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Missouri
Partners in Crisis Advocating Mental Health and Substance Abuse Services |
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Missouri
Partners in Crisis Advocating Mental Health and Substance Abuse Services |
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News Index Mental Illness Awareness Week, October 7– 13, 2007 What is Mental Illness Awareness Week? Mental Illness Awareness Week (MIAW) is an annual observance, created by a presidential proclamation in 1986 to recognize “the urgent need to educate the American public about mental illnesses and their treatments,” and in recognition of the National Alliance on Mental Illness’ efforts to raise mental illness awareness. MIAW activities will be held across the country from October 7-13, 2007. During this week, millions of Americans will honor the challenges of mental illness, as well as celebrate the recoveries they or their loved ones have embraced. MIAW provides an opportunity to bring the National Anti-Stigma Campaign (NASC) into your community and to the attention of your local media. How can you focus on the NASC during MIAW?
To spread the word about the NASC, order free materials from SAMHSA’s National Mental Health Information Center (NMHIC). You can access a list of materials on the NASC Web site at http://www.whatadifference.org/site.asp?nav=nav00&content=6_0_media. Due to shipping delays, contact NMHIC as soon as possible. If you are interested in ordering fewer than 100 copies of any material, please call NMHIC at 1-800-789-2647. If you would like to receive more than 100 copies of any material, please fax a request on your letterhead to 1-240-221-4295. Make sure to note the reason for your large order and let NMHIC know that you need the material by October 7th. Please keep in mind that orders may take several weeks to arrive. Please contact the NASC Liaison, America Doria-Medina (America.Doria-Medina@macrointernational.com) or Elizabeth Edgar (nasc-liaison@nami.org), if you have any questions or need assistance.
ADVOCACY TRAINING
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Missouri Partners in Crisis Newsletter - Vol. 2, Issue 2, July 2007
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Soft Steps... Legislative Efforts Reps. Chuck Portwood and Margaret Donnelly “went to bat” for mental health this session. In a daring, last-minute effort, Rep. Portwood introduced an amendment on the House floor to fund Assertive Community Treatment programs. During Conference Committee hearings, Rep. Donnelly worked tirelessly to try to convince the legislative leadership that transportation funding for DMH clients should be included. Both did a terrific job of educating their fellow lawmakers about the merits of ACT, Diversion & Re-Entry programs, and Transportation/Housing issues. To date, ACT funding of $1.8 million has been awarded. Transportation/housing funds have not been included. Since the Governor signed the budget bill which includes ACT funding, approximately 500 individuals across Missouri with serious and persistent mental illness and/or substance abuse problems will be helped! Activities Members of the PIC Steering Committee have been busy discussing implementation criteria for ACT programs. Fidelity to the National NAMI model and geographic considerations are two criteria the group is requesting. Data collection to monitor outcomes and DMH oversight are two others. Areas of the state that already have CIT training and Mental Health Courts should be given priority. Members have also been busy drafting “thank you” letters to Reps. Portwood and Donnelly as well as the Senate Appropriations staff. Federal Funding The Missouri Foundation For Health sponsored a health summit, “The Intersection of Health & Business," on May 24th. The main speaker, Ron Pollack, from Families USA, talked about the need for Missourians to ask U.S. Senators Kit Bond and Claire McCaskill to re-authorize the SCHIP program for children’s health insurance. SCHIP expires in September; 60 votes are needed for its passage. Pollack reported that MO stands to gain $967 million, which is 3 times the amount MO would normally receive in federal funds. Approximately $30 million will come from the Tobacco Tax; some will come from overpayments to Medicare Advantage, and some will come from improved tax collection methods resulting in more capital gain taxes. “Lots of kids in MO who are eligible are not enrolled," he said. (Senator McCaskill can be reached at: 202-224-6154; Senator Bond at: 202-224-5721). Pollack said health care will the #1 topic in the 2008 presidential race. Questions or comments:
Deena Dailey, Director, Missouri Partners in Crisis,
ddailey@namistl.org,
314-775-1600
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FACTS on Health Insurance "45 million people in the U.S. are uninsured; 700,000 in MO.” ...Ron Pollack, Families USA “I didn’t go into business to provide health care to my employees." ...Jim Henderson, President, National Federation of Independent Businesses “We are seeing strange bedfellows developing new approaches that combine the private and public sector." (Groups coming together: AARP, Chambers of Commerce, American Hospital Association, Labor). ...Ron Pollack, Families USA “We have to work within Medicaid/Medicare. The private sector is driving the Massachusetts universal coverage model… Prevention and health awareness are important." ...Steven Lipstein, Pres. & CEO, BJC Healthcare
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EDITOR'S NOTE: "Mental Health Disorders Going Untreated Due to Cultural Stigmas" is the third of BlackAmericaWeb.com's four-part Operation Healthy Us series. For the rest of the series, as well as other articles, go to www.BlackAmericaWeb.com.
For many black Americans suffering from chronic mental health disorders, there is no clear plan to manage emotional turmoil: They just ignore it.
"By the time black people come for medical help -- and assistance with mental health problems -- their lives are a mess," Dr. Robert Atwell, immediate past president of the Association of Black Psychologists, told BlackAmericaWeb.com Wednesday.
"Black people are very unlikely to acknowledge a problem with mental illness even when we recognize it because we are avoiding the shame of the stigma of mental disorders," Atwell said.
The statistics are troubling:
Atwell, a clinical psychologist based in Denver, said that many African-Americans -- particularly older black folks -- also harbor a deep "cultural mistrust" of white physicians and often times won’t allow white doctors to analyze their emotional well-being.
"There is a history of the medical profession actively working in a way that is detrimental to black people -- like using them as experimental subjects years ago," Atwell told BlackAmericaWeb.com. "There’s a systemic belief that they’re out to get us. This accounts for a magnification of the resistance to seek medical treatment for mental disorders."
A study published on the Journal of Black Psychology website shows a correlation between racism, stress and mental health problems. And according to the Office of Minority Health with the U.S. Department of Health and Human Services, mental illness has become a debilitating illness.
"Mental health problems are real. They affect one's thoughts, body, feelings and behavior. Mental health problems are not just a passing phase. They can be severe, seriously interfere with a person's life, and even cause a person to become disabled," Atwell maintained. "These disorders cause distress and result in a reduced ability to function psychologically, socially, occupationally, or interpersonally. People who have a mental illness might have trouble handling such things as daily activities, family responsibilities, relationships, or work and school responsibilities. You can have trouble with one area or all of them, to a greater or lesser degree. And you can have more than one type of mental illness at the same time."
Atwell said Americans across the board have a "natural resistence" to treatment for mental disorders, but said black people in particular refuse treatment because of the stigma associated with mental problems.
"Black people tend to seek treatment in the later stages of illness so they are much sicker by the time they walk through the door," Atwell said.
For many blacks, Atwell said, the stress of emotional and mental distress, often manifests itself through physical pain and even serious illness.
"Sometimes stress and mental disorders shows up through body aches and pains and ulcers," he said. "Immune systems are also impacted and people are constantly sick."
Atwell added that many black Americans are experiencing emotional disorders -- moderate or severe -- that they have kept to themselves for decades.
"Sometimes I see photos of people in their childhood, and in the photos, they are never smiling," he said. "So as adults, these people are not always despondent, but they’re not happy, either. These are disorders that people need help working through."
Black women, according to www.blackwomenshealth.org, are faced with a myriad of health-related challenges, including depression.
"It has historically been difficult to treat mental health problems in African-American women," the Web site says. "One reason for this is that black women tend to minimize the serious nature of their problems. Many believe their symptoms are "just the blues" and are not proactive in changing their condition. There also exists a stigma placed on mental health problems within the African-American culture that they are a sign of personal weakness, not a sickness."
"African-American women tend to rely on supports other than mental health services," according to the website. "There is a strong reliance on community, the support of family and the religious community during periods of emotional distress."
Atwell told BlackAmericaWeb.com that black women are often conditioned by society to take on added burdens, to tough out life situations and put more pressure on themselves.
"Some black women will carry on while ignoring their own well-being," Atwell said. "They will function despite severe distress."
While some black men may not recognize their own mental disorders, Atwell said, others may realize they have problems but will turn to drugs and self-medication to ease the dysfunction.
"Men are socialized to tolerate stress without complaining," he said. "They will know things are painful; and life is difficult, but they don’t seek help until life becomes unbearable. I point out [hypothetically] that they can ask for help after losing a few drops of blood; they don’t have to lose a pint of blood, or bleed out before coming for help."
And, he said, "black men will not own up to their own emotional problems and will turn to substance abuse, which relieves them of stress, but is very self destructive."
According to the Office of Minority Health and the U.S. Department of Health and Human Services:
For more information about mental health:
SAMHSA Center for Mental Health Services
National Institute for Mental Health
American Psychological Association
American Psychiatric Association
National Alliance for Mental Illness
National Mental Health Association
News from the TREATMENT ADVOCACY CENTER Index
Visit our web site
www.treatmentadvocacycenter.orgBlog TAC -
http://tacenews.c.topica.com/maah2qpabBAwobIYlo5b/1. DAILY BULLETIN (CA), September 26, 2007
[Editor's Note: Tonight 200,000 Americans with severe mental illnesses will lie down to, hopefully, sleep on steam grates, in the woods or - for the lucky ones - within a packed shelter. For most, the ticket out of that confounding situation is treatment.]
THE MENTALLY ILL HOMELESS: THEIR SUFFERING IS OURS TOO
By Mary Walker Baron
I have a friend who never owns a car she can't live in. She has "been there" and doesn't want to ever "done that" again. She knows better than many that permanent housing can be fragile and transitory.
A recent report from SAMHSA (Substance Abuse & Mental Health Services Administration) tells us that over a five-year period, 3 percent of the population of this country will experience at least one night of homelessness. Should that seemingly small percentage of our population happen to become homeless at the same time, at least eight million people will be looking for a safe place to sleep. The largest demographic group of homeless is single men. One out of every three of those homeless men is a veteran.
Families are the fastest-growing homeless population, soon to be followed by the homeless elderly. At least five percent of the youth in this country will be at one time or another - before they enter adulthood - homeless.
"What's going on here?" we are hopefully asking ourselves. Our question is answered in part by the August special report from the California Budget Project. About two million of California's working families have incomes well below the federal poverty line. In addition to not earning living wages, more workers in California are less likely to have job-related benefits than they were a generation ago. These findings present us with the horrifying reality that more and more Californians live from paycheck to paycheck with limited financial reserves to deal with crises such as unemployment or illness.
Factor into this increasingly dismal picture the reality that only 4 percent of the people in this country suffer from a serious mental illness while at least 20 percent of the homeless are seriously mentally ill. Are those who suffer from serious mental illnesses more likely to become homeless or are those who have become homeless more likely to develop serious mental illnesses? Ultimately it doesn't matter how the adolescent boy or the elderly woman wound up sleeping in the doorway. The urgent issue must be shelter for both of them.
Within the spectrum of housing, many are lucky transients who enter homelessness and exit homelessness quickly. For those who suffer from serious mental illnesses, however, the exit from homelessness is extremely difficult and frequently fleeting.
Unable to access essential resources, the seriously mentally ill homeless descend deeper and deeper into this national crisis. Wearing torn and dirty clothes, they sit at bus stop benches talking not to themselves but to beings invisible to passing motorists. Responding to voices telling them they are hateful and should be punished, they crouch in fear behind supermarket dumpsters. Wanting to contribute to society, they look for jobs and are turned away because they haven't showered in days.
Being homeless is difficult enough. Being homeless and suffering from a serious mental illness is far worse.
Until recently the state of California boasted one of the most successful mental health programs in the nation. Our statewide AB 2034 programs were created to address the needs of the severely mentally ill homeless. The $55 million allocated to those programs was cut from the state budget while other, seemingly less important, concerns remain funded.
Tri-City Mental Health Center's AB2034 program continues - without state funding - to respond to the needs of a hundred men and women who have been homeless and who suffer from serious mental illness. It can't provide housing and vocational services and medication support services and intensive case management services much longer, though.
The woman in white who up until two years ago spent her days surrounded by shopping carts and black trash bags will not return to the streets. Because of Tri-City's AB 2034 program she now lives in permanent Section 8 housing. Others will not fare so well. The money is gone.
These severely mentally ill homeless people are not our strangers. They are our veterans, our cousins, our daughters, our teachers, our brothers and my friend forced again to live in her car. They are ours, and might even one day be you and me. Now, because the money is gone, this tragedy, too, is ours.
Mary Walker Baron, LCSW, is interim program chief at Tri-City Mental Health Center in Pomona.
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2. PBS NEWSHOUR, July 2, 2007
[Editor's Note: There are many Assertive Community Treatment teams in the United States, but few like that of Rochester, New York's Project Link. This program has a forensic treatment team that is focused on people who have become ensnared, most often repeatedly, in the criminal justice system by the unchecked symptoms of severe mental illness. Most ACT teams have little recourse when a client refuses obviously needed treatment, but the treatment of most of those in Project Link is "leveraged" through the criminal system. One of the chief reasons for the success of the program is that for those in it non-compliance can mean re-incarceration.]
EXTENDED INTERVIEW: MENTAL HEALTH EXPERT EXPLAINS ASSERTIVE COMMUNITY TREATMENT
Psychiatrist Dr. Robert Weisman is the director of Project Link at the University of Rochester Medical Center. Project Link is a collaboration between the university and local community service agencies that aims to provide health care for people with serious mental illnesses who end up in the criminal justice system.
SUSAN DENTZER: Let's start off by talking about assertive community treatment. What is it?
ROBERT WEISMAN: Assertive community treatment is taking the mental health care to the individual that we're serving. This differs from traditional care where someone would come in and receive their care in a clinic. They would come, see a doctor, a nurse, a therapist, get their medication, go to a group. But there are a group of individuals that don't access that care, and for those individuals, assertive community treatment provides that necessary outreach so that they can get the treatment they need.
SUSAN DENTZER: And when we say forensic assertive community treatment, what are we talking about?
ROBERT WEISMAN: It's also an outreach program, but it differs from traditional assertive community treatment in that we integrate or collaborate with the criminal justice system, whether that's parole, probation, mandated care, or the court system. We communicate, collaborate for the care of the individual in the community.
SUSAN DENTZER: Let's talk about why that's necessary. In the big picture sense, what happens to people who are mentally ill that often entangles them in the criminal justice system?
ROBERT WEISMAN: By the nature of certain severe mental illnesses, let's say schizophrenia, someone may lack the insight or the appreciation, or deny their illness and not show up to treatment. And what happens is they may be out in the streets not taking their treatment, getting involved with drugs and alcohol, and as a result what can happen is they may end up in petty crimes, or maybe even more serious crimes. They end up in the wrong place. Rather than receiving treatment, they get locked up.
Now, there are a certain portion of individuals that need that intensive care, and that's what our program, Project Link, or that forensic assertive community treatment model does.
Project Link works with the criminal justice system, if you will, the three C's. We're the clinical care that works in collaboration with the criminal justice system, to help the client and the family to survive in the community.
SUSAN DENTZER: A lot of these people do wind up in jails or in prisons, correct?
ROBERT WEISMAN: That's correct. As I said, as a result of sometimes just nuisance behavior, or petty theft, or loitering, individuals may end up in the criminal justice system--first in the jails, and if they have longer sentences, may end up in prison. And depending on individual studies, that number may reach anywhere between 6 to 15 or 20 percent of the population being mentally ill in jails and prisons these days.
SUSAN DENTZER: Okay, and a case in point was Byron [a member of Project Link]. Let's talk about his case for a moment. Tell me about Byron, starting from when he appeared to be exhibiting symptoms of paranoid schizophrenia in his late teens, and what has happened to him since.
ROBERT WEISMAN: Sure. Byron's been in Project Link now since the late 1990s, since our program was developed, and Byron's story is not unlike a lot of other folks that we serve. Byron started out as a healthy young male, had odd jobs, went to school, traveled with his family from Rochester to Connecticut, and came back.
Around the late teens, early adulthood he started expressing symptoms of his mental illness and that included hearing voices, being hostile, having paranoid delusions, and prior to even enrolling in our program, he had around 10 hospital admissions for his mental illness.
The ultimate instance where he ended up into our program was following a visit to Washington, DC. One day Byron decided that he himself wanted to speak with the President. He had this idea. He was able to take his son - he had a nine year old son at the time--remove him from his mother's custody, was able to obtain two bus tickets and go to the White House. He ultimately was apprehended by the Secret Service and locked up for attempting to move into the White House.
He was released the next day, and I might note that while he was locked up, he ended up getting in a fight, into a fist-fight with another inmate there. He was released the next day from jail, and in fact ended up back at the White House, and repeatedly had to be apprehended.
SUSAN DENTZER: And he told us the story today, his brother retrieved him, took him to Baltimore. He eventually is brought back to Rochester. What happened then?
ROBERT WEISMAN: He was brought back to Rochester and was hospitalized at our local Rochester Psychiatric Center. That's a state facility, a long-term psychiatric institution. He was stabilized on medication and then released into Project Link.
What that allowed us to do then was to follow Byron at his home. We worked with his family, we made sure his medications were delivered on a regular basis.
But that still didn't solve all the problems. What we had to do was make sure that Byron took his medication. And as I spoke about before, people with severe mental illness often deny that illness, and don't feel that they need the treatment that's offered to them. And in Byron's case, there have been lapses, and he has fallen sick as a result. He's ended up back in the hospital, he's ended up entangled with police, and has put himself and sometimes other people at risk as a result.
More recently, Byron was released from the hospital. As you saw today, he's taking his medication. He's accepting his illness, and he's accepting injectable treatment, which is not an easy hurdle to overcome.
We are aware, though, based on reality, that Byron may stop again. What our program can do differently, though, than traditional care is that we can see early emergence of symptoms, and then hopefully treat him rapidly, or take the necessary steps to protect him or others.
SUSAN DENTZER: Now let's talk a bit about how Project Link works. Who carries it out? When a person becomes involved in the program, whom does that person see from Project Link and on what kind of a basis?
ROBERT WEISMAN: Sure, what Project Link is, is an actual mobile treatment team. If you will, you understand the intensive care unit at any hospital, USA. It has a number of staff, much higher than the rest of the floors, for the number of patients it serves. It's intensive, it costs a lot of money, and it requires very competent people to work there.
Our program is, if you will, the mental health ICU in the community. We go out, see people frequently, have the numbers to do that, and the support to do that.
In Byron's case, we go visit him if necessary daily. If he's doing well, we may titrate that down and see him on a weekly basis.
As he came out of the hospital this time, he's taking his medication. He looks stable, but we're always aware of the next turn of events that can occur. And what's important about our program is that we're available to both him and his family, and to see if there is any emergence of symptoms before he gets in trouble, or someone like him gets in trouble.
SUSAN DENTZER: And even with this program, he still is not entanglement free vis-Ã -vis the criminal justice system. He still is having episodes and he's still not completely adherent to his medication. He's gone off on these periods where he hasn't been taking his medication. So let's talk about that, that even with all of this, the challenges remain.
ROBERT WEISMAN: The challenges remain for a specific population that we serve in Project Link. Project Link is not for every person with mental illness. It's for the most seriously ill who are not adherent to treatment, who don't show up to traditional care. Knowing Byron and others like him who do well when they're treated really offers us, I think, the benefit of being able to see him do well when we visit him.
If he were left to traditional care, he may not show up, he may not take his medication, he may end up in the throes of the criminal justice system, or worse. Byron can look intimidating when he's not under appropriate care, and under an untrained eye he may be challenged. Someone, including himself or others, can get hurt, and we've seen that in the past.
Our job both is to keep an eye on his care, but also public safety, but at the same time all of our work is about improving autonomy of the individuals we work with.
SUSAN DENTZER: How so?
ROBERT WEISMAN: If someone is able, as you saw with Byron, to take his treatment, to get a better understanding of his illness, and have a reasonable acceptance of our treatment, he may be able to step back into work, to follow up with group programming, and maybe even develop relationships and improve his relationships and care-taking ability with himself and his family.
SUSAN DENTZER: Now, let's say something, because it's important for people to understand that it's not like you fix this, you cure the problem and the person is fine, that this is really a lifetime commitment for him and for you. [...] Do you ever succeed to the point that you could stop doing this for someone?
ROBERT WEISMAN: Unfortunately for severe mental illnesses, there are no cures that exist. But what we can do, is graduate our need of care or the delivery of care for those individuals who need it, rather than just assume one size fits all.
Byron will have mental illness for his whole life. Until we obtain a cure, he will still need our services, and hopefully will get a better understanding to stay on his treatment, and maybe transition to traditional services. The challenge is this is not just a mental health concern. This is a public health problem, and we need to continue to address that.
SUSAN DENTZER: Now, this program is not cheap. What does it cost?
ROBERT WEISMAN: It's difficult to ascertain what it costs, but we can add up all the costs of staffing, with wraparound funding, with insurance costs. We did a study looking at individuals over a year's period prior to entry into Project Link, and then the year after enrollment, and what we discovered is we were able to reduce their service utilization costs -- that's going to the hospital, arrests, jail and prison days -- by almost one-half for the year following enrollment.
So we know that this program costs money to run, but it also saves money as far as service utilization, and hopefully improves the community tenure of the folks we work with.
SUSAN DENTZER: Is it at least a break even situation, or is there a net additional cost to running this?
ROBERT WEISMAN: Well, there are additional costs, but again if you look at the comparison to an intensive care unit, let's say for a heart attack, or someone who has a stroke, that can run into the thousands of dollars per day. Being an inpatient for psychiatry can cost up to a thousand dollars a day, not including emergency room costs, not including the cost maybe of apprehending them and bringing them in with law enforcement, and also not including the considerable regression personally that can happen to somebody who is brought in under an arrest situation.
So it's really a losing situation both financially and personally if we can't help people in the community and prevent them from declining.
SUSAN DENTZER: Does society come out ahead with programs like these?
ROBERT WEISMAN: I think they do. Byron's a good example. You heard about his history, the potential risk for himself, to a ten year old boy. In this day and age with Homeland Security, someone walks into the White House with the wrong idea, tragedy can occur.
If we are able to treat them as they are in the community, for those who fall through the traditional care cracks, we may be able to prevent some of these tragic events that we've seen in the past.
SUSAN DENTZER: Now let's talk about the parallels, if any, to the case of Cho. Here is a young man who is picked up because he's sending harassing e-mails to female students. He's referred into at least the campus police, possibly also the justice system. He ends up being ordered to get mandatory outpatient treatment, and nothing happens.
First of all, how might things have functioned differently for him had he been in a jurisdiction that had a program like this?
ROBERT WEISMAN: It's always difficult to tell if a program like Project Link could prevent every tragedy. What's important and what we've seen, though, since the inception of our program is that we've been able to work with very high risk individuals, at risk for criminal justice involvement, and work with their families to prevent some of these tragic events.
What we do, I think, [is] work with the clients, work with their families, and that we integrate with that the criminal justice piece, that conditional release, that mandated care. We communicate after releases of information have been signed, to make sure that person is leveraged into treatment rather than leveraged into the criminal justice system.
That may sound like we're soft on crime. This program is not about being soft on crime. It's about treating mental illness, and preventing bad outcomes as a result of untreated mental illness.
Our ability to communicate with those leveraging facilities allows us to keep people in treatment and hopefully better their lives as well as keep an eye on public safety.
SUSAN DENTZER: What are your thoughts about the Cho case? What should have happened?
ROBERT WEISMAN: It's a very complex case. There's been a lot written about it. I was unable to evaluate the individual involved, so I don't want to make an opinion about his diagnosis or what should have been done. But what needs to be done in all cases, whether it's like Cho or others, is to have that level of communication or collaboration -- the three C's again: the clinical care combined with the criminal justice system, to keep our clients and their family members safe and well in the community.
SUSAN DENTZER: Here in Rochester, Judge Marks, whom we're going to see today, would see a client like this, like Cho perhaps, and say that he is a danger to himself or others, and recommend him into this system. Walk us through the steps. Let's say the phone rings today and it's a person much like Cho, hauled before the judge. What happens?
ROBERT WEISMAN: Well, we look at our risk factors and we can talk more about that. The risk factors include being off treatment, being involved with drugs or alcohol, having a family history of illness, and maybe hanging around with the wrong crowd, access to weaponry, and maybe limited oversight or support.
These are some of the common denominators that we see that end people up in trouble, jail, prison, or in untoward behavior.
Our role is to, at first blush, when we get that referral, to start looking to see what are the supports and strengths that individual has, and what are the potential pitfalls that they may fall into. Working then with support services, talking with the judge about what is the best treatment plan, and also looking at what type of legal leverage or what we call therapeutic leverage can be meted out so that we can properly serve that individual, avoid an unnecessary incarceration, and avoid an unnecessary bad outcome.
SUSAN DENTZER: What I need you to do is connect the dots for me and sort of lay out almost like a diagram, because if you look at the diagram of what happened in Cho's case, everything goes right. It gets referred to the judge. The judge says he needs mandatory treatment, and then it stops. So tell me how all the dots get connected. What are the dots here and how do all the dots get connected?
ROBERT WEISMAN: If Judge Marks calls me, I'll pick up the phone, she'll give me the name of the individual who is in question, she'll hopefully have some form of diagnosis that we can start with, and then we'll screen that individual to make sure that we can provide the necessary care that he or she needs.
Then what we'll do is we'll set up a very immediate appointment to go out and outreach to that person. We may even see that person while they're in custody. They may be in jail. We'll do a jail visit. Our mobile treatment team, our mobile ICU will go out there, which includes myself, nurse practitioner, case advocates or case managers to assess and find out what would be the best treatment plan for him or her.
Then we would give that report back to the judge. The follow-up appointment would be made, and the judge would have a schedule that that person needs to come back, check in, have an advocate with him to describe whether or not he or she is following that proposed treatment, and then decisions are made in a fluid way.
Each visit may be different. Somebody may be on their medication and doing well, or as often happens, someone may be off their medication, using drugs or alcohol and ending up in trouble. And that legal leverage standing over them, although sometimes coercive, may prevent them from harming themselves, others, and having a quality of life that's impeded.
SUSAN DENTZER: Let's imagine for a moment that a program like this had been in place in the area surrounding Virginia Tech. What do you think could have been forestalled?
ROBERT WEISMAN: It's again tough to tell. What again this underscores -- the Cho case or any other case -- is the need for the criminal justice system or mandated treatment programs to be able to communicate with the clinicians to have that [...] care. Neither one of those programs, the criminal justice system or the mental health system, can deal with this alone. We need to work together in a treatment-focused manner, and also consider the individuals' rights, but also understand the limits of their illness and what that can mean to their outcome.
SUSAN DENTZER: When the federal report comes out in a couple of weeks and the state report will come out at some point in the indefinite future, what do you think should be in it vis-Ã -vis recommendations along the lines of this program?
ROBERT WEISMAN: Well, of course I would say we should have more of our programs. These programs are intensive, but Dr. Lamberti and I go around the country doing technical assistance work and consultation, and no matter big or small community, there is a need for these kind of programs where we can collaborate between the mental health system and the criminal justice system.
There are a number of clinical services available in the United States, especially for those with mental illness, and that serves a particular population. But those who are at high risk for potential decline, those who do not access care, or are demonstrating high-risk behaviors that are not serious enough to be in the hospital need programs such as Project Link that look at that forensic aspect to make sure that that communication doesn't get overstepped.
SUSAN DENTZER: And to the degree there are not these programs around the country, why is that?
ROBERT WEISMAN: It's hard to tell. Again, these programs cost money. I think there are more and more programs being developed, and we've done some research about that to look at them. A lot of these programs were developed out of grant funding, and grant funding has a beginning, a middle and an end. And when they end, it's all about what can we do, or what can programs do to sustain themselves, and that's often easier said than done.
We have clinicians running these programs, academicians, and not necessarily people who hold the purse strings to the funding streams, and it's important that we make sure that the clinical care is there, that collaboration is there, but also that there is sustainability for programs as they are developing these days.
SUSAN DENTZER: Which means money.
ROBERT WEISMAN: Which means money.
SUSAN DENTZER: A steady stream of funding.
ROBERT WEISMAN: A steady stream of funding, but also the competent care. It can't just go to any odd clinic. This is a special group of individuals who need this care, and it requires, like the intensive care unit, specially trained individuals to do that intensive work.
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Biggs Forensic Hospital Tour Notes - July 10, 2007 Index
(PIC Co-Chair Nancy Leazer and Steering Committee members Bruce Eddy and Deena Dailey met with Russ DeTrempe, Maximum Security Unit Director, and Ken Lyle, Chief Financial Officer for Biggs. For an hour and a half we discussed the facility, its work and its many needs. Bruce talked about the advocacy work of the PIC. We then took a long tour of the Maximum security unit).
Biggs is a MAXIMUM security facility.
CLIENTS:
The overall goal is to restore these clients’ competency. Biggs has a “discharge guru” for this purpose. The practice now is for Public Defender to send clients to Biggs requesting “no meds.” The PDs do not want meds forced on their clients because the practice goes against their civil rights. Biggs does not force meds but recommends them. Clients who stay in the forensic unit without meds often end up long term. One client has been there 6 years. Once clients have the “forensic” label, they are often forgotten. (The client who has been at Biggs 6 years does not want to leave).
FACILITY/FUNDS:
The entire Biggs complex has been running at 496 capacity the last 4 or 5 years. Currently, it has 560 patients. About 220 are in the MAXIMUM security unit that we visited. About a month ago, 25 beds were added. Before that, 20 beds had been added. There are still not enough beds. This is due in part to the huge rise in the number of competency to stand trial cases and is true across the country. Hospitals all over the western part of the state are on diversion. Workers in the MAX unit are always searching for available space. Biggs receives clients from all over the state. Clients have little privacy, especially during the day.
Currently, Biggs has a $700,000 shortfall. By end of the year, they will need $3 million to cover expenses. One problem is the mandated payments for staff for which Biggs has no extra money. As for the facility itself, it would take $360-400 million to build a new forensic center based on today’s standards. Biggs was built in 1937 and added onto in 1966. It was built like a prison since, at first, it only housed the “criminally insane.” The units need new infrastructure. There are dead spaces where clients cannot be viewed even with cameras. There is no privacy for visitors. Unstable clients are no longer brought through the front of the building where visitors wait.
PROGRAMS:
CDRP is the cognitive rehab program for those with personality disorders. CP is for people who are high-functioning but are schizophrenic or bi-polar. Where someone is placed depends on their behavior, not their offense. The SOP is the social program for clients who are low-functioning.
Admission program:
Biggs has a contract with the Dept. of Corrections for those with civil commitments and those who are acute. They also have a Volunteer by Guardian admission for those who are behavior problems in other mental health facilities; those with major charges but not NGRI. There is a step-down program to Goulman, the medium security facility.
Safety Initiative:
Biggs has been decreasing the use of restraints considerably. They have been using former clients in their programs and have started the “Peace Club,” which focuses on non-violent behavior. Since the safety program started about seven years ago, the injury rates to clients and staff has declined.
MAIN PROBLEM:
The center is over capacity and cannot keep up with inflation. Example: food costs went up 12% from last year. The cost of medications has also risen. The facility is “throwing good money after bad” by adding new air conditioning to the gym, etc. The building is outdated and obsolete.
Ken Lyle, the CFO for Biggs, talked about how the better use of $2.3 or $3.3 million is intensive outpatient. Many of their clients could be served in the community. And, MRDD clients are clogging up/taking up services.
Other problems:
A systemic problem is the increasing number of “Incompetent to Stand Trial” clients. Many could be placed in DOC after their medications are adjusted and they are stabilized. Biggs staff could provide technical assistance and training for corrections officers.
ON PRIVATIZATION:
The problem is managing providers (accountability) AND personnel concerns. Getting qualified people to stay is difficult. Most direct care staff (Forensic Rehab. Specialists) have only high school educations. Fifty direct care staff are required per shift; 3 staff for every 20 beds. Mandated starting salary is about $26,000. Most experienced staffers have moved over to the Goulman Center which is medium security. Thus, the most inexperienced are working with the most difficult clients.
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Gunman's case highlights a crisis in care
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In Missouri, getting help for mental illness can be frustrating, difficult. By ERIC ADLER The Kansas City Star May 1, 2007. From all that is known about the murderous spree at Ward Parkway mall, it would seem obvious that the gunman, David W. Logsdon, was deranged. At a Monday news conference, his sister, Kathy Cagg, spoke of how her brother had a long history of mental illness combined with alcohol abuse. He had been hospitalized in October as suicidal, but only for six hours. “I wish he had been given the help he truly needed,” Cagg said in front of the church she attends, the First Church of the Nazarene at 118th Street and State Line Road. Her situation goes to the heart of how difficult it can be for loved ones, friends, neighbors or co-workers to get help for people they suspect are mentally ill and potentially dangerous to others. Mental illness is rampant in America. The American Psychiatric Association says close to 20 percent of the adult and childhood population is dealing with some type of diagnosable sickness, ranging from extremely mild and treatable depression to severe psychoses. Each year, members of the Kansas City police force, trained in crisis intervention, deal with from 500 to 600 calls involving people who are mentally ill. These do not include those involving drugs or alcohol. Each year the Probate Division of the Jackson County Circuit Court adjudicates close to 1,300 involuntary civil commitments. These are people — friends, relatives, spouses — who go to court to get their loved ones put in a hospital for what is supposed to be a 96-hour evaluation because the loved ones are either a danger to themselves or others. Whereas mental health care in Kansas is comparatively well-funded — the Legislature just committed an extra $17 million to its community mental health centers — mental health care is in crisis in Missouri. “There is no guarantee that they will be kept for 96 hours,” said Jackson County Circuit Judge Kathleen Forsyth. “Doctors can let them out any time. Sadly, there is no guarantee they’ll even let them in. Many times the hospital is full up.” Sometimes, she said, patients are let out in a matter of hours. “The statutory situation is not the problem,” Forsyth said. “The courts have no problem doing what needs to be done to commit people for evaluation. The issue is how much mental health treatment is available in the community. That’s where the whole thing breaks down. “There are so many people that need help. There is a logjam in the hospital.” The local state mental health hospital, Western Missouri Mental Health, had 100 inpatient adult psychiatric beds five years ago. With about $6 million in funding cuts, that number has been reduced to 75. Moreover, prior to 2003, Missouri employed mental health coordinators in its community mental health centers statewide. These individuals were trained to go to people’s homes to help families evaluate whether a loved one needed to be committed for evaluation or care which, depending on the case, could last up to a year. The coordinators helped the family through the judicial process. In 2003, those positions were eliminated. “The reason is funding, funding, funding,”
Forsyth said. “That was a horrible mistake.” “But it’s not the same thing. The people at the crisis hot line don’t have the ability to investigate. They can’t take the hands-on approach that the mental health coordinators did,” Forsyth said. Meanwhile, some in the Missouri Department of Mental Health are discussing privatizing one or more state hospitals. “There will be less access,” and the hospitals would mostly be for those who could pay, said Bruce Eddy, executive director of the Jackson County Mental Health Fund. “Access to acute care is already extremely limited,” Eddy said. “There are people in Western Missouri — an acute- care hospital — who are in there for long-term care because there is nowhere for them to go. I think it is probably worse here than anywhere else in the state.” Without an individual’s cooperation it is nearly impossible to get a loved one mental health care they may desperately need. Friends, neighbors or family members can try to initiate a 96-hour commitment. It requires at least two people to swear out affidavits and present them in probate court. Kansas has a similar procedure. In Kansas,
beds for emergency commitments are more available. But if one doesn’t want help, it can be hard and dangerous. “The whole issue is fundamentally a civil rights issue,” said Susan Crain Lewis, president of the Mental Health Association of the Heartland. “This is America. If you are not hurting anyone, you have the right to be as odd or weird as you want. … We allow people in America the freedom to make maybe poor, misinformed choices, unless they pose an imminent threat to themselves or others.” When that happens, the alternative is to
call the police, if it isn’t too late. This article reprinted by permission. © The Kansas City Star |
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Press Release Date: April 10, 2007. Agency for
Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/news/press/pr2007/hcup10pr.htm
Almost one-fourth of all stays in U.S. community hospitals for patients age 18 and older—7.6 million of nearly 32 million stays—involved depressive, bipolar, schizophrenia and other mental health disorders or substance use related disorders in 2004, according to a new report by HHS' Agency for Healthcare Research and Quality. This study presents the first documentation of the full impact of mental health and substance abuse disorders on U.S. community hospitals. According to the report, about 1.9 million of the 7.6 million stays were for patients who were hospitalized primarily because of a mental health or substance abuse problem. In the other 5.7 million stays, patients were admitted for another condition but they also were diagnosed as having a mental health or substance abuse disorder. Nearly two-thirds of costs were billed to the government: Medicare covered nearly half of the stays, and 18 percent were billed to Medicaid. Roughly 8 percent of the patients were uninsured. Private insurers were billed for the balance. The study also found that one of every three stays of uninsured patients was related to a mental health or substance abuse disorder. "Community hospitals play an important role in the treatment of people with mental health and substance abuse disorders," said AHRQ Director Carolyn M. Clancy, M.D. "This report gives health care policymakers an in-depth look at the impact of mental health and substance abuse care on the health care system." Substance Abuse and Mental Health Services Administration Administrator Terry Cline, Ph.D., said, "The significant number of hospital stays related to mental health and substance use disorders signals the need for an increased national effort to identify and intervene early before the conditions require a hospital stay. Too often because of social stigma or lack of understanding, individuals and health care providers don't recognize the signs or treat mental health or substance use disorders with the same urgency as other medical conditions." AHRQ found that most patients with mental health and substance abuse disorders were older. For example, although people age 80 and older comprised only 5 percent of the U.S. population in 2004, they accounted for nearly 21 percent of all hospital stays for these conditions—principally for dementia. There were also gender differences. The most frequent admitting diagnosis for women was mood disorders, while that for men was substance abuse. AHRQ also found that patients who have been diagnosed with both a mental health condition and a substance abuse disorder—those with "dual diagnoses"—accounted for 1 million of the nearly 8 million stays. Nearly half of these cases with dual diagnoses involved drug abuse, a third involved alcohol abuse, and one in five involved both drug and alcohol abuse. In addition, 240,000 women hospitalized for childbirth or pregnancy also had mental health or substance abuse problems. Four of every 10 of these patients were between 18 and 24 years of age. Suicide attempts accounted for nearly 179,000 hospital stays. Of these, 93 percent involved a mental health condition—most commonly mood disorders—and/or substance abuse. Nearly three-quarters of these patients were between ages 18 and 44 and more than half were women. Poisoning, by overdosing prescription medicines or ingesting a toxic substance was the most common way patients attempted suicide. The report is based on 2004 data—the latest currently available—from AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured. For details, go to Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004 at http://www.ahrq.gov/data/hcup/factbk10/. For more information, please contact
AHRQ Public Affairs: Stopping a revolving door Index On a wintry afternoon last month, 18 people sat quietly in the front of courtroom 516 in the Carnahan Courthouse. They looked like a group of citizens called to jury duty. There was a poetry-writing mother of four who prepares tax returns for a living. A veteran teacher who recently became a grandmother for the first time. A stylish teenager who graduated from high school last year. But these were not prospective jurors. These area residents — white and black, men and women, young and middle-aged — all had been arrested within the last two years for an alcohol- or drug-related offense. They were about to become the most recent batch of "graduates" of St. Louis Drug Court. At any given time, about 2,700 Missourians are enrolled in drug courts, designed to redirect people arrested for non-violent alcohol or drug offenses. Instead facing sentencing — and possibly jail — participants are required to make frequent court appearances, undergo substance abuse treatment, keep a job and submit to random drug testing. Those who break the rules, or who are arrested on new charges while in the program, are booted out and face immediate sentencing on their original charges. But if they complete the program, which typically takes about 18 months, charges are dropped. With limited funding, drug courts, by necessity, have focused on first-time offenders and those who have the best chance of beating their addictions and staying out of the criminal justice system. However, the time may have come in Missouri to expand eligibility to people typically excluded. Missouri operates more drug courts per capita than any other state — 98 of the nation's 1,927. Gavels will fall at five more in Missouri this year. Last year, the Missouri Legislature allocated an additional $2 million to the drug court budget for fiscal year 2007, bringing total funding to $5 million. That was good news. But the money covers treatment and drug testing only, so the state Drug Court Coordinating Commission now is asking the Legislature for an additional $500,000 to hire two more drug court commissioners and six administrators to handle increased caseloads across the state. The Legislature should say yes. It's not a lot of money if it means getting people clean and sober and keeping them out of jail — not to mention keeping them working and paying taxes. The next step should be offering drug court programs for more Missourians who could benefit from treatment and intensive monitoring. For example, the commission recently approved applications from three drug courts for pilot projects aimed at a tougher group: offenders undergoing treatment who were ordered to serve a portion of their sentences in prison. Helping such substance abusers could prevent future crimes and further reduce the state's prison population, saving the state money in the long run. Getting people off drugs, out of the criminal justice system and back to their families and communities is well worth the effort and the shortterm cost. It could stop the revolving door that frustrates police, judges, prosecutors, public defenders and parole officers — not to mention politicians and the public. At last month's graduation, St. Louis Drug Court Commissioner James Sullivan read a biography of each of the 18 participants. He asked them to stand and face the crowd. As he handed them their diplomas and wished them well, some gave him a hug. But after heaping lavish praise on the graduates for overcoming their alcohol and drug problems, he offered a stern reminder that he didn't want to see them again in his courtroom. "The taxpayer paid a lot of money to get you to this point," Judge Sullivan said. "Don't come back." Most don't. The recidivism rate in Missouri is 10 percent. This editorial is reprinted by permission of the St. Louis Post-Dispatch. Feb. 24, 2007 Police are dealing better with incidents; Legislature must step up Index By Joseph Mokwa and Jacqueline Lukitsch
launched the Crisis Intervention Team program. The goal of this team is to reduce injuries significantly — to anyone involved — when police officers intervene in crisis situations. Since the inception of the CIT program, 150 officers have been educated and trained in ways to de-escalate crises involving people experiencing psychiatric symptoms. Over that time, 120 psychiatric crises were handled without injury to anyone involved, and only a few cases resulted in any injuries. Given such positive results, the department is committed to training 250 more officers. In addition to handling interventions, the program also is designed to help people get appropriate mental health treatment. The more people who receive the treatment they need, the fewer people are likely to experience crises requiring police intervention. That would give police officers more time to work on preventing crimes in the community. We believe, therefore, that access to appropriate mental health treatment is an important community issue, and we strongly urge the Missouri Legislature to consider recent funding requests by the Missouri Department of Mental Health. Increasing people's access to services through Medicaid and funding the state Department of Mental Health through general revenue certainly will help reduce the number of mental health crises in our communities — and help reduce dependence on such expensive care options as emergency room and inpatient care. Just as St. Louis' Metropolitan Police Department is working to improve performance in dealing with people with mental illness, the Missouri Legislature must provide appropriate funding for mental health and substance abuse services that are critically needed in this community. Col. Joseph Mokwa is chief of the St. Louis Police Department. Jacqueline Lukitsch is director of the St. Louis chapter of the National Alliance on Mental Illness. This article is reprinted by permission of the St. Louis Post-Dispatch. Jan 18, 2007 Fewer officers, services for people on probation Index Regarding the editorial "No free pass" (Oct. 26): As probation and parole officers, members of the Service Employees International Union Local 2000, we share the demoralization with our brothers and sisters in law enforcement. The budget cuts of the Blunt administration have had a multitude of damaging effects that have particularly affected probation and parole officers. Fewer offenders are being returned to prison in an attempt to control inmate housing costs to the Department of Corrections. Sentencing guidelines place an increasing number of offenders on probation in an attempt to reduce the number of individuals being sent to prisons. Despite this increase in the number of offenders on probation or parole, the number of officer positions has been reduced statewide. As a result, probation and parole officers supervise more offenders. Offenders more quickly are moved to minimum or "call-in" supervision, often before many of the issues that brought them into contact with the criminal justice system can be assessed or addressed meaningfully. Offenders who would have been returned to prison 10 years ago for violating supervision now continue on supervision, often in contrast with the professional opinion and recommendation of the supervising probation and parole officer. This has had deadly effects on Missourians. We agree that intervention on the front end would be beneficial. However, the impact of budget cuts on social service agencies that provide support services such as mental health and substance abuse treatment to criminal offenders on supervision in the community have made this almost impossible on the front, middle or back end. Waiting lists are long and services are not available when they are most critically needed. Daniel D. Spring I St. Louis This letter isreprinted with permission from the St. Louis Post-Dispatch, Oct. 28, 2006 "Are there no prisons? And the workhouses, are they still in operation?" — Ebenezer Scrooge Sept. 25, 2006. Since 2002, the Missouri Department of Mental Health budget has been cut by $48 million. In the past 10 years, the number of state-funded hospital beds for people with severe mental illness has declined by 40 percent. It's not hard to find people whose care was once paid for by that money, who once occupied those beds. They're standing on busy street corners in St. Louis and Kansas City, shouting at their demons. They're walking bleary-eyed along winding rural lanes in torn, filthy clothes. They're desperately waiting for help in hospital emergency rooms already overcrowded with the uninsured and unlucky. Since 1993, Missouri hospitals have seen a nearly 85 percent increase in emergency department visits by people with mental illness. Many arrive in police custody. The lucky ones get treatment before they're sent back into the community, where help is often spotty or unavailable. The others end up in prison or jail. A U.S. Justice Department survey released this month found that 64 percent of local jail inmates and 56 percent of those in state prisons have serious mental health problems. Roughly one of every five state prison inmates — and nearly one-third of those in local jails or lockups — is delusional or hallucinating, symptoms of serious psychosis, the study found. What kind of people turn away from the seriously ill like that? It's inhumane to refuse help, and then lock people up when their illness flares out of control. It wastes lives, without doubt. And it wastes our resources. Instead of offering care in the community, where it can cost less than $20 a day, we're spending money for it in hospital emergency rooms, where it costs nearly $1,000 a visit, or in prisons or jails where it's even more expensive. Advocates for people with mental illness have been complaining about these skewed priorities for years. Now they're getting help from what some may consider unexpected allies: police and the courts. The Missouri chapter of the National Alliance for the Mentally Ill recently formed a group called Partners in Crisis, made up of mental health professionals, police, judges and government officials. They plan to educate lawmakers about the consequences of their short-sighted budget cuts, and advocate for treatment for the seriously mentally ill. People with mental illness don't disappear just because funding for their care goes away. We're hopeful their families and these new partners can break through the cruel indifference of Missouri legislators and set our priorities to rights. This editorial is reprinted by permission of the St. Louis Post-Dispatch.
New group sees crisis at hand By Clay Barbour ST. LOUIS POST-DISPATCH
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