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Congress Authorizes National AOT Demonstration Project

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(April 1, 2014) A national assisted oupatient treatment (AOT) demonstration project is a step closer to reality today, thanks to Rep. Tim Murphy (R-Pennsylvania) and Senator Debbie Stabenow (D-Michigan).

murphy3Last December, Murphy introduced the Helping Families in Mental Health Crisis Act (HR 3717), the most significant federal attempt to reform mental health care in the US since the Kennedy era.

Among the bill’s many groundbreaking provisions is a federal assisted outpatient treatment grant program to help local mental health systems launch their own AOT programs. First proposed by the Treatment Advocacy Center in January 2013 as a recommendation to Vice President Biden’s task force on gun violence, the federal grant program would be a godsend to the many local officials who tell us they believe in AOT but are challenged to raise the start-up costs, however modest, in a time of slashed public mental health budgets.

While work goes on to build support for HR 3717 itself – including a hearing this Thursday in the House Subcommittee on Health – Murphy and Stabenow last week added the AOT demonstration project to an unrelated bill to delay a scheduled cut in doctor reimbursements under Medicare (the “Doc Fix”). When President Obama signs the legislation, as expected, the Department of Health and Human Services will have authority to award $60 million for up to 200 AOT start-up grants over the next four years. (Individual grants could award up to $1 million.)

“Authority” represents only half the battle here. For the program to take shape, Congress must next appropriate the necessary funds. To keep up to date on this potentially enormous breakthrough (and help us support the programmatic request at the appropriate time), please make sure you are signed up for our email updates.

In the meantime, we commend and congratulate Rep. Murphy and Senator Stabenow for their great work in bringing the dream of an AOT grant program to life.

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Sen. Deeds to Give Major Speech on Mental Health

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(March 27, 2014) Sen. Creigh Deeds, a Virginia Democrat advocating for better access to mental health care, will speak at the National Press Club Monday March 31. Deeds became an advocate after his son was denied a bed when in a psychiatric crisis and subsequently wounded his father before committing suicide.

deeds2“The system failed my son,” Deeds has said. “For too long we've been shoving ... problems with respect to the mentally ill under the table . . . We need to take a good long look at fundamental changes in our system of care."

Following the tragedy, Deeds introduced several bills that might have helped his son, including one that would create a real-time psych bed registry and another that would increase the duration of emergency psychiatric holds from four hours – currently the shortest in the nation – to 24.  

The speech on March 31 will be the first time Deeds addresses the topic in Washington.

Sen. Deeds is a former county prosecutor who authored a law allowing public access to the Virginia sex offender registry. He was elected to the Virginia House of Delegates in 1991 and left the House in 2001 to join the state Senate. He was the Democratic nominee for governor in 2009.

Lunch will be served at 12:30 p.m., with remarks beginning at 1 p.m., followed by a question-and-answer session ending at 2 p.m. Tickets cost $36 for non-Press Club members (click here to purchase tickets). For questions about the event, please email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call (202) 662 – 7501.

To submit a question for the speaker in advance, put DEEDS the subject line and email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it before 10 a.m. on the day of the luncheon.

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Answers to “Where Have All the Patients Gone?”

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(March 26, 2014) “What would have happened if Aaron Alexis was not just given sleeping pills at the VA? Or if there was an available hospital bed or outpatient treatment available for others who later became violent, involved in a crime, unable to pay bills, or tossed out on the street?”

murphyThese were the questions posed by Rep. Tim Murphy  as he opened at this morning’s House subcommittee hearing on the shortage of psychiatric beds, the latest in a  series of hearings he has chaired on the nation’s broken mental health system.

For more than three hours, a panel of experts and family members described the devastating impact the psychiatric bed shortage has on patients and communities.

“Community programs serve those who seek and accept treatment. Those who refuse or are too sick to seek treatment voluntarily become a law enforcement responsibility,” said Chief of Police Michael Biasotti, Treatment Advocacy Center board member and immediate past president of the New York State Association of Chiefs of Police. “Hospitals are so overcrowded they often can’t admit new patients and discharge many before they are stable. They become what we call ‘frequent flyers.’” Read Biasotti’s testimony.

“My son was admitted on Friday morning and was in the ED that whole day, all day Saturday, all day Sunday and until late Monday afternoon because they could not find an open psych bed anywhere,” Lisa Ashley, the mother of a man with paranoid schizophrenia, told the committee. “He stayed in a room, tied to his bed for those four days and was heavily medicated. . . . I wondered ‘does it take that long to find a psych bed?’” Read Ashley’s testimony.

 “This is a crisis we must all care about – regardless of political affiliation – because it affects us all,” testified Sheriff Dart, who oversees Cook County Jail in Illinois, the largest jail in the country. “While some mentally ill individuals are charged with violent offenses, the majority are charged with crimes seemingly committed to survive, including retail theft, trespassing, prostitution and drug possession. . . . We have criminalized mental illness in this country and prisons and jails are where the majority of mental health care is administered.” Read Sheriff Dart’s testimony.

“Homelessness and mental illness are inextricably intertwined,” said Gunther Stern, executive director of Georgetown Ministry Center, which provides support to chronically homeless men and women in Washington DC. “Greg is someone I first met sitting on a bench in a nearby park. He was shabbily dressed and smelled bad. He would drink, I assume to tame the voices in his head. All of this belied the fact that Greg was once a gifted constitutional lawyer who delighted his children with his dry wit.” Read Stern’s testimony.

“It is an unplanned, albeit entirely unacceptable consequence of deinstitutionalization that the state psychiatric asylums, dismantled out of concern for the humane treatment and care of individuals with serious mental illness, have now effectively been replaced by confinement in prisons and homeless shelters,” Murphy said.

Read about Murphy’s plan to fix the nation’s broken mental illness treatment system.

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Farewell Thoughts from an Advocate – personally speaking

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(March 25, 2014) This is advocate Kristina Ragosta’s final week with the Treatment Advocacy Center after six years during which she led the effort to bring assisted outpatient treatment (AOT) to three new states (Maine, New Jersey and Nevada), directly influenced treatment law reforms in numerous other states and expertly managed numerous special projects.

Here are Kristina’s farewell thoughts:

After six exciting, challenging, frustrating and rewarding years as an advocate with the Treatment Advocacy Center, it is with mixed emotions that I am leaving the organization as an employee.

I have had the honor of meeting and working with countless families and individuals whose courage and passion to improve our mental illness treatment laws and to spare others the heartache they have endured is awe inspiring.

I leave, knowing that there is much more work to be done to improve things for people with serious mental illness, and hoping that support for the Treatment Advocacy Center’s work continues to grow while tragedies due to untreated mental illness decline.

While I am sad to be leaving, I am proud to have played a small role in improving treatment for those most in need.

The Treatment Advocacy Center is proud to have been Kristina’s professional home and cherishes her legacy of reform and resources. We say goodbye with the deepest admiration, fondness and best wishes.


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Tragedies in New York Highlight Need for Police Training on Mental Illness

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(March 24, 2014) Jerome Murdough, a 56-year-old homeless man with mental illness, reportedly “baked to death” in a jail cell at Rikers Island that was at least 100 degrees last month.

police_carWhat was Murdough’s offense? He was arrested for trespassing after he was discovered sleeping in the stairwell of a city housing project to escape the cold. Eight days after his arrest he was found dead in his jail cell. According to the autopsy, initial indications suggest extreme dehydration or heat stroke (“Mentally ill inmate 'basically baked to death' in Rikers cell,” Slate, March 19). 

New York has a well-documented history of poor outcomes when people with mental illness encounter the police. Last year a police officer shot and killed 22-year-old Rexford Dasrath after he threatened law enforcement with a steak knife. The police said they repeatedly ordered Dasrath to drop the knife, at which point he lunged at one of the officers. It was later confirmed that Dasrath had a long history of mental health issues (“NY bill seeks police training on mentally ill,” Democrat & Chronicle, March 22).

Tragedies like these are not surprising. Only 5% of New York’s population is served by crisis intervention teams, which consist of police officers who respond to service calls involving mental illness.

But there is some good news from New York.

Last week the state proposed $2 million so that it can establish crisis intervention team training programs to help police officers assess mental illness and de-escalate confrontations with people who appear to be in a psychiatric crisis. The hope is that this training will result in using force less frequently and a better ability to link individuals in crisis with services rather than unnecessarily arresting them.

In a better world, people with untreated severe mental illness would get help before their symptoms resulted in law enforcement involvement. But until then, states that fail to use such uncontroversial tactics as law enforcement crisis intervention teams are failing people like Murdough and Dasrath and their communities.

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