As we come to the end of the year, if you haven't already seen the Treatment Advocacy Center's (TAC's) list of The Top 10 Underreported Mental Illness Stories, 2007 I would encourage you to do so.
The second, "Requiring 'dangerousness' before someone can get mental illness treatment is dangerous for everyone," and fifth, "Psychiatric beds are shifting from civil to criminal" really hit home because I have personally had to watch my family member deteriorate to the level of "clear and present danger to self or others" before receiving treatment and because I have a friend whose daughter's untreated mental illness meant that she is currently serving time in a correctional facility, instead of receiving the help she needed in a psychiatric hospital.
As an advocate for changes to our mental health laws in Pennsylvania, the eighth, "Assisted outpatient treatment (AOT) programs make a difference – when they are used" and the tenth, "We are still protecting the right to be psychotic over the right to treatment" really summarize my reasons for trying to see our laws change to an AOT law such as our proposed SB 226. Hopefully, 2008 will see this timely treatment for mental illness piece of legislation become law in my state.
Monday, December 31, 2007
Sunday, December 23, 2007
Abandoned to the Streets - Around the World
Through the "google alerts" I've set on my computer, I found a new web site, World Fellowship for Schizophrenia and Allied Disorders, an organization that was originated in Canada with a membership of organizations around the world, including NAMI. The opening paragraph of the article I read, "Abandoned to the Streets" is: "It's been a hard year. I would not have been able to tell you most of the time where my daughter was — how she spent her days, or with whom. Carrie is a grown woman, attractive and kind-hearted; but she also suffers from the most debilitating of mental illnesses: schizophrenia."
The story really hit home because of a caring, concerned mother I've recently been in touch with, Bernadette, who was very worried because her daughter with a mental illness was constantly wandering off and not taking her medications that helped her. Bernadette worried for her daughter's safety and, after her daughter was missing for a month, Bernadette finally learned that she had spent that month in jail for a minor crime, because, without medications, her daughter wasn't thinking very clearly.
Unfortunately, the treatment laws in my state, Pennsylvania, require that individuals with a mental illness and lack of insight to make a request for medications and other treatments that could help them must first do something that shows that they are a "clear and present danger to self or others" before treatment is provided. While waiting for this dangerous level to be reached, many people in this situation do wander off, sometimes become homeless and find themselves in situations where they are victimized or sometimes are involved in minor crimes or worse.
When treatment works and helps someone with a diagnosis of mental illness, why put them and their families through the torture and worry of waiting for a dangerous situation to occur? That simply makes no sense at all. Any caring society would want to provide the help that would enable someone to avoid the type of dangerous situations that routinely occur with untreated mental illnesses. When enacted, Pennsylvania's proposed assisted outpatient treatment (AOT) bill, SB 226, will help people like Bernadette's daughter to receive treatment in a psychiatric hospital or in the community with the support of an intensive case manager or an ACT program, not in a jail.
The story really hit home because of a caring, concerned mother I've recently been in touch with, Bernadette, who was very worried because her daughter with a mental illness was constantly wandering off and not taking her medications that helped her. Bernadette worried for her daughter's safety and, after her daughter was missing for a month, Bernadette finally learned that she had spent that month in jail for a minor crime, because, without medications, her daughter wasn't thinking very clearly.
Unfortunately, the treatment laws in my state, Pennsylvania, require that individuals with a mental illness and lack of insight to make a request for medications and other treatments that could help them must first do something that shows that they are a "clear and present danger to self or others" before treatment is provided. While waiting for this dangerous level to be reached, many people in this situation do wander off, sometimes become homeless and find themselves in situations where they are victimized or sometimes are involved in minor crimes or worse.
When treatment works and helps someone with a diagnosis of mental illness, why put them and their families through the torture and worry of waiting for a dangerous situation to occur? That simply makes no sense at all. Any caring society would want to provide the help that would enable someone to avoid the type of dangerous situations that routinely occur with untreated mental illnesses. When enacted, Pennsylvania's proposed assisted outpatient treatment (AOT) bill, SB 226, will help people like Bernadette's daughter to receive treatment in a psychiatric hospital or in the community with the support of an intensive case manager or an ACT program, not in a jail.
Friday, December 14, 2007
When is it time to overhall mental health system?
In an article in the Washington Post, December 14, 2007, Kaine to Overhaul Mental Health System, Virginia's governor is preparing to overhaul their state's mental health system. While Virginia has an "imminent danger," standard, it is similar to the level of dangerousness required in Pennsylvania, which is "clear and present danger." As stated in this article by Christopher Ryan, a psychiatrist at the University of Sydney in Australia, "It would be better if people with these illnesses could receive the treatment they need before dangerousness becomes an issue."
The problem that sometimes exists with mental illness is that of anosognosia, or lack of insight. As stated in the article, "When someone doe not realize that they have an illness that can be helped by treatment, they do sometimes fall into crisis situations, as they decompenstate to the level of dangerousness required by some states laws." What a tragedy for that person as well as for the family and friends who wait by helplessly, watching this slow decent to a level of "imminent" or "clear and present" danger.
"Family members of mentally ill patients and mental health workers said Virginia's standard is too strict and results in the denial of treatment for people who need it."
I would echo the same sentiment regarding the laws in Pennsylvania that make it impossible to get someone the timely treatment they need, to help prevent something too dangerous happening to that individual or someone else.
According to the Treatment Advocacy Center, eighteen states have revised their standards since 1999. Hopefully, Pennsylvania will be one of the next states to change their outdated Mental Health Procedures Act through SB 226.
The problem that sometimes exists with mental illness is that of anosognosia, or lack of insight. As stated in the article, "When someone doe not realize that they have an illness that can be helped by treatment, they do sometimes fall into crisis situations, as they decompenstate to the level of dangerousness required by some states laws." What a tragedy for that person as well as for the family and friends who wait by helplessly, watching this slow decent to a level of "imminent" or "clear and present" danger.
"Family members of mentally ill patients and mental health workers said Virginia's standard is too strict and results in the denial of treatment for people who need it."
I would echo the same sentiment regarding the laws in Pennsylvania that make it impossible to get someone the timely treatment they need, to help prevent something too dangerous happening to that individual or someone else.
According to the Treatment Advocacy Center, eighteen states have revised their standards since 1999. Hopefully, Pennsylvania will be one of the next states to change their outdated Mental Health Procedures Act through SB 226.
Sunday, December 9, 2007
The Right to Treatment
How does one go about protecting one of the human rights that is most important to an individual with a severe mental illness and a lack of insight into the need to receive treatment?
The question is a global one, and was addressed recently in an article from the Irish Medical News, "Right to treatment should not be forgotten in psychiatry". As mentioned in this article, Dr. Brendan Kelly of the Department of Adult Psychiatry, UCD stated that "the Act [Ireland's Mental Health Act, 2001] does increase protection for the right to liberty – but indicated that other important rights relating to mental health, may not be equally protected." He stated “The Act certainly increases protection for the right to liberty, but it focuses on that right so much that there is scant attention paid to other rights – the right to treatment, for example."
I agree with Pete Earley's statement on this blog site under Commonsense Quotes: "If I had a chronic mental illness and there were medicines that could help me recover, I would want my loved ones and doctors to make certain that I got them, not to stand by and watch me suffer."
I think that we should take the same compassionate stand to help those whose lives are affected by the devastating consequences of untreated mental illness. They should have a right to receive timely treatment and we should do all that we can to advocate to help protect that vitally important right.
The question is a global one, and was addressed recently in an article from the Irish Medical News, "Right to treatment should not be forgotten in psychiatry". As mentioned in this article, Dr. Brendan Kelly of the Department of Adult Psychiatry, UCD stated that "the Act [Ireland's Mental Health Act, 2001] does increase protection for the right to liberty – but indicated that other important rights relating to mental health, may not be equally protected." He stated “The Act certainly increases protection for the right to liberty, but it focuses on that right so much that there is scant attention paid to other rights – the right to treatment, for example."
I agree with Pete Earley's statement on this blog site under Commonsense Quotes: "If I had a chronic mental illness and there were medicines that could help me recover, I would want my loved ones and doctors to make certain that I got them, not to stand by and watch me suffer."
I think that we should take the same compassionate stand to help those whose lives are affected by the devastating consequences of untreated mental illness. They should have a right to receive timely treatment and we should do all that we can to advocate to help protect that vitally important right.
Tuesday, December 4, 2007
The Church and Mental Illness: What is Their Role?
We certainly have come a long way from the days when the church considered those with mental illness as possessed by demons. http://encarta.msn.com/encyclopedia_761566888_9/Mental_Illness.html
However, how involved are churches today in dealing with mental illness? Or, more specifically, how knowledgeable are churches about mental illness?
Considering that one in four families copes with the challenges brought on by a family member dealing with mental illness, it would seem that most congregations, depending on their size, have several families who fit the profile.
During the brief period that my son, Todd, was taking his medication for schizophrenia, he sought out a church after moving into a new apartment in a new town. Soon thereafter, when Todd stopped taking his medication because he felt he wasn’t sick (see http://www.treatmentadvocacycenter.org/BriefingPapers/BP15.htm ) and started displaying symptoms, I contacted the church.
I was grasping at straws.
The ministers, a husband and wife team, said they would watch out for him. And they did. Months later, when Todd began acting inappropriately during services—pulling out his battery-powered electric shaver or shouting something out in response to the sermon—the ministers contacted me. They said they didn’t want to discourage his coming to church, but they didn’t want to cause discomfort for their congregation either. So, they formed “The Todd Project,” consisting of about 10 people, including a physician, a therapist, and several retired persons, whose job it was to more or less watch Todd and be with him when he came to services, kind of “guiding” his behavior—or misbehavior. Todd was never told of this group or of my interaction with group members. We didn’t want to alienate or cause any more paranoia than he already had.
To this church’s credit, during the next several months, the Todd Project met with me to better understand Todd’s history. And they did help him when the electric company terminated service due to nonpayment. Someone from the group regularly drove him to a nearby clinic to get his high blood pressure medication. Then, recently, Todd patted the head of a younger child, and the mother became frantically afraid. No one seems to know if he said anything inappropriate to the child. The mother told the minister she was going to leave and go to another church. The minister immediately told Todd that now he would need to come to report to the Todd Project. Todd turned on his heels and left. I’m not sure if he has returned. And I understand how the church as a whole wants to their church to be a safe place for their congregation. I can’t help but wonder, however, how frantic the mother would have been had a “normal” person patted her child’s head.
One of the Todd Project members told me that the head-patting issue had been elevated to The Session, and this group wondered why I hadn’t had him involuntarily committed.
http://www.phillyburbs.com/pb-dyn/news/111-11182007-1442905.html
That’s when I knew that our job of educating the world about mental illness has only just begun.
The need to address chronic mental illness is urgent. The 1988 General Assembly of the Presbyterian Church (U.S.A.) adopted a report and resolution which called the church to ministry and mission with those persons affected by serious mental illness including family, friends and professionals. http://www.pcusa.org/nationalhealth/programs/seriousmentalillness.htm#top
The report:
· acknowledged that the religious community is in a unique position to be the bridge between clinical settings and life in the home community and to offer support to the diversity of persons whose lives are touched by mental illness
· urged pastors and congregations to develop ways of inclusion
· urged that congregations cherish the presence of all in the community of faith as it worships, studies, gives, grows and heals together
· encouraged the church to learn more about mental illness and
· encouraged the church to seek new ways to respond to those with severe mental illness and their families.
What do you think? Did Todd’s church helped him, or did they lose him?
However, how involved are churches today in dealing with mental illness? Or, more specifically, how knowledgeable are churches about mental illness?
Considering that one in four families copes with the challenges brought on by a family member dealing with mental illness, it would seem that most congregations, depending on their size, have several families who fit the profile.
During the brief period that my son, Todd, was taking his medication for schizophrenia, he sought out a church after moving into a new apartment in a new town. Soon thereafter, when Todd stopped taking his medication because he felt he wasn’t sick (see http://www.treatmentadvocacycenter.org/BriefingPapers/BP15.htm ) and started displaying symptoms, I contacted the church.
I was grasping at straws.
The ministers, a husband and wife team, said they would watch out for him. And they did. Months later, when Todd began acting inappropriately during services—pulling out his battery-powered electric shaver or shouting something out in response to the sermon—the ministers contacted me. They said they didn’t want to discourage his coming to church, but they didn’t want to cause discomfort for their congregation either. So, they formed “The Todd Project,” consisting of about 10 people, including a physician, a therapist, and several retired persons, whose job it was to more or less watch Todd and be with him when he came to services, kind of “guiding” his behavior—or misbehavior. Todd was never told of this group or of my interaction with group members. We didn’t want to alienate or cause any more paranoia than he already had.
To this church’s credit, during the next several months, the Todd Project met with me to better understand Todd’s history. And they did help him when the electric company terminated service due to nonpayment. Someone from the group regularly drove him to a nearby clinic to get his high blood pressure medication. Then, recently, Todd patted the head of a younger child, and the mother became frantically afraid. No one seems to know if he said anything inappropriate to the child. The mother told the minister she was going to leave and go to another church. The minister immediately told Todd that now he would need to come to report to the Todd Project. Todd turned on his heels and left. I’m not sure if he has returned. And I understand how the church as a whole wants to their church to be a safe place for their congregation. I can’t help but wonder, however, how frantic the mother would have been had a “normal” person patted her child’s head.
One of the Todd Project members told me that the head-patting issue had been elevated to The Session, and this group wondered why I hadn’t had him involuntarily committed.
http://www.phillyburbs.com/pb-dyn/news/111-11182007-1442905.html
That’s when I knew that our job of educating the world about mental illness has only just begun.
The need to address chronic mental illness is urgent. The 1988 General Assembly of the Presbyterian Church (U.S.A.) adopted a report and resolution which called the church to ministry and mission with those persons affected by serious mental illness including family, friends and professionals. http://www.pcusa.org/nationalhealth/programs/seriousmentalillness.htm#top
The report:
· acknowledged that the religious community is in a unique position to be the bridge between clinical settings and life in the home community and to offer support to the diversity of persons whose lives are touched by mental illness
· urged pastors and congregations to develop ways of inclusion
· urged that congregations cherish the presence of all in the community of faith as it worships, studies, gives, grows and heals together
· encouraged the church to learn more about mental illness and
· encouraged the church to seek new ways to respond to those with severe mental illness and their families.
What do you think? Did Todd’s church helped him, or did they lose him?
Monday, December 3, 2007
Clarifying Senate Bill 226
I recently received a comment to the previous blog on the complexities of mental illness which made me realize that many people probably do not understand exactly how Pennsylvania's proposed legislation, SB 226 would be enacted, who it would affect, and the period of time that it would be in place.
In order for someone to qualify for an assisted outpatient treatment (AOT) court order under SB 226, the person has to meet ALL of the numbered criteria to be eligible for the program. There is one area of either/or in the criteria – number (4), parts (i) and (ii). To be eligible, a person must meet all of the other criteria, but they only have to either have had the history of hospitalization (i), or the history of violent behavior (ii), not both.
For example, simply meeting (7) “likely to benefit from AOT” would not be enough for entry into the program. ALL of the other criteria would have to be found by a judge by clear and convincing evidence, as well.
(1) The patient is 18 years of age or older.
(2) The patient is suffering from a mental illness.
(3) The patient is unlikely to survive safely in the community without supervision, based on a clinical determination.
(4) The patient has a history of lack of compliance with treatment for mental illness that has:
(i) at least twice within the preceding 36 months been a significant factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a correctional facility, not including any period during which the person was hospitalized or imprisoned immediately preceding the filing of the petition; or
(ii) resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the preceding 48 months, not including any period in which the person was hospitalized or imprisoned immediately preceding the filing of the petition.
(5) The patient is, as a result of the patient's mental illness, unlikely to voluntarily participate in the recommended treatment pursuant to the treatment plan.
(6) In view of the patient's treatment history and current behavior, the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to pose a clear and present danger of harm to others or to himself as determined under section 301.
(7) It is likely that the patient will benefit from assisted outpatient treatment.
The initial court order would be for a period of six months, followed by a review. If it was determined necessary, this could be continued for an additional year.
The number of people in New York under Kendra's Law, which SB 226 is modeled after, is approximately 750 each year. Given the size of Pennsylvania in comparison, the number of people who might be in an assisted outpatient treatment order would be approximately 500 each year. If that is broken down into counties, that could mean about 8 people in each county.
The benefit behind a sustained period of time in treatment cannot be underestimated, as the outcomes from Kendra's Law show. The major goal of a bill such as SB 226 would be to enable the very small minority of people with a mental illness who meet the criteria and who often initially lack insight and end up homeless, hospitalized, or incarcerated to receive timely, sustained treatment and then for them to move forward in whatever direction they may choose.
Without this supportive bill, are we really providing the care and support that someone with an untreated mental illness deserves?
In order for someone to qualify for an assisted outpatient treatment (AOT) court order under SB 226, the person has to meet ALL of the numbered criteria to be eligible for the program. There is one area of either/or in the criteria – number (4), parts (i) and (ii). To be eligible, a person must meet all of the other criteria, but they only have to either have had the history of hospitalization (i), or the history of violent behavior (ii), not both.
For example, simply meeting (7) “likely to benefit from AOT” would not be enough for entry into the program. ALL of the other criteria would have to be found by a judge by clear and convincing evidence, as well.
(1) The patient is 18 years of age or older.
(2) The patient is suffering from a mental illness.
(3) The patient is unlikely to survive safely in the community without supervision, based on a clinical determination.
(4) The patient has a history of lack of compliance with treatment for mental illness that has:
(i) at least twice within the preceding 36 months been a significant factor in necessitating hospitalization, or receipt of services in a forensic or other mental health unit of a correctional facility, not including any period during which the person was hospitalized or imprisoned immediately preceding the filing of the petition; or
(ii) resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others within the preceding 48 months, not including any period in which the person was hospitalized or imprisoned immediately preceding the filing of the petition.
(5) The patient is, as a result of the patient's mental illness, unlikely to voluntarily participate in the recommended treatment pursuant to the treatment plan.
(6) In view of the patient's treatment history and current behavior, the patient is in need of assisted outpatient treatment in order to prevent a relapse or deterioration which would be likely to pose a clear and present danger of harm to others or to himself as determined under section 301.
(7) It is likely that the patient will benefit from assisted outpatient treatment.
The initial court order would be for a period of six months, followed by a review. If it was determined necessary, this could be continued for an additional year.
The number of people in New York under Kendra's Law, which SB 226 is modeled after, is approximately 750 each year. Given the size of Pennsylvania in comparison, the number of people who might be in an assisted outpatient treatment order would be approximately 500 each year. If that is broken down into counties, that could mean about 8 people in each county.
The benefit behind a sustained period of time in treatment cannot be underestimated, as the outcomes from Kendra's Law show. The major goal of a bill such as SB 226 would be to enable the very small minority of people with a mental illness who meet the criteria and who often initially lack insight and end up homeless, hospitalized, or incarcerated to receive timely, sustained treatment and then for them to move forward in whatever direction they may choose.
Without this supportive bill, are we really providing the care and support that someone with an untreated mental illness deserves?
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