PA and VA - What We Have in Common

Providing the proper infrastructure of sufficient services for individuals with a diagnosis of severe mental illness such as acute respites, clubhouses, crisis centers, and hospitals is obviously a requirement that every state should have in place.

However, both PA and VA also have a need to change our treatment laws so that the small minority of people with a severe mental illness and lack of insight to seek and remain in treatment are provided the timely treatment they deserve through an assisted outpatient treatment (AOT) law, such New York's Kendra's Law.

In an article written by Alexander Harris, Capital News Service in the Henrico Citizen, "Lawmakers Seek to Update State’s Mental Health System," on January 27, 2008, Jonathan Stanley from the Treatment Advocacy Center states, “Should we help someone who is sick and determine what’s in their best interest, or abandon them without care?”

As Mr. Stanley also states, "A quarter of 1 percent of New York’s population [under Kendra's Law] is placed in assisted outpatient treatment programs every year. The same standards would place about 300 Virginians with mental illnesses into treatment programs that they would not receive otherwise."

In Pennsylvania, using the same statistical analysis, the number of people who would benefit from our proposed legislation, SB 226, would be about 500 a year, or, if broken down by area, approximately 8 people per county.

Hopefully both PA and VA will soon adopt a sensible approach through our proposed AOT legislation to help those who most often find themselves homeless, victimized, or incarcerationed because of lack of timely treatment.

The Ultimate Civil Liberty

As posted on the Treatment Advocacy Center's (TAC) website, Kurt Entsminger, the newly named Executive Director of TAC, was recently interviewed by Schizophrenia Connections' Robin Cunningham. The following question and answer explains in very logical, common sense language the reason timely treatment should be available and provided for anyone who has a severe mental illness and lack of insight to seek treatment:

Robin: Some consumers consider AOT laws to be a violation of their civil liberties, a form of incarceration.

Kurt: You can start from the proposition that people have a constitutional right, a civil liberty if you will, to remain psychotic and delusional, and to have thoughts and say things that make no sense. This seems to be the position that is taken by many civil libertarians. The TAC believes that if you look at the situation practically, the ultimate civil liberty that we want to protect is the ability of people to function normally and well in society, to be able to achieve their maximum potential as human beings. The only way to accomplish this is to be committed, as a society, to providing people help when they're unable to obtain help by themselves. So we see ourselves as being involved in helping to promote civil liberties by ensuring that people who are prisoners of a psychosis can be set free of it. In other words, we are involved in providing the key that will enable them to walk out of their private prisons and to once again function normally in society.

Virginia reviews involuntary commitment standard

Virginia's House of Delegates subcommittee has begun their review of the standard used for involuntary commitments for individuals with a mental illness who do not voluntarily seek treatment. VA's commitment law currently requires an imminent danger to self or others and the proposed legislation, House Bill 559, would change that to ‘There is a substantial likelihood that, as a result of that mental illness, a person will, in the near future, cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting or threatening such harm, or any other relevant information,’”

Just as in Pennsylvania, where our clear and present danger criteria and inability to include a history of prior hospitalizations when determining the need for treatment, Virginia's overly strict criteria often stands in the way of timely treatment that can help prevent the type of dangerous situations that both of our states' laws now require before someone is provided treatment.

In an article from Virginia's The Daily Progress, Mental health bill vetted by panel: Proposal would ease involuntary commitment standard, by Bob Gibson, January 12, 2008, Alex R. Gulotta, executive director of the Charlottesville-based Legal Aid Justice Center, stated “If we had the time and money, we would create more services at the front end” and prevent people from getting worse and needing involuntary commitments."

Providing more services alone does not identify what is at the core of the problem for those with a severe mental illness and a lack of insight (a.k.a. anosognosia) to seek treatment. If someone does not realize that they need support because they are experiencing the symptoms of a mental illness that could be helped with treatment, they will not ask for treatment, either before they are "getting worse" or when they are in dire need of immediate help, whether or not services are available.

In my own situation and from the many families I have spoken with, services were available for their family member: club houses, day programs, group therapy during hospitalizations and mental health professionals were also available: psychiatrists, therapists, and case managers. The only thing missing was a law that would require the person in need of help for the symptoms of their illness to accept the prescribed treatment from the mental health professionals who had evaluated their needs for medication, therapy, and services.

Laws such as PA's proposed Senate Bill 226 are court-ordered assisted outpatient treatment (AOT) laws that provide the services and treatments that an individual with a severe mental illness may need for an initial period of just 6 months, followed by a review and, if required, an additional year. The law would also require the designated provider to be responsible for providing the support and follow-up of services the individual may need. This type of timely, consistent support has been proven to be effective, as the outcomes from NY's Kendra's Law show so clearly.

Hopefully, over time, the results of effective AOT laws will lead other states around the country to use that model so that individuals with a severe mental illness and lack of insight to seek support on their own will have the benefit of timely, compassionate treatment.

Missing Persons

I was watching CNN Prime News this evening and there was a segment on a woman from Louisiana who is missing. Whenever I see these missing persons stories on the news, it seems they are often about a young child, a teenager, or a pregnant woman and I think how very tragic it is not just for that person, but also for the worried family and friends who are frantically trying to find them. I also sometimes wonder why you don't usually see information on people who may be missing and have a mental illness that is not being treated.

I was therefore surprised to see the brother of this woman on the news, talking about how very worried their whole family was because the missing woman has bipolar disorder and she had apparently written in her journal that she had stopped taking her medications three weeks ago. Her brother stated that when she is on her medications, she is a very kind, thoughtful woman. But without them, she is not thinking clearly and would be experiencing manic-depressive symptoms. Her brother gave an impassioned plea to help find her, asking for people to be compassionate and contact them if someone sees her and that someone from his family would then quickly go and take care of her. His family is from different parts of the country and they're taking turns going to Louisiana whenever there is a sighting.

I was so surprised that they mentioned on the news that this woman had an illness and that, because her family knew she might be even more vulnerable because she wasn't taking her usual prescribed medications, they were even more concerned for her. It really is rare for an anchor to ask the family member, as they did on this news show, "I know you mentioned you were especially concerned because of an issue with medication" and the brother to talk about how important the medications were for his sister and how much they are needed for her well being.

The worry and concern for the safety of someone you love when they are missing is difficult for anyone who has had that experience. This brother's concern because he understands that his missing sister could be even more vulnerable because of her untreated illness may help to educate the public of the importance of prompt, timely treatment.

AOT - a compassionate outreach

I am advocating for changes to our treatment laws in Pennsylvania for those with a severe mental illness and lack of insight into the need to seek or remain in treatment. Although many advocate for changes to treatment laws due to violent incidents that can occur with untreated mental illness and those stories are the ones that we most often see in the media, that is not what brought me to advocate for changes in my state.

My main concern for my daughter when she stopped taking the medications that helped keep the voices under control was that when she wandered off at the suggestion of those voices, she would put herself in too dangerous a situation, and would be victimized. A friend of mine whose daughter wandered off when not taking medications ended up in jail, with a charge of robbery, because she tried to get money from a drug store, even though she had a bank account that she could have accessed. She wasn't thinking clearly and she shouldn't be incarcerated now in order to finally receive the treatment she needed but lacked the insight to request.

Vermont is another state looking into changes for their treatment laws. An article in the Times Argus, "Involuntary medication acts to divide" simplifies the delay of taking medications by stating that people would be eligible for voluntary commitments simply because they don't "comply with a doctor's treatment plan within a week."

Assisted outpatient treatment (AOT) laws such as Kendra's Law in New York, (which is also the law that PA's proposed SB 226 is modeled after) have much more stringent criteria before someone would be required to remain in treatment, including a history of hospitalizations or incarcerations.

AOT laws are compassionate outreach programs designed to help someone regain the ability to take control of their own treatments. Without timely intervention, then the chances of homelessness, incarcerations, victiminizations, and yes, sometimes violence are increased significantly.

Preventive, timely treatment for those with mental illness and lack of insight is just common sense and shouldn't be a divisive issue.

When hospitals close their psychiatric units...

Yet another local hospital in my county is planning on closing their psychiatric unit. It seems that fewer and fewer hospitals want to (or say they can afford to) take care of patients in need of a safe, secure environment where their medications for a diagnosed mental illness can be adjusted and other treatments can be provided.

A guest opinion article, Must not only fix broken bones, but broken brains, too, was published in The Bucks County Courier Times on December 29, 2007. Many legitimate reasons were sited as to why closing this hospital would not be a wise decision.

As mentioned, "With appropriate effective medication and services most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence." For someone who lacks insight and does not remain with prescribed treatment, if this hospital closes, there will not be a nearby facility where they can receive the care they may need on either a voluntary or involuntary inpatient status.

Our state's very restrictive Mental Health Procedures Act, which only allows for treatment when someone is a "clear a present danger to self or others," does not provide the treatments someone may need to help keep them out of a dangerous situation. If we had an assisted outpatient treatment (AOT) law such as SB 226, clients in need of treatment who lack insight for a need for treatment could at least be assured timely treatment in the community.

But, if this hospital closes its psychiatric unit in February 2008, as they state they most likely will do, the support system for those who desperately need help for an untreated mental illness will be majorly reduced and the consequences will be devastating. Without either timely inpatient treatment in a hospital or continuous, sustained outpatient treatment through an effective AOT law, 2008 will not be off to a very good start for many people with a mental illness and their families and friends.