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"For Those with Mental Illness, the Facts Matter" - guest blog

(Dec. 7, 2012) Selective quotes taken out of context do not benefit our understanding of serious and persistent mental illness.

So, imagine my surprise when I discover that the Mad in America people are using an academic paper by Dr. Robert Zipursky of McMaster University as proof of the evils of antipsychotic medication. Their website states "decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors. The authors conclude that the majority of people with schizophrenia diagnoses have the potential to achieve long-term recovery."

marvin-ross And, one of the comments on the site states "Thank you for finding these studies - for helping build a catalogue of research on MiA - one that helps dispel the 'myth' of biospsychiatry." MiA is Mad in America. I happen to know Zipursky and even quoted him in my own book on the need for medication in schizophrenia so I was intrigued.

I've now read his paper in its entirety and he is not advocating against medication use. In fact, the paper says "with appropriate care, including the skillful prescription of antipsychotic medication, the early years following a FEP (first episode psychotic break) are not typically periods of decline but rather of substantial ongoing improvement in symptom severity and functioning." About 70-74% of patients achieve remission in the first year....

In a phone interview with me, Zipursky reiterated the need for medication which he described as "critical" for anyone with schizophrenia. Medication is needed, he said, for life so that the person with schizophrenia can remain well. And, he was a bit surprised that his paper was being used to refute the need for medication. It is important for all (consumers, family and professionals) to have a shared understanding of all the facts.

Read Marvin Ross's blog in its entirety on Huffington Post.

MARVIN ROSS
Writer, publisher and producer of "The Brush, The Pen and Recovery," a documentary exploring "the very issue of schizophrenia, the lives of the people it affects and the role of artistic expression in their recovery."

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Mental Illness, Hollywood-Style

(Dec. 6, 2012) The new movie Silver Linings Playbook is about mental illness. The story begins in a psychiatric hospital where a young man (played by Bradley Cooper) is being discharged to his mother’s care following eight months of involuntary hospitalization. It then follows him through re-entry to home, community and, of course, romance.

silverliningsplaybook The movie is generally getting good critical and audience reviews. Here’s what some of us and our Facebook friends have to say about it:

Doris Fuller, executive director, says…

“I saw Silver Linings Playbook with another parent whose adult child has a severe mental illness. We both really enjoyed it and thought it ‘got’ a lot of what families like ours go through. When we went home, I Googled director David O. Russell and found out he has a son with bipolar and the movie is based on a novel by an author with severe depression. Explains a lot about why the movie seemed to ‘get’ it.”

Millie Quiroz, supporter, says…

“I loved it. It's a small start to bringing this illness to the world. It was like watching parts of my family on the big screen. But if it was closer to reality it wouldn't have been a romantic comedy, unfortunately.”

Melody Robidoux, supporter, says…

“We saw the film and enjoyed it. It was a bit difficult to watch some of the family interactions where everyone is yelling and screaming; that hit a bit close to home. I thought the support of the parents for their bipolar son as he transitioned out of institutional care was particularly moving. I know this wouldn't happen in a lot of homes.”

Jamie Mondics, communications director, says…

“Silver Linings Playbook does a good job of showing that with treatment, people do recover from psychiatric crisis. There is a very clear difference before and after Pat takes his medication.”

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Let's Improve Kendra's Law Now

(Dec. 5, 2012) When Kendra Webdale was pushed to her death on the subway tracks of New York City by a man with untreated schizophrenia 14 years ago, the tragedy galvanized the state to create the nation’s most widely used assisted outpatient treatment (AOT) law. It was named “Kendra’s Law” in her honor.

nycsubway Now another New Yorker, Ki-Suk Han, 58, has been pushed to his death in the path of an oncoming subway train. New York Mayor Michael Bloomberg told reporters last night that alleged perpetrator Naeem Davis, 30, “appeared to [have] a psychiatric problem.”

The mayor stressed that subway pushings are extraordinarily rare in New York. This is true. Yet even one death resulting from a treatable disease that wasn’t being treated should give us pause. And, in reality, one is not even the tip of the iceberg. At least 10% of the nation’s homicides are estimated to result from untreated mental illness annually – nearly 1,700 preventable deaths in 2011 alone.

Two years ago, the Treatment Advocacy Center proposed legislation in New York to make improvements to Kendra’s Law, which has provided more than 10,000 participants with the boost they needed to begin recovery and has been shown effective by multiple studies to reduce the consequences of untreated mental illness.

Among other things, the improvements would have increased the maximum length of an initial AOT order from six months to one year, required counties to establish procedures for review of the need for AOT renewals, allowed AOT orders to remain in place when patients relocate to other counties, ensured greater attention to AOT patients who go missing, and prevented AOT from expiring until a missing patient is located.

The bill died twice in committee.

New York Senator Catharine Young (R,C,I-Olean), one of the bills' sponsors, has now issued a call to reconsider it. “We cannot wait any longer,” she said in a Dec. 5 statement.

We agree. In the wake of this latest subway death, we propose that Gov. Andrew Cuomo and the New York legislature take action to strengthen Kendra's Law. Surely these reforms would increase the chances that others like Naeem Davis receive treatment before people like Ki-Suk Han and Kendra Webdale lose their lives.

Read the reaction of Kendra Webdale’s father, Ralph, to the latest subway tragedy in "Horrifying subway homicide causes parents to relive death of daughter hurled to her death in January 1999" (Daily News, Dec. 5).

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What happened to Jeffrey Hillman’s Boots?

(Dec. 4, 2012) In a random act of kindness, a police officer charitably bought boots for Jeffrey Hillman, a barefoot man living on the streets of New York City. The story of generosity went viral, and the random act of kindness has been celebrated in print and photos.

jeffreyhillman Yet last Sunday, Hillman, 54, was spotted wandering the streets with bare feet. Hillman said “he hid the boots” that were a gift from the police officer “so they wouldn’t be stolen” (“Barefoot homeless man immortalized in photo isn't actually homeless,” NY Daily News, Dec. 3).

What’s more, Hillman isn’t even homeless. He has an apartment in the Bronx paid for through a combination of federal and disability benefits.

Nonetheless, despite the housing services available to him and the police officer’s generosity, Hillman continues to walk barefoot and live on the streets of NYC.

“Outreach teams from the Department of Homeless Services continue to attempt to work with him but he has a history of turning down services,” said Barbara Brancaccio, a spokesperson for the agency.

Nobody has said outright that Hillman is mentally ill. But given that one-third of the estimated 744,000 homeless people nationwide suffer from untreated mental illness and that he is going barefoot in the cold when he has shoes and living on the streets when he has housing, he certainly fits the profile on someone with psychiatric disease that renders him unable to make self-interested choices.

If so, Hillman needs help beyond handouts and homeless services. If we really want to get serious about helping, we need to recognize that many of the homeless need psychiatric treatment to escape the consequences of untreated mental illness.

The Treatment Advocacy Center is dedicated to reducing the consequences by advocating for the reform and implementation of laws that make treatment possible for those too ill to seek it themselves. To support our efforts, please give today.

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Clozapine Works But Few Doctors Prescribe It. Why Not?

(Dec. 3, 2012) Clozapine is the “gold standard” for treatment of schizophrenia. “More than a decade of research suggests that clozapine is the most effective antipsychotic agent for people with schizophrenia who do not respond adequately to other medications” is how a recent Psychiatric Services report put it.

Yet “despite its benefits, use of clozapine has declined since the introduction of newer antipsychotic medications,” according to “Factors Associated with Initiation on Clozapine and on Other Antipsychotics Among Medicaid Enrollees” (Psychiatric Services, Nov. 2012). Among the New York study subjects, clozapine was initiated with only 2% of the patients with a schizophrenia spectrum disorder even though 30% of individuals with schizophrenia are estimated to be treatment-resistant. Nationwide in the US, clozaphine accounts for less than 5% of all antipsychotic prescriptions.

The authors say multiple factors deter clinicians from prescribing clozapine, including fear of adverse side effects (e.g., agranulocytosis); the perceived burden of monitoring and administering the medication, which requires regular blood testing; and perceptions that patients will not accept the required blood-drawing schedule.

“[F]ailure to offer clozapine as a treatment option is a major barrier to optimal care,” the authors concluded.

As an organization that strives to eliminate barriers to treatment, we agree that failure to prescribe the only drug approved by the FDA for its effectiveness as an antipsychotic for treatment-resistant schizophrenia is a major barrier. Since clinicians are the ones who must bring this one down, we hope they examine these findings closely. People suffering from symptoms of schizophrenia deserve treatment proven to work.

If you have a family member with treatment-resistant psychosis, consider printing this paper out and sharing it with medical providers and case workers in a position to see that your loved one gets gold standard if he or she has a qualifying disorder.