(2-11-16) Fairfax County, Virginia, officially announced today that its Diversion First effort to reduce the number of persons with mental illnesses in the county jail by diverting low risk offenders into community based treatment is up-and-running. This is tremendous news. It was even sweeter news for me because my son, Kevin, was asked to speak at this morning’s news conference about the importance of jail diversion. I am proud that he is a member of the county’s jail diversion team. 

Getting support for Crisis Intervention Team training, jail diversion, the opening of a crisis drop-off/assessment center, and a mental health docket has been a long and bumpy process in my home county. But thanks to a handful of determined officials it has happened.

In Virginia, we have a board of supervisors that runs our county governments, and Board Member John C. Cook and Board Chairwoman Sharon Bulova have been the driving forces behind Diversion First. On the law enforcement side, Sheriff Stacey Kincaid, Fairfax Police Chief Lt. Col. Edwin C. Roessler Jr., and Deputy County Executive David Rohrer each played key roles in forming a coalition that eventually brought more than a 100 different groups together to endorse jail diversion. On the mental health side, the effort was championed by Gary Ambrose, a member of the Community Service Board, which provides mental health treatment in Fairfax; Laura Yager, who assisted him, and Tisha Deeghan, our CSB executive director. Delegates Marcus Simon and Vivian Watts provided support in the general assembly.

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(2-8-16) I believe in the power of a single individual to cause change.  I believe in the power of one because of what I have personally witnessed visiting all but two states during the past ten years and what I continue to see each day.

Consider Vontasha Simms.

She is the 47 year-old mother of Romechia Simms, who was charged with manslaughter and child abuse after her 3-year-old son, Ji’Aire Lee, was found dead on a Maryland playground sitting in a swing. Romechia, who has schizophrenia and depression, had been pushing him for forty continuous hours and was still pushing him when the police arrived. An autopsy showed he died of hypothermia and dehydration.

Last week, Vontasha borrowed a car and drove 45 minutes from her home in Waldorf, Maryland to the state capitol in Annapolis, to talk to  lawmakers about the need for mental health reform, according to a story  by Fenit Nirappil in the Washington Post.

Vontasha had never been to the State House before and didn’t recognize any of the key players there but she went anyway to urge them to make it easier for parents or close relatives to take charge over adults who had mental disorders.

At the time of her grandson’s horrific death, Vontasha was living in a motel on public assistance. She is not someone who is a polished lobbyist but since Ji’Aire’s death and her daughter’s arrest, she has testified before her county commissioners and used the public outrage about the playground tragedy to talk about how she repeatedly tried to get her daughter help for her mental illness but couldn’t.

That takes courage.

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On Friday, 1-29-16, I posted a blog by  journalist/author Robert Whitaker questioning the value of anti-psychotic medications. Whitaker felt compelled to explain his position about medications because of statements challenging him made by Dr. Allen J. Frances, Professor Emeritus of Psychiatry and Behavioral Sciences at Duke University Medical School in an email.  Here is Dr. Frances’ response to Whitaker’s response.

Do Antipsychotics Help Or Harm Psychotic Symptoms?

By Dr. Allen J. Frances

This is the latest, and perhaps last, of several debates with Bob Whitaker on the role of antipsychotics in treating psychotic symptoms. It was triggered by a recent email exchange that clarified our areas of agreement and disagreement. 

Bob and I agree strongly on the following:

1) Antipsychotic medicines are used far too often in people who don’t need them.

2) Even when necessary, doses are often too high and polypharmacy too common.

3) Antipsychotics are neither all good, nor all bad. Used selectively, they are necessary and helpful. They are harmful when used carelessly and excessively.

4) The treatment of people with psychosis relies far too much on medication alone, far too little on social engagement, psychotherapy, vocational rehabilitation, and providing adequate housing. We both like the normalizing, recovery models offered  by Trieste, Open Dialogue, and Hearing Voices. (click here to read more on this subject.)

5) The care provided for the mentally ill in the US is a disaster that shames our country. (click here to read my thoughts about this.) 

Bob and I disagree strongly on the following:

1) Bob believes that long term use of antipsychotics makes psychotic symptoms worse. He therefore recommends that patients try to avoid antipsychotic medicine altogether or taper off them, whenever possible. 

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Two internal memos, not previously made public, show that state mental health officials in Virginia were warned earlier than has been widely reported about “streeting” – the practice of turning people away from hospitals because of a lack of psychiatric beds.

The two in-house warnings were written by then Inspector General G. Douglas Bevelacqua and sent to James A. Stewart, who was serving as Commissioner of the Virginia Department of Behavioral Health and Developmental Services (DBHDS) at the time, and his upper management.  The memos are dated April 14, 2011 and May 12, 2011.

The public first learned about “streeting” from media reports when Bevelacqua issued an IG report on February 28, 2012, specifically about the practice.

These earlier two memos establish a timeline that shows DBHDS officials were aware of “streeting” some 31 months before State Senator Creigh Deeds and his son, Austin “Gus” Deeds were “streeted” with tragic results.

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I recently asked Washington area management consultant Steven Kussmann to suggest ways the mental health community could be more effective in achieving meaningful reforms. Here is the thoughtful and creative blueprint that he sent me.

Changing The Mental Health Movement From Within

by Steven Kussmann 

Less than 3% of our population self-identifies as gay or lesbian. Yet, the LGBT community created a movement that changed our nation’s definition of marriage and secured same sex marriage as a constitutional right! Change did not happen organically nor overnight. It was the result of a highly-effective social movement strategy and decades of well-targeted action.

The number of U.S. citizens with a serious emotional and mental health disorder is 10-times greater than the LGBT population. Why then do our social and political successes pale in comparison with those achieved by this community? What can we learn from them to achieve similar results? How can we apply those lessons to transform the mental health movement into a powerful engine for effective change?

The lessons are many, and their application requires a fundamental refocus of movement strategy and structure. To succeed as a force for real social and political change, the mental health community, both its leadership and grassroots network, must rethink and retool its strategy and tactics.

Here are five get-the-ball-rolling ‘lessons learned’ from the success of others the mental health community can act on now:

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