Psychiatric Advance Directives Make Sense: You should have one!

If you have read my book, this blog, or heard me speak, then you know that the first time my son became psychotic, I raced him to a hospital emergency room. Mike (his name in the book) was delusional, but he didn’t believe anything was wrong with him, and he was convinced that all “pills were poison” so he refused treatment. The emergency room doctor told me that he could not intervene until Mike became an “imminent danger” either to himself or others. That was the law in Virginia at that time.

My son had a right to be “crazy.”

Forty-eight hours later, he was arrested after he broke into an unoccupied house to take a bubble bath.

The second time Mike became psychotic, I waited until he became dangerous and what happened? Our local mobile crisis team refused to come help me, the police were called, and Mike was shot with a Taser.

As a father, those two situations frustrated and enraged me. What I didn’t know at the time was there was an alternative that could have helped Mike and possibly prevented what had happened to us.

It’s called a Psychiatric Advance Directive and this week, I received a wonderful email from my state National Alliance on Mental Illness chapter telling me that PADs, as they are known, are becoming more common in my home state of Virginia.

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(9-26-16) Mental health advocates are expressing outrage about a new Halloween amusement park ride that demonizes individuals with psychiatric disorders.

Initially called: Fear VR: 5150, the virtual reality “haunted experience” promises to scare patrons by transporting them inside a psychiatric hospital where a demonically possessed patient is on the loose.

The 5150, which refers to California police code for a mentally ill person who is a danger to himself or others, was dropped from the title last week after several bloggers, including my friend, Chrisa Hickey at The Mindstorm, joined the National Alliance on Mental Illness chapter in Orange County in complaining to the ride’s makers — Hollow Studios — and Knott’s Berry Farm where it is being featured.

Knott’s Berry Farms is offering the ride as part of a seasonal Halloween Haunt. It also is being featured at California’s Great America park in Santa Clara and Canada’s Wonderland outside Toronto.

News of the offensive ride spread after The Los Angeles Times (a paper whose editors should have known better) published a flattering review of the ride written by Brady MacDonald who described his five minute “VR experience” as “immersive, captivating and scary.”

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(9-23-16) I was not the most eloquent speaker during the three-day Conference on Justice and the Rights of Homeless Persons with Mental Health Issues that I attended in Chennai, India earlier this month.

An Indian woman, at times poking her finger in the air to emphasis her point, was far more persuasive — and I didn’t understand a word that she was saying because she was not speaking English.

I had an interpreter but even before her words were translated, I could tell from watching her and listening to her emotional inflections that her’s was a powerful testimony.

She had been one of the known 8,000 homeless Indians living on the streets of Chennai (population 4.6 million) when she was caught by the police trying to sell her baby son for a bowl of rice. She was psychotic and starving. Fortunately, the police delivered her to The Banyan, the city’s largest mental health service that rescues women, rather than locking her in jail.

Now fully recovered, she lives with her son in a rural area outside the city where she works as a Banyan trained social worker in small villages seeking out and helping women who have untreated mental illnesses and often have been driven from their homes.

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(9-21-16) This is the second in a three part series that I am writing about my recent trip to India to speak about mental health reform.

Mental health services in India are scarce and living conditions for many of those who are ill often border on being barbaric. This is especially true for women and children who find themselves homeless and abandoned on the streets or confined in facilities where restraints are commonly used and physical and sexual abuses are all too common.

During my short visit to Chennai for the three day summit, I wasn’t able to do much except visit a handful of local facilities and listen to personal stories that I later augmented with articles and news reports. Everyone readily admitted to me that India faces incredible challenges. Much of the problem is because of scale. India has a population of 1.3 billion, has more than two thousand different ethnic groups, and has two nationally recognized languages. Some 58% of its residents earn less than $3 per day, putting them under worldwide poverty guidelines.

As is true in other nations, serious mental illnesses – such as schizophrenia and bipolar disorder – are thought to be prevalent in seven percent of the population. In India that translates to multi-millions, yet there are only an estimated 40,000 mental health beds nationally in government and private hospitals. The widespread poverty in India causes high numbers of other mental disorders such as anxiety and depression. In the past decade, suicides have jumped 22 percent. It’s estimated that only one in four Indians have access to any sort of psychiatric care, and that is strictly among the middle and wealthy class.  In India, insurance companies do not pay for psychiatric care.

For the poor, there are little or no services and stories of abuse and neglect routinely surface. In 2001, a fire at a mental facility killed 26 persons who were burned alive chained to their beds. More recently, a children’s hospital came under public criticism when it was revealed that guards were knocking out the youngsters’ teeth so that they could better perform oral sex on the staff. Between 2010 and 2013, as many as 84 patients died in a single state-run mental hospital in one Indian state. All were thought to have curable illnesses but they died because of abuse, communicable diseases contracted in the mental hospital, poor sanitation, malnutrition, and lack of treatment.

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(9-19-16) This is the first of three blogs about my recent trip to India where I toured mental health facilities.)

“Individuals with mental issues are incapable of making their own decisions.”

“I disagree. They are not condemned to impaired thoughts 24/7 and their voice needs to be respected.”

It’s an argument that could be heard in any American city. But I was hearing it in Chennai, India during a three day conference on Justice and the Rights of Homeless Persons with Mental Health Issues.

I’d been invited to give the conference keynote and, unknowingly, my talk thrusted me into a spirited debate in India about patient rights.

Vandana Gopikumar, a co-founder of The Banyan, one of the largest mental health service organizations in India, had read my book, and invited me to speak. (More about this amazing advocate and The Banyan in upcoming blogs.) Of course, I spoke about my son, Kevin, and his recovery. Mid-way through my talk, I mentioned what I see as an ongoing feud in mental health circles in the United States.

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