We're all responsible

I received a comment to my previous post yesterday which made me realize that there still continues to exist so much misunderstanding about assisted outpatient treatment laws.

The comment I received was: "Yay. More dead psych patients to come, thanks to you and yours http://youtube.com/watch?v=dx11j0kcLn4. Hard for anyone to remain in treatment when they're killing their patients left and right."

The video is certainly a very sad, tragic story of loss of life due to neglect of the hospital staff and they should be held responsible for not providing the help that woman obviously needed. However, assisted outpatient treatment laws, such as Senate Bill 226, means that a person is provided treatment in the community where they live and they are given supportive services by the mental health agency or provider who is required by the court order to ensure the timely, consistent treatment, including medications, is provided for an individual wherever they reside.

Hospital emergency rooms aren't the only places where people are ignored. I think it is also terrible that, as a society, we walk by homeless people with a mental illness every day and ignore them as they sleep on the streets. They are often victimized (robbed, molested, left out in the elements) and sometimes commit crimes that then put them in jail or prison. People with severe mental illnesses who lack insight to seek treatment are ignored by our mental health system all the time, unless they are engaged in a dangerous activity. Even families who try to help their loved ones who are exhibiting psychotic symptoms and who desperately need help have to wait until there is a "clear and present danger" to report in our state.

So, yes, that video was a stark example of the neglect of the hospital staff and they should lose their jobs. But what consequences should the mental health administrators and agencies face because, on a daily basis, large numbers of people with a mental illness are neglected, too. You don't see them on a video in a psychiatric hospital, but just wander through the streets, visit some jails, or maybe go to a NAMI support group and listen to the families who are unable to help their loved ones obtain consistent treatment because they haven't yet done something to fulfill the "danger to self or others" that is required by law. Or visit the Treatment Advocacy Center's "Preventable Tragedies" site to see how many people we turn our backs on day after day, year after year.

In the end, we're all responsible for this negligence. Requiring our state law to allow for timely, compassionate assisted outpatient treatment would show that we understand and want to help those who lack insight to seek and remain in treatment. Passing Senate Bill 226 would show that we care...it is the responsible thing to do.

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.

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.

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. "

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.

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.

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.

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

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.

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.

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?

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.

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.

TAC's Top 10 List of 2007

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.

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.