SAMHSA Once Frowned on Assisted Outpatient Treatment: Now It’s Pushing It

(5-20-19) A new publication by the Substance and Mental Health Services Administration (SAMHSA) about involuntary commitment reveals how dramatically Dr. Elinore McCance-Katz is changing the federal government’s view of Assisted Outpatient Treatment.

Prior to Dr. McCance-Katz’s 2017 appointment to the newly created position of undersecretary for mental health and substance abuse, AOT was not a federal priority. AOT proponents, such as Dr. E. Fuller Torrey and D.J. Jaffe, accused SAMHSA of funding anti-AOT organizations.

Now SAMSHA is promoting AOT in a report released last month entitled Civil Commitment and the Mental Health Care Continuum: Historical Trends and Principles for Law and Practice .

AOT requires someone, who meets criteria, to undergo court-supervised, mandatory treatment in a community setting. Its opponents frequently call it “forced medication” although AOT can require other treatment services besides or in addition to medication. Its supporters argue it is necessary to rescue individuals with serious mental illnesses who “lack insight” and do not understand they are ill.

Mental Health Weekly, a subscription service that reports about litigation, legislation and corporate policy affecting mental health, interviewed Dr. McCance-Katz about the new report. It quotes her stating that the purpose of the new SAMHSA report “is to start to talk about the needs of the population with serious mental illness [SMI] and how we can best meet those needs.”

“What we’re trying to do is discuss circumstances and conditions under which individuals might need commitment and how that process might be undertaken.”

The SAMHSA report looks back more than 40 years to the closure of state hospitals and the failure of states and the federal government to fully support community based care. It reports there are insufficient hospital beds for Americans with mental illnesses. It suggests AOT laws can be a successful alternative to a lack of beds and postulates that AOT laws can force states to better fund better community services. The rational: if someone is ordered by a judge to undergo treatment, then community treatment must be provided.

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My Account of Thomas Silverstein’s Death Prompts Complaints: An Incomplete And Too Sympathetic Portrait

(5-16-19) The blog I posted on Mother’s Day announcing Thomas Silverstein’s death in Colorado from heart complications, sparked a flurry of personal emails from retired and current federal Bureau of Prison employees whose opinions I respect.

Many of whom I had interviewed in 1987-89 when I was doing research inside the U.S. Penitentiary in Leavenworth for my book, The Hot House: Life Inside Leavenworth Prison.

Several complained that I had written an overly sympathetic and incomplete portrait of Silverstein who had spent 36 years in isolation, believed to be the longest of any federal prisoner. They argued that I failed to document how dangerous he was and why isolationing him was necessary.

In retrospect, I agree there were incidents in Silverstein’s life that I should have posted to be fair. I omitted them, not because of any ill intent, but because I was focusing in my blog about his three decades and more of isolation and our 32 years of correspondence about his life behind bars.

While the murder of Correctional Officer Merle Clutts was the impetus for putting Silverstein under “no human contact” status, I failed to explain that he had already been convicted of brutally murdering three fellow prisoners, although his first conviction was later overturned.

An official involved in isolating Silverstein said the BOP couldn’t risk releasing him into the general prison population or even into solitary confinement in a special housing unit where other prisoners were kept because of his demonstrated history of killing.

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Will Mental Health Reform Be An Issue In 2020? One Candidate Says It’s A Priority.

(5-14-19) I’m not interested in endorsing any presidential candidate nor getting involved in a conversation about partisan politics.

My focus is on seeking better mental health care for all Americans.

Last Friday, I happened to see Morning Joe on MSNBC when Democratic hopeful Sen. Amy Klobuchar (Minn.)  was a guest.

She told the hosts and viewers that improving our mental health care system and addressing the opioid crisis were her top priorities. She explained how deinstitutionalization and a lack of proper funding for community care had lead to homelessness and the inappropriate incarceration of persons with serious mental illnesses. (Click here to view her segment.) 

Ohio governor John Kasich mentioned the need for better mental health care during the 2016 campaign, as did Hillary Clinton, but Sen. Klobuchar is the first presidential candidate this time around, who I have heard, making it a priority.

During her televised appearance, Sen. Klobuchar spoke openly about mental health issues in her own family.

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Thomas Silverstein: Held In Isolation Cells For 36 Years, Major Character in The Hot House, Has Died

(Note: My blog announcing Silverstein’s death prompted complaints by some readers who said I was overly sympathetic. I responded by posting a second blog about their criticism.)

(5-12-19) Thomas Silverstein, a major character in my bestselling book, The Hot House: Life Inside Leavenworth Prison, and one of America’s most famous federal prisoners, has died.

He died Saturday (5-11) evening in a Colorado hospital from heart complications. He had been hospitalized for several weeks. He was 67.

Silverstein had been held in isolation since 1983, after he killed Corrections Officer Merle Clutts at the Marion Penitentiary in Illinois. At the time, there was no death sentence for murdering a correctional officer. Bureau officials told me, while I was researching my book, that they created a new punishment for Silverstein called “no human contact” designed to completely seal him off from other prisoners and the outside world.

Prison officials explained they had little choice but to isolate Silverstein. By the time he murdered Clutts, Silverstein already had been found guilty of the brutal murders of three other prisoners, although his conviction of one of those murders was later overturned.

Initially, he was held in the bureau’s Atlanta maximum security penitentiary with absolutely nothing in his cell with the lights on 24 hours per day. He later was moved to an isolation cell in the bowels of the federal penitentiary in Leavenworth where I first met him in 1987. The lights were kept on 24 hours per day there too – under the pretense they were needed so that cameras could monitor him. For months he was only provided with freezing cold water for showers. Most of the officials who oversaw him refused to speak to him. He had little idea whether it was day or night, and no idea what was happening in the outside world.

Prison officials gradually began granting Silverstein privileges, such as books and art supplies for his paintings. This was not necessarily done out of kindness, but for practicality. Having something to take way as punishment if he didn’t obey a direct order – such as return a food tray after eating.

Silverstein spent his last 36 years in isolation – believed to be the longest an American has been held in such conditions by federal officials. He prided himself, in his words, “for not letting them break me!”

He was serving a life sentence in an isolation cell at the federal “Supermax,” the United States Penitentiary, Florence ADX (USP Florence ADX) in Colorado, when he became ill earlier this year and was taken to a Denver hospital for treatment. Even when he was incapacitated and incubated, I was told that his BOP guards initially kept him in four point restraints tied to a hospital bed with as many as three officers standing watch. Hospital officials told callers that there was no patient named Silverstein being treated and get-well cards were returned “undeliverable” apparently to keep his location a secret.

(Before his death, his ex-wife, daughter, and his fiancee – were allowed to see him.)

While other inmates have periodically attacked and killed correctional officers, Silverstein’s actions were responsible for ushering in a new era in modern day corrections.

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Mom Learns Son Was Fatally Shot By Police After “Running around without shirt on and ‘acting strange.'”

Distraught mother issues plea in minute and half video. 

(5-8-19) “Dear Pete:

               “I received news today my son Ethan Austin Murray , was shot & killed by police officers in Spokane Valley Saturday May 4th.

              “My son suffers from mental illness & drug addiction.

              “I’m heartbroken, angry, & in shock.

              “I love you Ethan Murray and I will never stop advocating for change, police CIT training & breaking the stigma for people with mental illness. ❤️”

              “Your mom, Justine Murray”

In a late night email Tuesday, Justine wrote:  “The police have told me it’s a very high profile case because Ethan did not have a weapon and was shot 6 times by one of the officers.” 

Some frightening facts:

323 Americans have been fatally shot by police so far this year, according to a database maintained by the Washington Post. 50 of them had known mental illnesses.

American with mental illnesses are 16 times more likely to be shot during an encounter with police than other citizens, according to the Treatment Advocacy Center.

A 2016 review of studies estimated that 1 in 4 people with mental illness has a history of police arrest.

Son shot multiple times after being seen running around without a shirt

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“Hit In The Head With A 2×4” Tim Murphy – My Personal Struggles Helped Put Life In Perspective

(5-6-19) “The Lord works in mysterious ways,”  Tim Murphy told me.

When he was a member of Congress, he wielded power and enjoyed prestige – especially in the mental health community.

It was Murphy who held hearings immediately after the December 14, 2012 mass shooting of school children at Sandy Hook Elementary School in Newtown, Connecticut. (I testified at his first hearing about how the “imminent danger” criteria prevented me from getting my son help after I rushed him to a local emergency room.)

Murphy pushed for passage of the Helping Families in Mental Health Crisis Act, a bill he drafted. Its goal was to make mental health a federal priority. He faced strong and bitter opposition. He stepped on toes. Fought the status quo. Democrats blocked him. His first attempt died in committee.  A CEO of a major mental health organization in Washington smirked and assured me Murphy’s bill would never become law.

His critics badly under-estimated his tenacity. “All he does is talk about mental illness. That’s it. Every conversation,” one of his Republican colleagues told me privately.

Murphy gained support, won allies. A Wall Street Journal OP Ed said his bill was the only reform measure that most likely could have prevented shootings such as those that felled Rep. Gabrielle Giffords, as well as other victims of a spate of shootings.

In July 2016, Murphy won. His bill passed the House of Representatives by a vote of 422-2. In the Senate, Dr. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.) drafted their version and a compromise bill was later folded into the larger 21st Century Cures Act, which became law during the final days of the Obama Administration.

His work was described as the most important mental health bill in recent memory, creating an assistant secretary for mental health at Health and Human Services and the Interdepartmental Serious Mental Illness Coordinating Committee.

And then Murphy fell from grace.

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