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'Behind the Yellow Door’ - the Ex-Wife’s View

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(July 7, 2014) The torment of a family unable to get help for a loved one with untreated severe mental illness is the subject of Stephanie McCrummen’s devastating piece in the Washington Post (“Behind the yellow door, a man’s mental illness worsens,” the Washington Post, June 28).

behindtheyellowdoorFor the next four days, the Treatment Advocacy Center will share brief excerpts from the tale.

One point of view in McCrummen’s narrative is that of the ex-wife, Jennifer, as she watches helplessly while her ex-husband deteriorates.

Jennifer’s perspective:

“She has been watching him deteriorate for three years now.... He began reading conspiracy theory Web sites. He started saying he was going to jail and taking batteries out of cellphones. Jennifer told herself it was stress and tried to get him to see a counselor, but he wouldn’t.

“Then one day a package arrived, and he told her to take the kids outside, and she watched as he put on a biohazard mask and used long-armed tools to open the box, which contained a crank radio he ordered.

“He started wearing all yellow or all white. When they visited a relative who had a gun with five bullets mounted on a wall, he said the bullets were a sign that their family of five was going to be killed. Jennifer kept trying to persuade him to see a counselor, but there was nothing else she could do to get him treatment until the day he disappeared with the boys.

“What she wishes is that her ex-husband, whom she still loves, could be involuntarily committed to a psychiatric hospital for however long it takes doctors to figure out what’s wrong, for medications to work, and for him to once again be the person she married.

“But because she can’t have him committed, she is doing the only thing she can think of to do. In accordance with the divorce decree, she is selling the house, which she is hoping will force her ex-husband into a situation desperate enough that he might meet the standard for involuntary commitment. For him to get better, she realizes, she and his family have to let him get worse.

“’He’ll be homeless. . . . And we just have to let it happen.’”

Read the entire story by Stephanie McCrummen.

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Discrimination Rampant in Mental Health System

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(June 27, 2014) In less than three years, Laura Pogliano spent $250,000 on psychiatric care for her 22-year-old son who has schizophrenia, a number that reflects both state and federal discrimination in laws that allow access to treatment for mental illness (“Mentally ill suffer in sick health system,” USA Today, June 26).

jessedawson“Every parent I know has to fight for treatment for their child,” Pogliano told reporter Liz Szabo about how state laws prevent people with severe mental illness from accessing treatment. In Pogliano’s case, civil commitment laws kept her from getting her son into treatment when he started deteriorating psychiatrically. In Maryland, where she lives, mandatory inpatient treatment is only available to people who are deemed dangerous to themselves or others – leaving families like hers out in the cold.

“Many patients can only get help after they’ve become psychotic,” said Ron Manderscheid, executive director of the National Association of County Behavioral Health & Disability Development Directors.

When Pogliano's son did manage to meet the standard for treatment, doctors were sometimes unable to locate available psychiatric beds - forcing her into the more expensive private system.

Szabo attributes lack of psychiatric bed availability to discrimination at the federal level in the way that Medicaid and Medicare reimburse treatment of mental illness.

Medicaid funds may be used to treat physical health conditions, but they are more difficult to use for mental health treatment and Medicare limits the number of days people can get treatment for a mental illness in hospitals. “Without federal support, states haven’t been able to afford to keep their psychiatric hospitals open,” Szabo writes.

“By denying hospital care to the mentally ill, Congress has set two standards for health, effectively telling the country that the mentally ill are less deserving of a decent life than others,” Representative Tim Murphy told Szabo. Murphy has a bill that currently aims to help more people get access to inpatient care.

All of this means that people with mental illness wait nearly a decade after their symptoms first appear to get treatment, or like Pogliano, pay exorbitant amounts to get loved ones into care, according to Szabo. Ultimately, this denial of coverage results in many under-treated people who become so ill they often wind up homeless, in jail, or a risk to themselves or others.

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After Parity, No Upswing in Use of Mental Health Services

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(June 26, 2014) Six months after implementing the Affordable Care Act in Pennsylvania, mental health professionals say they have not seen greater use of mental health care in their region (“ACA hasn’t boosted use of mental-health care services in Philly region,” Kaiser Health News, June 24).

doctor patientPeople aren’t accessing treatment because “there is still a lot of stigma [attached to mental illness],” says Patricia Kleven, director of outpatient mental health services at the Belmont Center for Comprehensive Treatment.

Actually, “the main issue is the Medicaid gap,” said Joseph Rogers, chief advocacy officer for the Mental Health Association of Southeastern Pennsylvania. "If you don't have private insurance and you are not poor enough to be on Medicaid, it is very difficult to get behavioral-health services."

But perhaps it isn’t just stigma or the Medicaid gap that are preventing people from using services. Even though the Affordable Care Act has significantly increased insurance coverage for mental health care, it won’t help the people who need treatment the most.

These are the people who suffer from a condition called anosognosia, an anatomical brain condition that affects approximately 50% of individuals with schizophrenia and 40% of individuals with bipolar disorder. People with anosognosia are simply unable to recognize their own illness – no matter how painfully obvious it may be to everyone around them. They are the people sleeping on the front steps of a community clinic, but who will not walk inside to seek treatment.

If we really want to address the most vulnerable people we need to foster universal adoption of mental illness treatment laws based on a person’s need for treatment and provide sufficient public psychiatric beds to treat individuals in psychiatric crisis.

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Prevalence of Untreated Severe Mental Illness by State

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(June 25, 2014) To continue raising public awareness of mental illness treatment issues, the Treatment Advocacy Center has published a fact sheet providing state-by-state population numbers on the prevalence of schizophrenia and severe bipolar disorder, including the number of those people who are untreated during a 12-month period.

mental illness genericPrevalence of Untreated Serious Mental Illness by State” provides the public with a central source of state-by-state information about the following:

  1. Number of adults diagnosed with schizophrenia and severe bipolar disorder

  2. Total number of those diagnosed with untreated schizophrenia

  3. Total number of those diagnosed with untreated severe bipolar disorder


The numbers were calculated using 2014 U.S. Census Bureau population data and National Institute of Mental Health (NIMH) estimates of prevalence and treatment by diagnosis.

Individuals with untreated schizophrenia or severe bipolar disorder are the most at-risk populations for a host of poor outcomes that affect them and their communities. These consequences of non-treatment include arrest, incarceration, hospitalization, homelessness, victimization and violence, including suicide, homicide and other violent acts.  

“Prevalence of Untreated Serious Mental Illness by State” is published as a public service of the Treatment Advocacy Center to further evidence-based knowledge and understanding of mental illness treatment issues in America.

All of the Treatment Advocacy Center’s resources can be found at TACReports.org, including our studies on mental illness in jails and prisons, state civil commitment laws and law enforcement shootings involving people with untreated severe mental illness.

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We are Making a Mockery of Civil Rights – personally speaking

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(June 23, 2014) I was the probate judge in Contra Costa County for 11 years. I am here to support the implementation of Laura’s Law in our county.

gavelLaura's Law provides a very thorough protection of the civil rights of the persons with severe mental illness. But, you will hear claims that Laura's Law is an infringement of civil rights.

At the core of our civil rights is our ability to choose to do what we want. When a person is unable to understand the nature and consequences of their decisions because of their illness, that person is fundamentally deprived of the ability to exercise any civil rights.

When we consider civil rights in this context, we should consider the annihilation of the civil rights of victims of homicide by persons with untreated severe mental illness.

We should consider the civil rights of people who are severely injured, whose lives are changed forever.
We should consider the civil rights of the families of the victims of the violence by persons with mental illness.

We should consider the horror for someone who is treated successfully, then learns they have done terrible things while untreated. They will find no comfort in being told we only cared about their civil rights and not at all about giving them the treatment they needed.

We should consider the civil rights of the vast majority of persons with mental illness who are shunned because of the public’s fear that all mentally ill people are violent, making it harder for consumers to find places to live and to get jobs.

We make a mockery of civil rights when we ignore people with severe mental illness, leaving them on the streets until they do something we characterize as a crime, then we lock them in our overcrowded jails and prisons.

Laura’s Law will fill a gap in our mental health system. We currently have no option treating people with severe and persistent mental illness who have demonstrated violent tendencies and do not accept treatment voluntarily.

Don Edward Green
Testimony from Contra Costa County, California

 
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