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Steps Forward in Maryland

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(May 7, 2014) Our neighbor Maryland has long been among the very worst states in the union for those who cannot seek or agree to essential treatment for their severe mental illness. Marylanders in this condition (and the families who love them) currently face a tragic triple whammy:

md bill signing1. A hospital commitment standard requiring a finding of “danger to life or safety,” which is often interpreted to slam the hospital doors on anyone who doesn’t appear imminently violent or suicidal;

2. The notorious “Kelly Decision” of 2007, in which the Maryland Court of Appeals ruled that a patient committed to a mental hospital who refuses medication cannot be medicated over objection without evidence that the person poses a danger while in the hospital, irrespective of the danger the person would pose in the community if released in his or her current unmedicated state;

3. The lack of an assisted outpatient treatment (AOT) law to help those caught in the revolving doors of the mental health and criminal justice systems to survive safely in the community. (Only four other states share this dubious distinction.)

With the strokes of several pens yesterday morning, Maryland Governor Martin O’Malley gave hope for a brighter day ahead. The governor signed two bills championed in this year’s legislative session by the Treatment Advocacy Center and our indefatigable partners in NAMI-Maryland.

One bill, HB 592/SB 620, nullifies the Kelly decision (effective October 1) by amending the state law interpreted by the court. The new language makes explicit that a committed patient may be medicated over objection if a review panel finds the patient’s mental illness symptoms cause dangerousness in the hospital, caused the dangerousness that led to commitment, or would cause dangerousness if the person were released.

The second bill, HB1267/SB882, represents progress towards addressing the two other glaring flaws in Maryland’s treatment laws. It directs the state’s Department of Health and Mental Hygiene (DHMH) to convene a work group to examine AOT and deliver to the legislature by November 1, 2014 “a proposal for a program that … best serves individuals with mental illness who are at high risk for disruptions in the continuity of care.” It further directs DHMH to “evaluate the dangerousness standard for involuntary admissions and emergency evaluations of individuals with mental disorders, including … how the standard should be clarified[.]” (DHMH is already on record acknowledging the state’s need for both AOT and a consistent, more flexible interpretation of “danger to life or safety.”)

For now, we’ll say “one down, two to go,” with optimism that by this time next year, Maryland will stand proudly among the best states in meeting the needs of those whose anosognosia puts voluntary mental health care out of reach. We offer heartfelt thanks and kudos to the Maryland lawmakers who this year carried the mantle of this too-often-voiceless population: Senator Dolores Kelly and Delegate Dan Morhaim of Baltimore County, and Senator Mac Middleton and Delegate Peter Murphy of Charles County.

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I am My Brother’s Keeper – personally speaking

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(May 6, 2014) I first came to understand mental illness through my brother’s experience.

brothersisterNever understanding what mental illness was until years later, I came to know my brother’s diagnosis as severe bipolar disorder. Watching my brother struggle is similar to observing a roller coaster: he will have manic episodes where he speaks quickly and paces up and down hallways. Then he will have depressed episodes in which he will lie in bed for days with a curtain drawn. There was one incident in which my brother stole my car and disappeared for two weeks and I did not know where he was.   

Current HIPPA laws kept me from trying to help him. The HIPAA privacy rule kept me completely locked out of his care and I was powerless to help him.  The first time I encountered this roadblock was when my brother was admitted to the psychiatric hospital a few years ago. I went to visit him but he was gone. The nurse told me that she couldn’t give me any information about my sick brother’s whereabouts because of the privacy rule. So I was left to worry about where he was and what he might be doing. It was a wake-up call to realize that to help my brother, I could only count on myself and not the system.

For years I have been told by mental health professionals that my brother is an adult and can take care of himself. However, the truth of the matter is that he is not mentally capable of taking care of himself as I am now finally his caregiver.

I am my brother’s keeper.

Tracey Davis
Resident of Pennsylvania

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"Shot in the Head”

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(May 5, 2014) Paul was a shapeshifter, a skinwalker, a Navajo witch able to spot another witch no one else could see. He had powers none of us could understand.

shot in the headIn actuality, a toothless 48-year-old with schizophrenia, Paul needed nebulizer treatments twice a day for his bad lungs. He also suffered from anosognosia, like many mentally ill people he didn’t really believe he was mentally ill.

But why did someone else have to be in jeopardy for Paul to be given intensive care? The bottom line was that the state had a timetable and the social workers had followed it, without letting us know about it. The decision to give him more freedom seemed to be disconnected from any evaluation of his connection to reality. Unless he was a danger to himself or others, he was a free man.

He’d never been able to hold down any sort of job. And his hygiene was certainly terrible. Even with the rules at the halfway house, he sometimes arrived at family gatherings smelling so bad we had to send him to the shower.

As I drove to his apartment for the first time, I tried to imagine treating another kind of neurological disorder this way. Tell someone with a spinal cord injury that they’ve been in a wheelchair long enough. Time for you to walk! someone says, and the wheelchair is whisked away.

Or imagine telling someone who suffers from Alzheimer’s, enough of this hanging around doing nothing. You’ve been in this nursing home for six months now. We can’t look after you forever. From now on you’ll have to take care of yourself.


Absurd.

Excerpted from Shot in the Head: A Sister’s Memoir, A Brother’s Struggle
Katherine Flannery Dering.


In the book, Flannery details her life with her younger brother. “My younger brother Paul was more than a schizophrenic,” the author says. “He was a brother, a son and above all, a person that my eight siblings and I loved.” Meet the author.

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One Day Our Son Just Disappeared

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(May 2, 2014) One day our happy 14-year-old boy disappeared and in his place was a paranoid person who heard voices and believed the FBI was out to get him, Ed Kelley tells NPR host Robert Sullivan (“Effort to force treatment on severely mentally ill meets resistance,” May 1).

fathersonThat is why Kelley supports the Helping Families in Mental Health Crisis Act,introduced by Rep. Tim Murphy (R-PA) last December and co-sponsored by more than 70 members of both parties in Congress.

The bill, among other things, would lower or remove some of the barriers to treatment that commonly prevent people with severe mental illness from getting the treatment they need.

Kelley believes his son would never harm anyone, and a majority of people with mental illness never become violent. But a small subset of people with severe mental illness can be prone to violent acts, or other consequences of non-treatment when untreated. It is this subset of people the bill intends to help.

“I hope that the people who are shouting and keeping the families from having their loved ones treated properly, I pray they never have the experiences that our family or other families have had because it would change their perspective,” Kelley tells Sullivan.

Listen to the interview.

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Gov. McAuliffe Signs Bill Spearheaded By Sen. Deeds

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(April 30, 2014) Virginia Governor Terry McAuliffe signed legislation on Monday to reform the state’s mental health system with Sen. Creigh Deeds seated at his side (“McAuliffe signs ‘first step’ to reforming Virginia’s mental health system,” the Washington Post, April 28).

deedssigningLast November, less than a day after Sen. Deeds’ son, Gus , was released from an emergency hold at a Virginia hospital - reportedly because no psychiatric beds were available - the young man stabbed his father in the head and torso before fatally shooting himself.

Just two months after losing his son, Sen. Deeds returned to the Virginia capital determined to turn personal loss into public gain by changing the laws that hindered access to treatment for his son.

On Monday McAuliffe and Deeds traveled to the same hospital that treated Deeds’ son to ceremonially sign SB 260, spearheaded by Deeds, which increases the duration of emergency psychiatric holds from 4 hours – currently the shortest in the nation – to 12, with a safety net clause that state mental health hospitals are required to accept patients for temporary detention after 8 hours. The bill also extends the time period that a person can be held involuntarily under a temporary detention order from 48 hours to 72 hours.

“It’s an important first step,” McAuliffe said. “Let us be crystal clear: We have a long, long way to go.”

While every improvement is worth celebrating, Gov. McAuliffe is correct, there is much more work to do.

Virginia remains the nation's extreme outlier on providing enough time for a mental health examiner to be called, to get to wherever the patient is being held because of psychiatric symptoms and to conduct an evaluation (48-72 hours is much more common).

What's more, some individuals - especially suicide risks – do not stabilize sufficiently during the emergency hold to leave the hospital safely. This is far more likely when the hold exceeds just a few hours.

The new law will go into effect on July 1.

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