pogliano
Maryland

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Alabama Prisons Indifferent to Inmates' Medical Needs

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(June 12, 2014) The Alabama Department of Corrections is indifferent to the serious medical needs of inmates and they're condemned to facilities where “systemic indifference, discrimination and dangerous…conditions are the norm,” according to “Cruel Confinement,” a new report from the Southern Poverty Law Center (SPLC).

prisonconditionsThe system fails to identify inmates with mental illnesses, provide adequate mental health care or equip the facilities for mentally ill inmates, the SPLC said. “Psychiatric medication is often stopped or changed without any discussion between the psychiatrist and the patient.”

One prisoner reported hearing voices and engaged in self-harming behavior for eight years before the prison staff identified him as in need of mental health care.

“The failure to identify prisoners in need of mental health care or to provide them with the level of care needed is a violation of the Eighth Amendment,” the report says.

Of the 60 patients who did actually receive medication for a mental illness in April 2014, none had any further contact with a mental health professional, according to the report. There are 4 full-time psychiatrists and 5.6 psychologists for all the inmates in the Alabama corrections system.

“This disregard for adequate health care and the law endangers the health and the lives of prisoners,” the report notes.

The report was based on inspections of Alabama’s 15 prisons, interviews with more than 100 prisoners, a review of thousands of pages of medical records as well as depositions and media accounts and the policies, contracts and reports of the Alabama Department of Corrections (ADOC) and two of its major contractors.

Read the entire report here.

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