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Maryland Needs to Modernize Its Mental Health Laws

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(Oct. 31, 2013) Two letters in this week’s Baltimore Sun are calling for better treatment options for people who don’t recognize they are sick – a category that includes about half of those suffering with the most severe mental illnesses.

saint-elizabeths“Imagine you have a 24-year-old daughter with schizophrenia, delusional, living on the street, eating out of garbage cans and hearing voices telling her not to trust you or anyone else,” writes Arlene Saks-Martin in a call for assisted outpatient treatment (AOT) in Maryland (“Helping Maryland's mentally ill,” Oct. 30).

“She denies wanting to hurt anyone or herself so for years you cannot get treatment for her. Although she is gravely disabled, police and doctors have told you she does not meet the ‘dangerousness’ standard for involuntary hospitalization. Her teeth are falling out, her body has sores and she is a victim of crime, even rape. Can you honestly tell me she knows or cares or can exercise her civil rights?”

Kathleen Branch, the mother of an adult child with mental illness who is all too familiar with the shortfalls in the Maryland treatment laws, also weighs in. “It is critical for lawmakers to know that many of us desperately want to get a loved one evaluated and potentially hospitalized before something worse happens, but the laws stand in our way,” she writes  (“Laws surrounding mental illness make it harder for victims to get treatment,” Oct. 30).

Even though Maryland is one of the more well-resourced mental health systems in the country, the system exists largely for those who recognize they are ill and can voluntarily seek services.

The state is one of only five that remain without a law providing for mandatory outpatient treatment, and it has a high threshold for providing mandatory treatment in a hospital. If the state were to modernize its civil commitment laws to provide for court-ordered outpatient treatment and lower its threshold for involuntary hospitalization, those who are too ill to recognize it would be more likely to receive services.

“It is up to society — you and me — to rescue those with anosognosia by assuring they get timely, extended treatment to enable recovery,” urges Saks.

We agree.

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Schizophrenia Robbed My Son of His Dignity - personally speaking

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(Oct. 30, 2013) I have a 33-year-old son suffering from schizophrenia who is currently homeless. He is too paranoid to stay in a rented room and too delusional regarding our intentions as his parents to remain at home. And despite his multiple hospitalizations there have never been any positive outcomes upon his discharge. Despite all our efforts with him (since he was 20) in multiple counties with different doctors, he has been unable to avail himself of current treatment resources. Like many, he suffers from anosognosia, rendering him incapable of knowing that he is ill. This devastating form of denial is the impact of the disease of schizophrenia on the brain.

homelessness-feetThe other day he called and asked if I would bring him his books. I did and brought him home with me. When we got home I discovered what I have heartbreakingly discovered many times before: his legs were full of sores from bug bites caused by sleeping in the grass; his face was seriously sunburned, having no protection from the elements; the bag he was carrying smelled of urine; and his clothes did not come clean even after two washings. I let him shower, fed him, and let him sleep—hoping he would be free of the terror of being accosted while he slept.

And then I sat down and cried. I’m still crying as I write this, for I know the outcome already. He will stay here a few days but no longer. I can say this with certainty because the pattern is a very old one. After just a few days of rest he will begin to pace and then he will begin to accuse us of things that make no sense to the actual behaviors we exhibit. Then he will start to yell frightening comments and he will leave, sometimes voluntarily, but sometimes only with a call to 911.

With over fifteen years of hospitalizations and outcomes leading to homelessness each time, I have learned the horrifying reality that the only role I seem able to play in his life is to give him some respite now and then.

The good news is that my son has a group of supporters that we have never met: men and women who have struggled with their own severe mental illness. They are the heroes I watch with hope in my heart for my son. They are the men and women fighting for those who cannot fight for themselves. These men and women have found recovery, restoring the best of themselves with the help of medications, group and community support, county resources, and the ability to choose their own best approach. Sometimes they fight “for” and sometimes they fight “against” mental health recovery changes, like certain laws or regulations they feel steal a person’s dignity or human rights. Their motto is “nothing about us without us.” I like it.

They are saying to those who change the laws “please consider the human rights of each individual before you finish printing that law, or protocol, or program.” We need their voice! Grounded in their own experience and strengths, they have insights I may not have.

But as a parent of man who has been homeless and suffering for 16 years, I too, like many other parents with similar stories, have insights and experiences that others simply may not have. I have watched this illness rob my son of all personal dignity, of all ability to gauge what is real.  On the continuum of illness, he has been robbed of his ability to choose a path that creates the life his supporters now have.

And so I remind each of us: we are all on the same team. Our stories, however different, have informed our advocacy. We are fighting for people like my son—not against his ability to choose, but for the platform created by interventions that will get him to the same playing level that you, his supporters, now stand on. It is our job as fellow human beings to fight for the right to have the right to choose recovery.

Sometimes mandatory compliance and intervention are the only things that will restore a person to sanity so that he or she is no longer wandering city streets with a sleeping bag and “dying with [his] rights on.” (E. Fuller Torrey).

Gloria Davidson, MS, LMFT
California

Davidson hopes that sharing her story might reinforce the desperate need for Laura’s Law, California’s assisted outpatient treatment program, in Alameda County

 

Everyone Suffers In Fatal Encounters

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(Oct. 28, 2013) “A police dispatcher had sent Officer LaRosa to what seemed like a routine accident call. When he arrived, [Billy] Lane, 25 years old, was outside his wrecked SUV, bloodied, holding a butcher's knife and threatening passersby. Mr. Lane advanced relentlessly on the police officer, who shot him four times. Mr. Lane died on the spot (“Lives of Mentally Ill, Police Collide,” the Wall Street Journal, Oct. 22).”

lane_larosa“You go through the academy expecting Joe Bad Guy to bail out of a car and start shooting at us," Officer LaRosa told Wall Street Journal reporter Gary Fields. "They don't train us for Billy."

Encountering “Billy” and other people in the throes of psychosis is often what leads to deadly encounters between law enforcement and people with severe mental illness. Our report “Justifiable Homicides: What is the Role of Mental Illness?” found that untreated severe mental illness is an increasing factor in officer-involved homicides.

When the responsibility for seriously mentally ill persons is shifted away from the mental health system to law enforcement, many people get hurt. "No police officer does well with shooting someone, let alone someone with mental illness," Michael Biasotti, Treatment Advocacy Center board member, told the Journal. “That destroys a bunch of people at once.”

We couldn’t agree more. Until states improve and use their assisted outpatient treatment (AOT) laws to support at-risk individuals and communities use crisis intervention team (CIT) policing to train law enforcement to handle encounters with people in psychiatric crisis, officer-involved shootings will continue to increase.

Read this powerful piece in the Wall Street Journal about collisions between people with severe mental illness and law enforcement.

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Mental Health As a Health Issue, Not a Safety Issue

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(Oct. 25, 2013) In the wrap-up panel at this week’s inaugural Kennedy Forum in Boston, SAMSHA  Administrator Pam Hyde brought up a topic increasingly in the news: mental illness and violence.

james-holmes“We are increasingly talking about mental health as a safety issue, not a health issue,” Hyde told the audience of mental health professionals, leaders and advocates. “When we talk about mass killings, we are talking about mental illness not being treated.”

Hyde said she found it concerning to see mental health framed primarily as a matter of safety rather than health.

There’s good reason for such concern.

An estimated 3.3 million people in the U.S. are estimated to have schizophrenia or severe bipolar disorder, and about half of them receive no treatment for these treatable diseases in any given year. Headline violence involving mental illness typically comes from a very small subset of this untreated population. Typically, these are at-risk individuals who were running red flags for violent action up the flagpoles of their lives long before they acted.

Rare though they are, mass killings and other public violence play an outsized role in how the public views mental illness. A 1999 study found that 61% of American adults believe an individual with schizophrenia is “very likely” or “somewhat likely” to do “something violent to others.”* And that was before the headlines from Virginia Tech, Tucson, Aurora, Navy Yard and so many more locations now linked to violence and mental illness.

There is a school of thought that the stigma that results from such events will go away if we just don’t talk about it. It won’t. No matter how small their numbers, at-risk individuals who are left to deteriorate without treatment do pose elevated safety issues to their communities, will act on their untreated symptoms and will shape public attitudes not just toward their own small population but toward everyone with a severe mental illness diagnosis.

See “Stigma: Violence by seriously mentally ill persons is its major cause” for more on this issue.

* Pescosolido BA, Monahan J, Link BG et al. The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health 1999;89:1339–1345.

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Live from the Kennedy Forum

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(Oct. 24, 2013) Treatment Advocacy Center Executive Director Doris A. Fuller has been in Boston this week for the Kennedy Forum on mental health organized by former Congressman Patrick Kennedy.

The stated goal of the forum is to unite the community of mental health. Among the attendees were Vice President Joe Biden, Kathleen Sebelius, Chelsea Clinton, Chris Matthews, Dr. Steve Sharfstein and many more.

Doris has been tweeting live! So make sure to follow us on Twitter, we are @TreatmentAdvCtr. Here are just a few of her tweets:

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