When California passed their assisted outpatient treatment law (AOT) Laura's Law in 2003, it passed without mandating that the counties in that state implement it. Unfortunately for the people in that state with a severe mental illness and lack of insight to remain in treatment, few counties are currently making use of that law.
However, according to an article in the California Chronicle, that could soon change. "Senator Leland Yee (D-San Francisco/San Mateo) has introduced legislation that would help local governments in providing assisted outpatient treatment (AOT) for people with severe mental illnesses. SB 1606 would remove a number of unnecessary and cumbersome requirements in the statute known as 'Laura´s Law,' and will allow counties to maximize their local dollars while giving appropriate services to the individuals who need AOT."
As Carla Jacobs, co-coordinator of the California Treatment Advocacy Coalition, states in this same article"We have the framework and a mountain of data to support AOT, what we need is the will from local government leaders to put this statute into action. People are dying who could have been helped."
As many of us advocate for changes to the treatment laws in Pennsylvania, we wish them success to see their AOT law implemented state-wide and will be sure to require that our counties have a mandate to implement our proposed bill, SB 226, when it becomes law.
Wednesday, February 27, 2008
Sunday, February 24, 2008
Self-determination without insight
The letter to the editor , Keep mental health care consumer-driven, that appeared in the Roanoke Times February 21, 2008, pretty much explains why it is so difficult to see changes to the "imminent" or "clear and present" danger levels to our treatment laws and why advocates for assisted outpatient treatment (AOT) bills struggle to see AOT legislation become law in their states.
Fortunately, the majority of individuals diagnosed with a mental illness can and do take control of their own treatment decisions and can rely on a written document, called an advanced directive, to state which treatments they want or would approve of if they were in a crisis situation and they weren't capable of requesting treatment.
Wesley Dickens states in his letter, "In any matter related to mental health, self-determination and empowerment should always be at the forefront of the debate." Of course, that statement ignores the small minority of people with a mental illness who lack insight that they have an illness and by their own self-analysis, do not seek treatment. In their case, "self-determination" can leave them out in the cold, sometimes literally and with fatal results, as mentioned in a recent blog from the Treatment Advocacy Center.
I think it is important to understand that lack of insight or anosognosia can prevent someone from seeking help before they are dangerous or from writing an advanced directive and that they need the sustained treatment that AOT laws provide to keep them out of crisis, until they reach a point where they seek their own treatment.
If everyone who believed in "self-determination and empowerment for anyone with a mental illness" would take the time to read Dr. Xavier Amador's book, I Am Not Sick, I Don't Need Help, I think that they might also begin to believe that a small minority of people with a mental illness may need the consistent, sustained support and services that AOT laws require.
Fortunately, the majority of individuals diagnosed with a mental illness can and do take control of their own treatment decisions and can rely on a written document, called an advanced directive, to state which treatments they want or would approve of if they were in a crisis situation and they weren't capable of requesting treatment.
Wesley Dickens states in his letter, "In any matter related to mental health, self-determination and empowerment should always be at the forefront of the debate." Of course, that statement ignores the small minority of people with a mental illness who lack insight that they have an illness and by their own self-analysis, do not seek treatment. In their case, "self-determination" can leave them out in the cold, sometimes literally and with fatal results, as mentioned in a recent blog from the Treatment Advocacy Center.
I think it is important to understand that lack of insight or anosognosia can prevent someone from seeking help before they are dangerous or from writing an advanced directive and that they need the sustained treatment that AOT laws provide to keep them out of crisis, until they reach a point where they seek their own treatment.
If everyone who believed in "self-determination and empowerment for anyone with a mental illness" would take the time to read Dr. Xavier Amador's book, I Am Not Sick, I Don't Need Help, I think that they might also begin to believe that a small minority of people with a mental illness may need the consistent, sustained support and services that AOT laws require.
Friday, February 22, 2008
The trouble with our mental health system
I just posted a comment on the blog site, The Trouble with Spikol, regarding an article, Leave Britney Alone, that she had posted on February 19th and which I had also referenced on my post of February 13th, Understanding Mental Illness.
My comment to her post:
I've been on the phone this morning with a friend whose daughter was incarcerated for attempting to rob a drug store and who, after spending over a month in jail, was just cleared last week of the charges because they realized that she did so while she was not receiving treatment for her mental illness. Her mother had paid $440 to get her out of jail just barely a month ago, (jails and prisons are now the places where many people with a severe mental illness end up instead of psychiatric hospitals). After bringing her daughter home, she wandered off, listening to the voices in her head that told her to leave, and was found walking in Philadelphia with no shoes on her feet on a very cold, rainy day in January by a good Samaritan who took her took a hospital. Her daughter was given treatment through a 303 involuntary commitment which should have been for 20 days but lasted for 2 weeks.
Back home since this past Monday, she still leaves her home and walks away (she does not drive) at all times of the day and night. Her mom, brother, and neighbors try to take turns watching her, trying to keep her safe on these cold, wintry snowy days. In the past few months, she has been found wandering and has slept in parks and was once found in the parking lot of the Philadelphia Zoo, having taken an overdose of over-the-counter drugs (they did hospitalize her then because she was a "clear and present danger" as required by our current law).
But the voices continue to tell her to leave, and this morning she wandered off again. Her mom called 911. The police picked her up and the mom told him that her daughter was still technically on a commitment order to be in treatment (which should have been the 20 days commitment in a hospital). But, she was released early and, in case you're not aware, that commitment order means nothing in this state once you're released. In theory it should, but it doesn't.
So, this mom and son of this very ill woman who desperately needs treatment just took her to an emergency room to see if they would involuntarily commit her this daughter/sister again, because they are concerned for her health and safety and for want could happen the next time she wanders off without medications or an understanding of the need to seek shelter on a freezing day or night. The mom just called me to say that the crisis center would not admit her because she doesn't qualify under our state’s "clear and present danger" criteria requirement.
So, for anyone who believes that someone with a severe mental illness who lacks the insight to remain in treatment and who constantly put themselves in precarious situations, who does something while not thinking clearly and ends up in jail, who is found unconscious in a parking lot or walking around the city without shoes on a cold, wintry day, please explain to me why you wouldn't want to help someone so vulnerable and ensure that she receives shelter and treatment in a hospital.
No, this woman does not want to be in a hospital, she says that she needs to listen to the voices in her head (these are audio hallucinations that are a part of the psychotic symptoms of some severe mental illnesses). But as a caring, humane society, shouldn't we be helping her in a time of need when she doesn't know better and is making decisions that put her very life in jeopardy? Someone, please explain why withholding treatment is the right thing to do.
Yes, our current laws say that is the right thing to do, do you?
My comment to her post:
I've been on the phone this morning with a friend whose daughter was incarcerated for attempting to rob a drug store and who, after spending over a month in jail, was just cleared last week of the charges because they realized that she did so while she was not receiving treatment for her mental illness. Her mother had paid $440 to get her out of jail just barely a month ago, (jails and prisons are now the places where many people with a severe mental illness end up instead of psychiatric hospitals). After bringing her daughter home, she wandered off, listening to the voices in her head that told her to leave, and was found walking in Philadelphia with no shoes on her feet on a very cold, rainy day in January by a good Samaritan who took her took a hospital. Her daughter was given treatment through a 303 involuntary commitment which should have been for 20 days but lasted for 2 weeks.
Back home since this past Monday, she still leaves her home and walks away (she does not drive) at all times of the day and night. Her mom, brother, and neighbors try to take turns watching her, trying to keep her safe on these cold, wintry snowy days. In the past few months, she has been found wandering and has slept in parks and was once found in the parking lot of the Philadelphia Zoo, having taken an overdose of over-the-counter drugs (they did hospitalize her then because she was a "clear and present danger" as required by our current law).
But the voices continue to tell her to leave, and this morning she wandered off again. Her mom called 911. The police picked her up and the mom told him that her daughter was still technically on a commitment order to be in treatment (which should have been the 20 days commitment in a hospital). But, she was released early and, in case you're not aware, that commitment order means nothing in this state once you're released. In theory it should, but it doesn't.
So, this mom and son of this very ill woman who desperately needs treatment just took her to an emergency room to see if they would involuntarily commit her this daughter/sister again, because they are concerned for her health and safety and for want could happen the next time she wanders off without medications or an understanding of the need to seek shelter on a freezing day or night. The mom just called me to say that the crisis center would not admit her because she doesn't qualify under our state’s "clear and present danger" criteria requirement.
So, for anyone who believes that someone with a severe mental illness who lacks the insight to remain in treatment and who constantly put themselves in precarious situations, who does something while not thinking clearly and ends up in jail, who is found unconscious in a parking lot or walking around the city without shoes on a cold, wintry day, please explain to me why you wouldn't want to help someone so vulnerable and ensure that she receives shelter and treatment in a hospital.
No, this woman does not want to be in a hospital, she says that she needs to listen to the voices in her head (these are audio hallucinations that are a part of the psychotic symptoms of some severe mental illnesses). But as a caring, humane society, shouldn't we be helping her in a time of need when she doesn't know better and is making decisions that put her very life in jeopardy? Someone, please explain why withholding treatment is the right thing to do.
Yes, our current laws say that is the right thing to do, do you?
Wednesday, February 20, 2008
What does it take
It is hard to understand just what it will take before states with too stringent criteria treatment laws, that require an imminent or clear and present danger before treatment is provided, will come to understand the need for timely treatment for individuals with severe mental illnesses who lack the insight to seek and remain in treatment. What happened at Virgina Tech should have opened the eyes of legislators to the need for an effective assisted outpatient treatment (AOT) law, but they failed to act on a proposed bill that could have put an effective law in place.
In an editorial in the Washington Post, After Virginia Tech, the author expressed regret that they didn't really address what needed to be changed, "Other states have adopted more flexible standards under which people can be detained who are likely to become dangerous if not treated, or whose condition is rapidly deteriorating, or who are incapable of making rational decisions about their treatment. The effect of those reforms is to provide treatment to people before they are in extreme crisis -- in other words, before it may be too late."
Virginia's proposed SB 177, as well as Pennsylvania's proposed SB 226, would require the type of supportive services that would help someone avoid extreme crisis and which also helps to reduce hospitalizations, homelessness, and incarcerations.
I look forward to the day when legislators in every state understand the need for sensible, timely AOT laws
In an editorial in the Washington Post, After Virginia Tech, the author expressed regret that they didn't really address what needed to be changed, "Other states have adopted more flexible standards under which people can be detained who are likely to become dangerous if not treated, or whose condition is rapidly deteriorating, or who are incapable of making rational decisions about their treatment. The effect of those reforms is to provide treatment to people before they are in extreme crisis -- in other words, before it may be too late."
Virginia's proposed SB 177, as well as Pennsylvania's proposed SB 226, would require the type of supportive services that would help someone avoid extreme crisis and which also helps to reduce hospitalizations, homelessness, and incarcerations.
I look forward to the day when legislators in every state understand the need for sensible, timely AOT laws
Wednesday, February 13, 2008
Understanding mental illness
Sometimes you read or hear a story about someone who really understands the struggles that individuals with a mental illness and their families encounter and it touches your heart in such a way that it brings tears to your eyes.
The reporter who wrote the article in the Los Angeles Times, Leave Britney alone, had that effect on me this morning.
I also have a family member who was diagnosed with schizo-affective disorder and she is the reason that I advocate for changes to our treatment laws. Witnessing someone you love go through the deterioration caused by untreated mental illness when they lack the insight to receive treatment, while waiting for them to reach a level of dangerousness required by law, is one of the most heartbreaking experiences that you can imagine.
I was recently contacted by CNN asking what it was like to have to seek involuntary commitment orders for my daughter. They then asked if my daughter would appear on TV for an interview, talking about her experiences dealing with her illness. At first she was willing, thankfully she now has the insight to remain in treatment, but after we talked it over, we declined. A big part of the reason was that I didn't want her to appear on their news show because I didn't want her to become a part of the circus that the media has made out of Britney Spears experience.
Although I think that station would have handled the topic of mental illness with dignity, I don't know what other media sources might have picked up on it and I certainly wouldn't want the person who I admire and respect for her courage in dealing with her illness to be exposed to any humilation as some media sources have done to that entertainer and her family. My sympathy goes to all of them.
Mental illness is a biological disease that should be treated and discussed with the utmost respect and compassion for those whose lives are affected by it. The timely treatment that assisted outpatient treatment laws provide should be given to all of those who lack the insight to seek their own treatment.
The reporter who wrote the article in the Los Angeles Times, Leave Britney alone, had that effect on me this morning.
I also have a family member who was diagnosed with schizo-affective disorder and she is the reason that I advocate for changes to our treatment laws. Witnessing someone you love go through the deterioration caused by untreated mental illness when they lack the insight to receive treatment, while waiting for them to reach a level of dangerousness required by law, is one of the most heartbreaking experiences that you can imagine.
I was recently contacted by CNN asking what it was like to have to seek involuntary commitment orders for my daughter. They then asked if my daughter would appear on TV for an interview, talking about her experiences dealing with her illness. At first she was willing, thankfully she now has the insight to remain in treatment, but after we talked it over, we declined. A big part of the reason was that I didn't want her to appear on their news show because I didn't want her to become a part of the circus that the media has made out of Britney Spears experience.
Although I think that station would have handled the topic of mental illness with dignity, I don't know what other media sources might have picked up on it and I certainly wouldn't want the person who I admire and respect for her courage in dealing with her illness to be exposed to any humilation as some media sources have done to that entertainer and her family. My sympathy goes to all of them.
Mental illness is a biological disease that should be treated and discussed with the utmost respect and compassion for those whose lives are affected by it. The timely treatment that assisted outpatient treatment laws provide should be given to all of those who lack the insight to seek their own treatment.
Tuesday, February 12, 2008
Reform with care
"Some -- though not all -- advocates for mental health care reform want the state to adopt a law similar to New York's Kendra's Law, one that would trigger mandatory outpatient treatment well before someone would be considered a danger to himself or others."
This quote, from an editorial from Virginia's Roanoke Times, Reform with care, could have just as easily been published in a newspaper from Pennsylvania.
Both VA and PA are fighting to see a sensible law passed that will allow timely, compassionate treatment for their family members with a mental illness who do not seek treatment on their on due to a lack of insight of their illness. As the article states, "These advocates argue the state should mandate treatment for people who suffer substantial effects from their illness but are unable to understand the nature of it and, without treatment, will deteriorate and become significantly less able to function in their communities."
Changing treatment laws to help those individuals who are often most vulnerable is an effort worth fighting for and Kendra's Law in New York is a proven model that we should follow.
This quote, from an editorial from Virginia's Roanoke Times, Reform with care, could have just as easily been published in a newspaper from Pennsylvania.
Both VA and PA are fighting to see a sensible law passed that will allow timely, compassionate treatment for their family members with a mental illness who do not seek treatment on their on due to a lack of insight of their illness. As the article states, "These advocates argue the state should mandate treatment for people who suffer substantial effects from their illness but are unable to understand the nature of it and, without treatment, will deteriorate and become significantly less able to function in their communities."
Changing treatment laws to help those individuals who are often most vulnerable is an effort worth fighting for and Kendra's Law in New York is a proven model that we should follow.
Sunday, February 10, 2008
Involuntary commitment - helpful in times of crisis
Treatment for mental illness sometimes does require an involuntary commitment when someone lacks the insight to seek treatment on their own which can then lead to times of crisis. As posted in an article on Pantagraph.com, "In Illinois, a new law taking effect this summer could make it easier for people to obtain mental health treatment before they reach such a crisis level."
In Pennsylvania, Senate Bill 226 could help to prevent crisis situations from occurring at all, since it is an assisted outpatient treatment (AOT) law, modeled after Kendra's Law, that has proven results that show a reduction in hospitalizations, homelessness and incarcerations.
Timely, compassionate treatment can make the difference between someone suffering needlessly and finding themselves in dangerous situations that could have been avoided and receiving treatment that allows them to return to their usual routines.
How unkind and unfair it is to withhold the treatments that work - as a caring society, we should do better than that.
In Pennsylvania, Senate Bill 226 could help to prevent crisis situations from occurring at all, since it is an assisted outpatient treatment (AOT) law, modeled after Kendra's Law, that has proven results that show a reduction in hospitalizations, homelessness and incarcerations.
Timely, compassionate treatment can make the difference between someone suffering needlessly and finding themselves in dangerous situations that could have been avoided and receiving treatment that allows them to return to their usual routines.
How unkind and unfair it is to withhold the treatments that work - as a caring society, we should do better than that.
Saturday, February 2, 2008
Timely Treatment Tested
Although I planned to avoid the topic that is currently in most newspapers and on every news station lately about Britney Spears and her need to, at the very least, be evaluated for treatment for a possible illness, I decided to write about my views after all. I ignored it until now because it was presented in the typically exploitive way that most Hollywood stories are told. But, there are important lessons that can be learned about the importance of timely treatment from this situation.
As a mother who experienced the need to have my own daughter involuntarily committed into a hospital for treatment, and as a friend of many people who have had to seek this type of supportive help for their family members when they desperately needed it, I know the heartache, frustration, sense of hopelessness and mixed feelings that we all encounter.
In a perfect world, whenever someone needed help for any illness or disease, they would seek it out on their own, and find the appropriate level of care, services, and treatments that would be beneficial. However, with some illnesses, such as schizophrenia and bipolar, approximately half of the people may lack the insight that they have a diagnosed, treatable illness and therefore they do not seek any medical advice at all. If a family member or friend does not step forward to help and advocate on their behalf, individuals with untreated symtoms of mental illnesses can find themselves in terrible situations, can become a victim themselves or end up homeless or incarcerated.
Watching someone you love deteriorate to a level that is often required by many state laws is both heartbreaking to observe and frustrating, especially when effective treatments are available and could help him or her return to their usual level of health and competency. A family member does feel hopeless if they try to enlist the help that mental health services could provide but are told, "No, your loved one must first pass a test - he or she must first do something that is considered dangerous, otherwise we can't provide any treatment."
Although families who have witnessed this process with their loved one can identify with this experience, others who may not have had this experience can now begin to see the illogical reasoning that withholding treatment implies, and although I still think that this young rock star (who may or may not have a mental illness) and her family should be able to privately handle this situation without cameras and reporters following their every move, they may be helping to bring attention to an issue that is often ignored and misunderstood.
Yes, even families and friends who advocate for changes to treatment laws have mixed feelings about involuntary commitments because we would rather see our loved ones seek treatments on their own, or would rather that their loved one didn't have an illness at all. All of the parents I know hope to see their family members make their own choices and live independent lives. But, when we see our loved ones suffer and watch them deteriorate, few can turn their backs and just hope for the best. If you put yourself in that position, would you?
As a mother who experienced the need to have my own daughter involuntarily committed into a hospital for treatment, and as a friend of many people who have had to seek this type of supportive help for their family members when they desperately needed it, I know the heartache, frustration, sense of hopelessness and mixed feelings that we all encounter.
In a perfect world, whenever someone needed help for any illness or disease, they would seek it out on their own, and find the appropriate level of care, services, and treatments that would be beneficial. However, with some illnesses, such as schizophrenia and bipolar, approximately half of the people may lack the insight that they have a diagnosed, treatable illness and therefore they do not seek any medical advice at all. If a family member or friend does not step forward to help and advocate on their behalf, individuals with untreated symtoms of mental illnesses can find themselves in terrible situations, can become a victim themselves or end up homeless or incarcerated.
Watching someone you love deteriorate to a level that is often required by many state laws is both heartbreaking to observe and frustrating, especially when effective treatments are available and could help him or her return to their usual level of health and competency. A family member does feel hopeless if they try to enlist the help that mental health services could provide but are told, "No, your loved one must first pass a test - he or she must first do something that is considered dangerous, otherwise we can't provide any treatment."
Although families who have witnessed this process with their loved one can identify with this experience, others who may not have had this experience can now begin to see the illogical reasoning that withholding treatment implies, and although I still think that this young rock star (who may or may not have a mental illness) and her family should be able to privately handle this situation without cameras and reporters following their every move, they may be helping to bring attention to an issue that is often ignored and misunderstood.
Yes, even families and friends who advocate for changes to treatment laws have mixed feelings about involuntary commitments because we would rather see our loved ones seek treatments on their own, or would rather that their loved one didn't have an illness at all. All of the parents I know hope to see their family members make their own choices and live independent lives. But, when we see our loved ones suffer and watch them deteriorate, few can turn their backs and just hope for the best. If you put yourself in that position, would you?
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