As I continue to advocate for changes to our outdated mental health treatment laws in Pennsylvania that require someone to be a "clear and present danger to self or others" before treatment is provided to someone who lacks the insight to request treatment on their own, I realize that people in states all around the country are facing the the same problems with laws in their states that also need to be changed to help those who are not receiving the timely treatment they deserve.
As mentioned in an article posted on klab.com News Channel 5 in Alexandria, LA:
"The mental health care package announced by the Governor, Secretary Levine, and legislators today in New Orleans includes four bills:"
In my opinion, the most important of these is:
"'Nicola’s Law' - Involuntary Outpatient Treatment Allowing the use of involuntary outpatient placement enables mental health experts and courts to ensure compliance with treatment protocols for those who have a behavioral illness, who have a violent history, who are likely to become violent, and who also refuse treatment or do not comply with their treatment plan. 'Nicola’s Law' is modeled after similar legislation in New York, 'Kendra’s Law,' which has been supported by behavioral health advocates and experts throughout the nation. More than 40 states have now established similar laws. After Kendra’s Law was passed in New York, incarcerations fell from 23 percent to three percent, psychiatric hospitalizations decreased from 97 percent to 22 percent, and homelessness fell from 19 percent to five percent."
PA's Senate Bill 226 also follows Kendra's Law, and when passed, will be expected to show the same reductions in hospitalizations, homelessness, and incarcerations.
Tuesday, March 25, 2008
Friday, March 21, 2008
Shortage of psychiatric beds
A must read:
The Treatment Advocacy Center recently posted a report on their web site on the Shortage of Public Hospital Beds: http://www.treatmentadvocacycenter.org/Reportbedshortage.htm. Pennsylvania is listed under the category of "Severe bed shortage (12-19 beds per 100,000 population)," with just 18.9 beds per 100,000 population.
Fifteen experts on psychiatric care in the United States were asked "to assume the existence of good outpatient programs and the availability of outpatient commitment and told them that they would not be publicly identified."
As stated in the report, "The replies received were surprisingly consistent. Almost all 15 experts estimated a need for 50 (range 40 to 60) public psychiatric beds per 100,000 population for hospitalization for individuals with serious psychiatric disorders. Since it assumes the availability of good outpatient programs and outpatient commitment, this is a minimum number."
As the chart shows, Pennsylvania currently has 2,349 beds, and using the formula above of 50 per 100,000, we should have 6,182 beds, or an increase of 3,833.
I'm not certain why our state continues to down size and close our state hospitals. Maybe its time to find out before even more beds are lost.
One of the six solutions offered is "Implementing and using PACT [a.k.a. ACT] programs and assisted outpatient treatment (AOT) in every state; both programs have been proven to decrease the need for hospitalization." Thankfully, our state OMHSAS is increasing the number of ACTs in our state and will soon be publishing PA ACT Standards which will ensure fidelity to the model.
We now need to work even harder to see our AOT bill, SB 226 pass. With your help, we can.
(An article on Poynteronline was also posted on this week on this vitally important issue)
The Treatment Advocacy Center recently posted a report on their web site on the Shortage of Public Hospital Beds: http://www.treatmentadvocacycenter.org/Reportbedshortage.htm. Pennsylvania is listed under the category of "Severe bed shortage (12-19 beds per 100,000 population)," with just 18.9 beds per 100,000 population.
Fifteen experts on psychiatric care in the United States were asked "to assume the existence of good outpatient programs and the availability of outpatient commitment and told them that they would not be publicly identified."
As stated in the report, "The replies received were surprisingly consistent. Almost all 15 experts estimated a need for 50 (range 40 to 60) public psychiatric beds per 100,000 population for hospitalization for individuals with serious psychiatric disorders. Since it assumes the availability of good outpatient programs and outpatient commitment, this is a minimum number."
As the chart shows, Pennsylvania currently has 2,349 beds, and using the formula above of 50 per 100,000, we should have 6,182 beds, or an increase of 3,833.
I'm not certain why our state continues to down size and close our state hospitals. Maybe its time to find out before even more beds are lost.
One of the six solutions offered is "Implementing and using PACT [a.k.a. ACT] programs and assisted outpatient treatment (AOT) in every state; both programs have been proven to decrease the need for hospitalization." Thankfully, our state OMHSAS is increasing the number of ACTs in our state and will soon be publishing PA ACT Standards which will ensure fidelity to the model.
We now need to work even harder to see our AOT bill, SB 226 pass. With your help, we can.
(An article on Poynteronline was also posted on this week on this vitally important issue)
Sunday, March 16, 2008
Mental Health Parity Questioned
Do you ever read The Trouble With Spikol blog? The person who wrote the article that Liz Spikol posted questions the benefits of Mental Health Parity bills, because of having to equate mental illness on the same level as physical illness.
This post on March 14th grabbed my attention because I believe it is the reason behind why some people do not believe that lack of insight of an illness and need to seek treatment exists for some individuals with mental illnesses such as schizophrenia, schizo-affective, and biopolar disorder. This belief is also why some people are against assisted outpatient treatment (AOT) bills.
I understand why people want to be in control of any situation, including their medical needs, and that through their own efforts they can make their symptoms better, because that is empowering, which is at the heart of the consumer recovery movement. Fortunately, for the majority of individuals with a mental illness, that is true.
But I don't think that those individuals may realize the burden they put on others whose mental illness requires prescribed medications (and other supportive services and therapy) because there really is a chemical imbalance in their brain and that the untreated symptoms are not so easily managed, regardless of how strong or empowered they are. Needing to take medications for a biological brain disease should never be considered a weakness or a character flaw - no one ever thinks that of someone who needs insulin for diabetes.
NAMI has worked very hard to see both a Senate and House Mental Health Parity bill pass, and it is hard to imagine that anyone would question the wisdom of allowing individuals with mental illness the ability to access medical treatment just as anyone else with any other illness or disease can.
This post on March 14th grabbed my attention because I believe it is the reason behind why some people do not believe that lack of insight of an illness and need to seek treatment exists for some individuals with mental illnesses such as schizophrenia, schizo-affective, and biopolar disorder. This belief is also why some people are against assisted outpatient treatment (AOT) bills.
I understand why people want to be in control of any situation, including their medical needs, and that through their own efforts they can make their symptoms better, because that is empowering, which is at the heart of the consumer recovery movement. Fortunately, for the majority of individuals with a mental illness, that is true.
But I don't think that those individuals may realize the burden they put on others whose mental illness requires prescribed medications (and other supportive services and therapy) because there really is a chemical imbalance in their brain and that the untreated symptoms are not so easily managed, regardless of how strong or empowered they are. Needing to take medications for a biological brain disease should never be considered a weakness or a character flaw - no one ever thinks that of someone who needs insulin for diabetes.
NAMI has worked very hard to see both a Senate and House Mental Health Parity bill pass, and it is hard to imagine that anyone would question the wisdom of allowing individuals with mental illness the ability to access medical treatment just as anyone else with any other illness or disease can.
Wednesday, March 12, 2008
California's Laura's Law
When another assisted outpatient treatment (AOT) bill, Laura's Law, was passed in California in 2002, it didn't include a provision that would require every county to enact it, only those that chose to do so. Advocates in that state are now working to see this legislation in place so that those with severe mental illness and lack of insight will receive the timely treatment they deserve.
One of the advocates made this observation in a post called, Laura's Law--what is it and should we enact it?:
"It seems that it is a very reasonable bill. People who are deteriorating can engage in violent acts towards themselves and/or others because their ability to reason is seriously damaged. Without medication, I don't see how they can stabilize and come back to reality. It seems harsh to force them to take medications, but the alternative could be a disaster. It takes a lot to meet all the criteria for involuntary treatment, and I think the people that meet it should not be walking around without a good deal of assistance. "
One of the advocates made this observation in a post called, Laura's Law--what is it and should we enact it?:
"It seems that it is a very reasonable bill. People who are deteriorating can engage in violent acts towards themselves and/or others because their ability to reason is seriously damaged. Without medication, I don't see how they can stabilize and come back to reality. It seems harsh to force them to take medications, but the alternative could be a disaster. It takes a lot to meet all the criteria for involuntary treatment, and I think the people that meet it should not be walking around without a good deal of assistance. "
Monday, March 10, 2008
Closing of psychiatric hospitals
On her latest post, The Trouble with Spikol, Liz Spikol writes about the possible closing of a New Jersey hospital due to the terrible conditions that exist. No mention is made of how to improve those conditions, just that Ancora Hospital should be shut down.
However, I think the comments made by some of her readers are very insightful and explain that it isn't as simple as closing down a facility that doesn't provide the care that is desperately required for someone who has a diagnosis of a severe mental illness and needs very intensive support.
HS wrote, "Despite the clear lacking in care at hospitals like Ancora the reality is that the patients they treat can't live on there own and most do need an inpatient hospital level of care." Stan stated "Sure you can close down the hospitals, (they did that is California a long time ago without private or community resources’ to feel in the gaps, and you had lots of mentally ill people living on the streets without or with very limited mental health care options). So then where do you put these people?"
I think both of their comments show that this issue is more complex than just mandating the closure of hospitals. The consequences could be even worse for those in need of intensive support than what already exists.
Although Stan is not in favor of hospitals serving everyone with a mental illness, he acknowledges that some individuals do that that level of care, "I’m definitely not convinced that institutions are the best way to provide effective mental health services unless we are dealing with the most extreme and dangerous patient population."
I also agree with his analysis that "holistic community based programs would not only be more effective and humane, but would be much more cost effective also." Assertive community treatment (ACT) programs can fill that need, when they are run well and follow the model.
However, in states where inadequate treatment laws exist, those who are unable to seek treatment because of their lack of insight would receive no supports or services at all. Only assisted outpatient treatment laws could help those individuals.
I think we've reached a crisis point in how we approach these issues and intensive attention needs to be paid to providing the proper supports to those who are often the most vulnerable in our society. Until then, we will continue to see an increase of homelessness, incarcerations, and victimization.
We need to act now.
However, I think the comments made by some of her readers are very insightful and explain that it isn't as simple as closing down a facility that doesn't provide the care that is desperately required for someone who has a diagnosis of a severe mental illness and needs very intensive support.
HS wrote, "Despite the clear lacking in care at hospitals like Ancora the reality is that the patients they treat can't live on there own and most do need an inpatient hospital level of care." Stan stated "Sure you can close down the hospitals, (they did that is California a long time ago without private or community resources’ to feel in the gaps, and you had lots of mentally ill people living on the streets without or with very limited mental health care options). So then where do you put these people?"
I think both of their comments show that this issue is more complex than just mandating the closure of hospitals. The consequences could be even worse for those in need of intensive support than what already exists.
Although Stan is not in favor of hospitals serving everyone with a mental illness, he acknowledges that some individuals do that that level of care, "I’m definitely not convinced that institutions are the best way to provide effective mental health services unless we are dealing with the most extreme and dangerous patient population."
I also agree with his analysis that "holistic community based programs would not only be more effective and humane, but would be much more cost effective also." Assertive community treatment (ACT) programs can fill that need, when they are run well and follow the model.
However, in states where inadequate treatment laws exist, those who are unable to seek treatment because of their lack of insight would receive no supports or services at all. Only assisted outpatient treatment laws could help those individuals.
I think we've reached a crisis point in how we approach these issues and intensive attention needs to be paid to providing the proper supports to those who are often the most vulnerable in our society. Until then, we will continue to see an increase of homelessness, incarcerations, and victimization.
We need to act now.
Sunday, March 2, 2008
Reliving the experience
I've been in touch with a new friend who is going through a very similar experience that I had when my daughter's mental illness included a lack of insight that prescribed medications could help her. Because of non-compliance with treatment, she cycled in and out of hospitals, each time becoming more symptomatic, and endangering her life as she wandered off at all times of the day and night. Eventually, after reaching the required level of "clear and present danger to self or others" required by law, she would be hospitalized through an involuntary commitment.
My friend's daughter's journey has also included a month and a half period spent in jail, because while off medications and not thinking too clearly, she attempted to rob a store. This woman is not a criminal and, she had never tried to do anything like that before. Eventually, charges were dropped, after my friend had posted bail. Even the authorities understood that this woman was not well and was acting irrationally. Untreated mental illness does unfortunately, lead some people to listen to voices in their head and/or not listen to the common sense instincts that would have prevented her from attempting to break the law.
My heart truly breaks for my friend and her son who are trying to keep this daughter/sister safe and find a way to help her understand the need to reach out for treatment that has proven effective in the past or to convince the mental health system that she needs very intensive services. Until then, all I can do is be a friend, a sounding board, offer some advice on how to approach the mental health system that no longer seems to believe in long-term hospitalizations or intensive assisted outpatient services and who are not legally obliged to require someone to stay in treatment unless they are a "clear and present danger to themselves or others."
My friend's daughter's situation one more reason why I advocate for changes to our Mental Health Procedures Act in Pennsylvania through the proposed assisted outpatient treatment law, SB 226. Although the majority of people with a mental illness can and do reach out for treatment, this small minority of people with a severe mental illness and lack of insight need a compassionate law that will help them and require intensive mental health services of those whose jobs it is provide treatment.
With the support of other advocates, including this mother, we will hopefully see a better mental health system in place.
My friend's daughter's journey has also included a month and a half period spent in jail, because while off medications and not thinking too clearly, she attempted to rob a store. This woman is not a criminal and, she had never tried to do anything like that before. Eventually, charges were dropped, after my friend had posted bail. Even the authorities understood that this woman was not well and was acting irrationally. Untreated mental illness does unfortunately, lead some people to listen to voices in their head and/or not listen to the common sense instincts that would have prevented her from attempting to break the law.
My heart truly breaks for my friend and her son who are trying to keep this daughter/sister safe and find a way to help her understand the need to reach out for treatment that has proven effective in the past or to convince the mental health system that she needs very intensive services. Until then, all I can do is be a friend, a sounding board, offer some advice on how to approach the mental health system that no longer seems to believe in long-term hospitalizations or intensive assisted outpatient services and who are not legally obliged to require someone to stay in treatment unless they are a "clear and present danger to themselves or others."
My friend's daughter's situation one more reason why I advocate for changes to our Mental Health Procedures Act in Pennsylvania through the proposed assisted outpatient treatment law, SB 226. Although the majority of people with a mental illness can and do reach out for treatment, this small minority of people with a severe mental illness and lack of insight need a compassionate law that will help them and require intensive mental health services of those whose jobs it is provide treatment.
With the support of other advocates, including this mother, we will hopefully see a better mental health system in place.
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