Once Scrappy Underdog, Treatment Advocacy Center Receives Major Award From APA – A Sign Of Its Advocacy Prowess

Dr. Torrey and early TAC backer, D. J. Jaffe pushed AOT legislation for years together.

(5-11-21) The American Psychiatric Association awarded its 2021 Distinguished Service Award to the Treatment Advocacy Center, founded by Dr. E. Fuller Torrey.

What’s interesting about the APA award is that it shows that Dr. Torrey’s 1998 creation is no longer, as one advocate put it, “a scrappy underdog”  hoping for a seat at the table.

The award and TAC’s recent actions cement its role as a power player. This is especially true when it comes to calling for criminal justice reform. More than mainline organizations such as Mental Health America and the National Alliance on Mental Illness, TAC has arguably been the most aggressive critic of the inappropriate incarceration of Americans with mental illnesses.

Calling TAC a “David to the Goliath” of a mental health care system that fails to meet the needs of individuals with serious mental illnesses, Dr. Jeffrey Geller, president of the APA, said in announcing the award:

“Not afraid to go out front with issues that could fundamentally improve the lives of persons with SMI but were not initially seen favorably, Treatment Advocacy Center has led the way to the availability of Assisted Outpatient Treatment (AOT) in almost every state.

“It has and is doing so by nurturing the concept, educating all stakeholders, developing model legislation, lobbying for statutory changes, and assisting in implementation. Treatment Advocacy Center continues in these efforts, focused on expanding the utilization of AOT statutes nationwide.”

The APA Distinguish Service Award honors “exceptional meritorious service to the field of psychiatry.” APA describes itself as the “leading psychiatric organization in the world” with some 40,000 members in a hundred different countries, all engaged in psychiatry.

TAC’s agenda has not made it universally loved. Mental Health America, the Bazelon Center For Mental Health Law, and groups such as Mad In America, strongly oppose AOT. Critics also have accused TAC of releasing reports that bend facts to push its platform.

TAC began as a spunky outsider.

As I recount in my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, TAC’s beginnings can be traced to a lone individual. Jonathan Stanley began showing signs of bipolar disorder while in college that led to a psychotic break in Manhattan where he was confronted by police while standing naked on a milk crate talking gibberish.

His parents, Ted and Veda Stanley, contacted Dr. Torrey for help because he had recently published Surviving Schizophrenia (1983), which is still considered the bible for patients and their families. The Stanleys had made a fortune selling decorative plates, commemorative postage stamps, and other collectibles through the mail. They offered Dr. Torrey $50,000 to help their son. Dr. Torrey agreed to help but told them to make the check out to NAMI.

Jon got the help that he needed to fully recover and become an attorney. Wanting to help others, the Stanleys began donating millions to what became the Stanley Medical Research Institute launched by Dr. Torrey to study mental illnesses.

In 1997, Dr. Torrey published, Out of the Shadows, a powerful expose that documented how deinstitutionalized and failed government policies had lead to jails and prisons becoming de facto mental asylums. Dr. Torrey argued that involuntary commitment laws, especially the imminent dangerous criteria, were preventing individuals from getting help.

AOT Seen As Solution

He was equally certain that AOT was a pathway for getting individuals who were sick help, even if they didn’t believe they needed it. While NAMI initially supported AOT, it was not pushing it as enthusiastically as Dr. Torrey hoped, especially as it began attracting more and more consumers as NAMI members.

Dr. Torrey suggested that the Stanleys underwrite the creation of a group to push passage of AOT laws. The couple agreed, which caused a growing split between Dr. Torrey and NAMI. The psychiatrist had played a major role in helping launch NAMI but its national leaders resented him diverting Stanley’s contributions away from NAMI into TAC.

Despite the Stanley’s start-up financing, TAC got little attention until its first director, Mary T. Zdanowicz, a lawyer whose sisters had schizophrenia, became horrified when she read about a murder that should never have happened.

Kendra Webdale and TAC’s first AOT success

On Jan. 3, 1999, Andrew Goldstein pushed a young woman named Kendra Webdale from a subway station platform in front of an oncoming train killing her. A disgusted social worker released Goldstein’s confidential 3,500-page medical record to The New York Times Magazine. It revealed that Goldstein had attacked eight people before murdering Webdale and been hospitalized 15 different times for mental problems. Shortly before pushing Webdale, Goldstein had walked into a Queens hospital complaining about voices in his head. He’d been turned away.

Zdanowicz contacted Webdale’s parents, Ralph and Patricia Webdale, and they joined TAC in pushing for passage of the nation’s first, major AOT law. The ACLU and the Washington- based Bazelon Center for Mental Health Law strongly opposed AOT, but the New York legislature signed Kendra’s Law into effect in August 1999. It soon became a national model.

Over the years, all but three states adopted AOT laws.

Expanding Its Campaign To Eliminate “Barriers To Treatment”

TAC began targeting other issues. It popularized the term “anosognosia” claiming that individuals who were sick had a “lack of insight” because of their illnesses and, therefore, weren’t capable of making rational decisions about their treatment.

It issued dozens of reports often authored by Dr. Torrey and pushed by early TAC advocate, D. J. Jaffe, that revealed how individuals, who experienced a psychotic episode, were more likely to be thrown in jail than be hospitalized.

It produced studies that suggested individuals with untreated serious mental illnesses were, in fact, more dangerous than the general public – contrary to positions taken by all other mental health groups who insisted that individuals with mental illnesses were more likely to be victims of violence than perpetrators.

TAC’s critics blasted its reports, but its studies were widely quoted in the media and TAC became the group seemingly most called upon whenever there was a mass shooting or stories about prisoners with mental illnesses dying in jails and prisons.

TAC claims multiple accomplishments

In Washington, TAC played a major role in helping Rep. Tim Murphy (R-Pa.) draft and push his Helping Families In Mental Health Crisis Act. It was watered down by critics before becoming law during the final days of the Obama administration, but it set the stage for TAC’s biggest recent accomplishment.

With the strong backing by Dr. Torrey and TAC, President Donald Trump chose Dr. Elinore McCance-Katz as the first Assistant Secretary for Mental Health and Substance Abuse. She pushed a pro-TAC agenda, implementing greater funding for AOT and approving waivers so that states could ignore the IMD Exclusion, which prevents federal dollars from reimbursing facilities with more than 16 psychiatric beds.

Although D. J. Jaffe had launched his own advocacy organizations at Mental Illness Policy. Org, he continued to push the same agenda as TAC and was invited by to address President Trump’s White House’s mental health summit where Dr. Torrey had a front row seat and was repeatedly praised for his advocacy. TAC’s membership began expanding when disgruntled NAMI members began leaving it after NAMI decided to expand its “tent” to become “everything to everyone” with a mental illness.

John Snook Takes TAC Mainstream

Under its last director, John Snook, TAC was welcomed by mainstream mental health groups in several efforts, including urging the Biden Administration to increase its efforts to fight opioid crisis.

Upon accepting the APA award, Lisa Dailey, TAC’s acting director stated:

“Since the Treatment Advocacy Center’s founding in 1998, we have never been shy in seeking to convince those in power of the need to focus on people with the most severe mental illness, a chronically overlooked population whose needs are too frequently ignored in favor of problems with simpler solutions. We could not accomplish our goals without trusted partners like the APA, whose expertise informs our work, and whose members deliver the care we work hard to give access to.” 

Here is what TAC sees on its website as its major accomplishments:

“TAC has produced a manual for mental health professionals who are implementing assisted outpatient treatment (AOT); fought state hospital closures; published evidence-based research on topics including the impact of untreated severe mental illness on law enforcement, the criminalization of mental illness and anosognosia (“lack of insight”); filed amicus briefs with the U.S. Supreme Court and state courts; raised public awareness of mental illness treatment issues through active media outreach; and otherwise served as a watchdog for and champion of expanded treatment options for its target population.

Clearly, TAC is no longer on the outside pounding on the door demanding to be allowed inside.





About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.