Slammed Trump Report Contains Worthwhile Mental Health Recommendations Despite Charges Of Political Bias.

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(2-16-21) Recommendations by a Trump appointed commission studying ways to, among other things, improve law enforcement interactions with those in a mental health crisis are well-worth reading – despite heavy criticism aimed at the panel for being politically partisan and apparently violating federal open meeting requirements.

Shortly after the President’s Commission on Law Enforcement and Administration of Justice was appointed in January 2020, I warned in a blog that then-Attorney General William Barr was putting partisan politics above common sense in stacking the commission with pro-Trump officials or those who came from strong Trump voting districts rather than drawing from a wider swath of experts. A federal judge appointed by former President George W. Bush ruled last November that the panel was bias and had not notified the public about its meetings. He issued an order requiring it either to broadened its membership or include a disclaimer in its final report acknowledging his complaints. The panel chose to add the disclaimer.

Because of the political dust-up, the commission’s December report has been largely dismissed.

That’s a shame because several of its recommendations about mental illness are spot on.

Among them: create drop off centers rather than hauling those in crisis to jails and emergency rooms, make certain everyone booked into jail is screened for mental illnesses, increase police training about mental illnesses, do a better job triaging emergency calls, and create more treatment dockets.

The commission also called for ending the IMD exclusion, that prohibits federal Medicaid dollars from being used to reimburse facilities with more than 16 beds.

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My Only Sister Died. Nineteen Years Later, I Went Looking For Answers

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Pete Earley and His Sister Alice

(2-13-21) My only sister, Alice, died on this date  fifty-five years ago after being struck by an automobile. I was 14 years-old at the time and it was my first experience with death. Nineteen years after her death, I awoke one night calling out her name. I realized that I had repressed most of my memories about Alice because her death was so painful. My good friend, Walt Harrington, who was an editor at the Washington Post, suggested I return to Colorado and investigate my own sister’s death as a reporter. The Post published my account in 1986. I am posting it today in her memory. With the passage of time, the hurt and memories fade, but in your heart, you still feel the loss.)

Missing Alice: The Story of My Sister

By Pete Earley for The Washington Post

Midway across Ohio, the man beside me on the DC-10 asked where I was going.

“Fowler, Colorado. A little town of about a thousand people near Pueblo.”

“Why would anyone go to Foouuller?” he asked, grinning as he exaggerated the name.

“A death. My sister.”

“Sorry,” he mumbled and turned away.

I was relieved. I didn’t have to explain that my sister had been dead 19 years. Alice was killed when I was 14. She was two years older and we had been inseparable as children.

I couldn’t talk about her death at first. My voice would deepen, my eyes would fill with tears. My parents would cry at the mention of her name, and we rarely spoke of her. Then it seemed too late.

After I left home, my mother would phone me each February 13 and remind me that it was my sister’s birthday. Year after year, I would forget — and find myself angry with my mother’s insistent reminders. It was just before last Christmas, as I shuffled boxes in the basement, that I ran across Alice’s picture and clipping describing her death.

“A tragic accident Tuesday, June 14, about 7:05 p.m., took the life of Alice Lee Earley…” I sat down on the concrete floor, closed my eyes and tried to picture her. I couldn’t. I tried to focus more sharply. Alice eating Sugar Pops beside me at the breakfast table. Alice washing the green Ford Falcon. Alice stepping on my toes while singing in Church.

The events I recalled vividly. Alice’s face I recalled not at all.

I could only see the girl in the photograph — an image I had never liked, the face being without joy or expression. But in my mind I found no other. For the next week, I seemed to think of Alice constantly.

One night I awoke in bed, turned to my wife, and said, “Alice, are you there?” It took me an instant to realize what I had done.

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Want Better Govt. Mental Health and Substance Abuse Programs? Let Us Help!

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Bumper sticker on Pete’s old truck

(2-8-21) Let’s hope the Biden Administration takes advantage of a wonderful tool that could help the federal government better coordinate and prioritize its mental health programs.

The Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) was created in December 2016 by Congress to foster collaboration and shared accountability for the 8 federal agencies that deliver services to adults with serious mental illnesses (SMIs) and children and youth with serious emotional disturbances (SEDs) and their families.

Within a year, ISMICC’s first report was sent to Congress. Titled: The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, the report offered 45 recommendations in five categories, that were drafted by ISMICC’s fourteen public members.  As a parent representative on ISMICC, I focused on much needed criminal justice reforms.

Among the recommendations that I helped write:

  1. support implementation of the sequential intercept model that identifies key moments when incarcerated individuals with SMI and SED can get into treatment,
  2. support jail and prison diversion programs,
  3. train all first responders on how to work with individuals with SMI and SED,
  4. improve and streamline competency restoration services,
  5. support therapeutic justice dockets for SMI and SED individuals,
  6. require universal screening for SMIs and SEDs for every person booked into jail,
  7. limit or eliminate solitary confinement, seclusion, restraint and other forms of restrictive housing for SMI and SED prisoners,
  8. support post conviction recovery services,
  9. support federal programs created to reduce incarceration of SMI and SED Americans.

These are lofty, but achievable goals.

After that report was issued, my 13 public colleagues and I got right to work with the 15 representatives from the government agencies and departments that administer SMI and SED programs.

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Is Conspiratorial Thinking A Psychiatric Sickness? What Are The Boundaries Between Rational Thought And Illness?

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(2-5-21) In this guest blog, Joseph Meyer, the parent of an adult with a serious mental illnesses, ponders psychiatric illnesses, conspiratorial thinking, public policy and criminal justice.

Illness, Crime and Punishment

Guest Blog By Joseph Meyer 

I think it was Ronald Reagan who said more than 40 years ago that some people make the choice to live homeless under bridges and in public squares. I have been reflecting on Reagan’s words and the history of psychiatric institutionalization as a political weapon used by authoritarian governments of the past. Together with a desire to cut taxes, a concern for the civil liberty of free choice is partly responsible for laws that make it difficult for family members of adults with psychiatric illnesses to get them off the streets and into treatment for delusions and their sometimes conspiratorial thinking that makes them reject help. 

Whether motivated by free choice or psychiatric illness, conspiratorial thinking that preceded and catalyzed behaviors like the recent invasion of the US Capitol building is going to have legal or psychiatric consequences for the individuals actively involved.

Today, beliefs in conspiracies promoted by QAnon and like groups can be thought of as ‘delusional.’ Others often use that word in informal conversation to describe odd thinking and a Google search returns this definition from the Oxford English Dictionary:

‘An idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument, typically a symptom of mental disorder.’

During the political divide of the last four years or longer, that definition of delusional thinking would seem to fit conspiratorial thinkers, whether or not they have a psychiatric illness. 

Recently, a large group of clinicians concerned about the psychiatric health of Donald Trump signed onto a letter calling for a rethinking of the Goldwater Rule that considers it unethical for psychiatrists to assess the behavioral symptoms of public figures who are not their patients from a distance and without a formal examination. Today’s conspiratorial thinking and activism raises questions about the difficulty of setting boundaries between what is normal and abnormal behavior.

How does one decide where the boundaries are between rational thought and clinical illness? How does the boundary affect public policy?

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Drs. Torrey and Satel Urge White House To Continue Policies Enacted By Trump’s SAMHSA -AOT, IMD Waivers

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(2-1-21) I posted a blog in December by several peer leaders urging the Biden Administration to reverse a slew of actions that Dr. Elinore McCance-Katz implemented while Assistant Secretary for Mental Health and Substance Abuse. Not surprisingly, two of her biggest political backers, Dr. E. Fuller Torrey and Dr. Sally Satel, are urging the new administration to do just the opposite – to continue and build on her policies. Their argument was published today in The National Review and also sent to me.

Don’t Undo The Trump Administration’s Mental Health Reforms

By Dr. E. Fuller Torrey and Dr. Sally Satel

Those with the most severe mental illnesses had a great friend in Trump’s Department of Health and Human Services. President Biden must build on that legacy.

As the executive orders pile up and President Biden seeks to distance his administration from President Trump’s, he should be careful to preserve and learn from the things Trump got right.

One such positive legacy is the work of Dr. Elinore McCance-Katz on improving services for people with serious mental illnesses. McCance-Katz resigned in early January after almost four years as the first assistant secretary for mental health and substance use and the director of the Substance Abuse and Mental Health Services Administration (SAMHSA), which runs point on federal mental-health policy.

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Crisis Intervention Team Training vs Alternatives Without Police: Which Is Better?

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Major Sam Cochran explaining Crisis Intervention Team training program. (Photo courtesy of NAMI Tennessee)

 

(1-29-21) Should the police be the first responders when someone with a mental illness is in distress? Recently, Crisis Intervention Team programs have come under fire because of incidents such as the killing of Patrick Kenny who had paranoid schizophrenia. The four Springfield, Oregon police officers involved in his death all had CIT training and one was a CIT instructor. Jeff Fladen, executive director of the Tennessee state chapter of the National Alliance on Mental Illness defends CIT programs, and sees them as necessary even if communities develop alternatives to having the police respond.  You can read here about the history and effectiveness of the estimated 400 CIT programs currently in the U.S.. 

CIT is Foundational (and We Need Co-Response Too)

Guest blog by Jeff  Fladen

As a leader of my state’s effort to expand CIT (Crisis Intervention Training) for law enforcement and other first responders, I have been hearing the same story nearly every day.

Instead of CIT, what about Co-Response and Alternative Response models, where mental health professionals assist the police during a mental health crisis either in person such as a social worker ride along or remotely from a control room or crisis center.

The Cahoots (Crisis Assistance Helping Out On The Street) program, launched by the White Bird Clinic in Eugene, Oregon some 30 years ago, is often brought up as an example of a successful co-response, although this program does not include social workers “riding along” with law enforcement. Cahoots features two-person teams consisting of a medic (a nurse, paramedic, or EMT) and a crisis worker who has substantial training and experience in the mental health field.

The program developed as an alternative to law enforcement acting as the mental health crisis first responder and offers an alternative approach to non-emergent issues. Other Co-response models include the Boulder Early Diversion Get Engaged (EDGE) program in Colorado, and the Boston Police Co-Responder Program, in existence since 2011. Additional programs around the country have developed  or have been announced in the past year.

I am deeply concerned that this is sometimes framed as an either/or discussion when it comes to CIT.  It shouldn’t be.

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