NAMI National Convention and link to MTV True Life Series

The NAMI National Convention will be held in just three weeks and I am thankful for the opportunity to be one of the presenters, along with two other advocates from Illinois and California, and the new Executive Director of the Treatment Advocacy Center, Kurt Entsminger, to talk about the advocacy efforts that I have been involved in since I first became a member of NAMI in January 2000.

I was fortunate to be a part of a very important advocacy effort, along with Charles Bechtel and Ted Burchess, that brought the first Program of Assertive Community Treatment (know as ACT or PACT) to Pennsylvania, which is located in Bucks County . As the Co-Chair of our PA Treatment Law Advocacy Coalition, along with Taylor Andrews, Esq., I will have the opportunity to talk about our current advocacy effort to change our state's assisted outpatient treatment (AOT) law through State Senator Greenleaf's proposed SB 226.

Following is information about the presentation that I will a part of, as well as information about the Crisis Intervention Training (CIT) presentation, which includes a good friend, Wendy Stewart, Executive Director NAMI Cambria County, who successfully started the first CIT in Johnstown, PA. We are fortunate that here in Bucks County, Agnes McFarlane is currently heading an effort to bring CIT to our county.

Lastly, I've also included a link to a MTV presentation by young people who have a diagnosis of schizophrenia or schizoaffective disorder and their families who share their personal stories.

From NAMI National Convention 2008 Brochure:

Grand Ballroom E Workshop 3-H One Person Can Make a Difference: Learn to be a Catalyst for Change and Treatment

In this workshop, three accomplished advocates will give you a blueprint for fostering change and creating treatment in your community. The three winners of the 2007 Advocacy Award from the Treatment Advocacy Center will explain how they turned their personal desires to help loved ones with untreated mental illness into powerful grassroots efforts for the reform of laws, programs, and policies denying effective treatment in their states and counties. These three family members relate not only what they have done, but the strategies and tactics behind their successful advocacy.

❖ Karen Gherardini, mental health treatment advocate, Shattuc, IL❖ Jeanette Castello, mental health treatment advocate, Newtown, PA❖ Janice Deloof, mental health treatment advocate, Fullerton, CA❖ Moderator: Kurt Entsminger, executive director, Treatment Advocacy Center, Arlington, VA

9:45am – 12:30pm SPECIAL SESSION Salon 3 CIT – A MODEL FOR ALL COMMUNITIES

CIT programs have been established in hundred of communities in the U.S. and internationally. These innovative collaborations between law enforcement and mental health systems have saved lives and fostered linkages with the mental health system for people who require treatment, not incarceration. This special session on CIT will feature leaders of two cutting-edge and diverse CIT programs – one in a large city, the other in a rural multicounty region. The session will also feature a question-and-answer session with Major Sam Cochran, founder andcoordinator of the first CIT program in Memphis.

❖ Jeffrey Murphy, lieutenant, Chicago Police Department, Chicago, IL❖ Suzanne Andriukaitis, executive director, NAMI Greater Chicago, Chicago, IL❖ Wendy Stewart, executive director, NAMI Cambria County, Johnstown, PA❖ Officer Daniel Marguccio, police coordinator, Laurel Highlands Region Police Crisis Intervention Team, Johnstown Police Department, Johnstown, PA❖ Moderator: Major Sam Cochran, coordinator, Crisis Intervention Team, Memphis Police Department, Memphis, TN
http://www.nami.org/Template.cfm?Section=CIT&Template=/ContentManagement/ContentDisplay.cfm&ContentID=62298


If you haven't seen the MTV episodes on young adults who have a diagnosis of either schizophrenia or schizoaffective disorder and their families you can find it on NAMI's home page: http://www.nami.org/ or at
http://www.nami.org/template.cfm?template=/ContentManagement/ContentDisplay.cfm&ContentID=62365&lstid=275

Inpatient and Outpatient Treatment

The presentation from Mark Heyrman: "Why the Legal Standard for Involuntary Commitment to Mental Hospitals Doesn't Matter" is worth an hour of your time to listen to a very short but comprehensive history of involuntary commitment laws in the United States since the 1950's. Mark Heyrman is Clinical Professor of Law at the University of Chicago Law School and his talk was recorded on November 6, 2007 as part of the Chicago's Best Ideas Series.

Unfortunately though, he limits his talk to inpatient involuntary commitment treatment in hospitals and the difficulties faced by hospitals, both state and private, due to cost of treatment for those with a severe mental illness, as well as the reduction in the availability of psychiatric hospital beds, which have decreased from 55,000 in 1952 to approximately 1,400 now (or a reduction of approximately 95% in all 50 states). He does not mention the positive effects that assisted outpatient treatment (AOT) laws, such as the outcomes from New York's Kendra's Law. And obviously, since it had not yet been released at the time of his talk, he did not refer to the outcomes from the Treatment Advocacy Center's report, "The Shortage of Public Hospital Beds for Mentally Ill Persons."

I do not agree with all of Prof. Heyman's solutions because he does not mention the effects of lack of insight or anosognosia for those who receive (or I should say do not request or accept) mental health services outside of a hospital. His suggestion that increased intensive services in the community alone will solve the problems that the reduction of beds available for those with a severe mental illness has caused does not address the difficulty of providing services to individuals who do not think they have an illness, due to lack of insight.

One of the most important experts on anosognosia, Dr. Xavior Amador, provides a method called LEAP (which stands for listen, empathize, agree, and partner) in his book, "I Am Not Sick, I Don't Need Help!" However, Dr. Amador has also stated and given me permission to post on my blog site that, "AOT is a vital tool that we need to help people who have anosognosia, or lack of insight, for mental illness."

Only a very small minority of people with a severe mental illness and lack of insight need this AOT "tool" that provides court-ordered assisted outpatient treatment, but they are often the very individuals whose lives are devastated when treatment isn't provided. Sensible treatment laws, like NY's Kendra's Law, and PA's proposed AOT law, SB 226, will ensure that those individuals are given the compassionate, timely treatment they deserve.

Avoiding Victimization

I started advocated several years ago for changes to the Mental Health Procedures Act in our state that currently requires someone to be a danger to self or others before treatment is provided. Having experienced the heartache and tragedy of watching my family member go through numerous crisis situations followed by involuntary hospitalizations, I knew something had to change.

From the perspective of law enforcement, who often become involved when someone with a mental illness is in crisis, Dr. Laurence Miller has written an article that appeared on PoliceOne.Com news on May 12, 2008, P1 Exclusive Series: Dealing with mentally ill citizens on patrol.

The part that hit home for me and my main reason for my assisted outpatient treatment (AOT) advocacy efforts is the last sentence in the first paragraph under "Law enforcement response to the mentally ill," which states "However, the mentally ill are far more often the victims of crime than the perpetrators, and are three times as likely to be crime victims as ordinary citizens."

I think that people who have symptoms of severe mental illness and are not able to remain in treatment because they lack the insight to understand the need to take prescribed medications fall into the category of being "three times as likely to be crime victims." Helping someone remain in treatment, even if that requires court ordered assisted outpatient treatment, can help individuals avoid dangerous situations that can lead to victimization.

Involuntary commitment laws based on need for help

I read an article today that appeared in the BN Village, Mentally ill man dies a lonely death on L.A.'s streets . Another very sad, tragic, preventable event occurred in California because someone, Troy Green, who was in desperate need of treatment for his mental illness, did not receive help.

As stated in the article, "Across the country, Los Angeles County sheriff's homicide Det. Robert Harris was also not surprised when he learned the details of his newest case. He said he has seen similar cases again and again: mentally ill people, adrift in gang-populated neighborhoods, falling victim to homicide."

A friend of mine has been trying desperately to keep her daughter safe and able to receive consistent treatment. But, each time her daughter is released from a short stay in a hospital (and one time from a jail), her daughter wanders off and puts herself in a precarious situation that could potentially cause her harm. My friend doesn't want to see her daughter, who has a mental illness and wanders off and sleeps in parks at night, become one of the homeless statistics. But the mental health system only responds when she is a "clear and present danger to herself or someone else." A history of an individuals repeated hospitalizations and/or incarcerations is not considered if it is beyond the previous 30 days for an involuntary commitment.

The next time you see someone who is living on the streets, remember that they may have had a family that tried to get them help but that our mental health system didn't provide that assistance, because, by our outdated treatment laws, they weren't required to help.

Troy Green's sister, Lillian Green, "condemns a system that she said left her with few options to keep her brother safe." She further states, "she understands involuntary commitment laws. But, she says, "It shouldn't be that way. It should be based on whether they need help."

We need to change our commitment laws in all of our states to ones that provide timely help for those with severe mental illnesses who are not able to ask for that help themselves. A decent society would do no less.