(9-28-20) Michael Estrada has made a powerful hour-long documentary entitled Benevolent Neglect that chronicles his decade long journey trying to help his seriously mentally ill mother, Josie.

A teacher, Estrada, took a year sabbatical to make his film with small contributions from friends but no movie making experience after his mother died in 2018. Benevolent Neglect is such an important film, I believe it should be shown in every National Alliance On Mental Illness chapter, circulated by the National Council on Behavioral Health, and watched by our elected leaders.

It is both a painful reminder that we are not doing enough to avoid what Estrada notes is “much sorrow, needless suffering and preventible deaths.”

In telling his mother’s story, Estrada shares a much bigger story about how our legal and health care system are contributing to suffering rather than helping protect and heal.

Because Estrada wanted to add context to his documentary, he interweaves such larger issues of deinstitutionalization, involuntary commitment, and shortages of crisis care beds into his film. But the most revealing moments come when Estrada takes viewers into his world as events with his mother unfold. A Modesto police officer refuses to involuntary commit Josie so she can go to the hospital even though she is clearly a danger to herself. Why? Because she is able to tell him what day and month it is, along with the name of her street. A  hospital supervisor ignores Estrada’s pleas even though his mother has nearly died because voices are telling her not to take her diabetes medication. Why? Because Josie wants to be discharged and the supervisor doesn’t want responsibility for her.  A California Department of Mental Health employee rebuffs Estrada when he says his mom has been kicked out of so many apartments, she now is homeless. Why? Because she is living in her car and therefore has a roof over her head.

The fact that Josie presents well, is well-groomed and can carry on a conversation without a hint of her illness stymies Estrada’s efforts to get her care even when voices in her head cause her to pull covers over her head and cower during a “spiritual attack” and when those same voices convince her that her diabetes medicine is poison and the FBI is watching her.

Josie’s actions are so troubling that they eventually cause her to be held involuntarily five times under California’s 5150 law. (Nearly always after she is stopped by police driving erratically and delusional.) But she is always released within 24 hours and always without any treatment.Click to continue…

(9-25-20) This is not about mental illness.

The death of Gerald Shur, my good friend and co-author of WITSEC: Inside the Federal Witness Protection Program, has prompted a slew of obituaries and a Life Lived Well segment on CBS. I want to share this story from The Times of London in the U.K., because it tells an  engaging story about Gerald and what it was like to battle the mob.

Founder of the Witness Protection Programme that helped the likes of ‘Sammy the Bull’ and ‘Fat Vinnie’ to testify against mob bosses

From the Times of London

When a poetry-writing hitman named Joseph “The Animal” Barboza betrayed his former associates in the New England mafia they were desperate to stop him from testifying.

Federal agents were equally determined to keep him alive for the trial of the crime boss Raymond “Il Patrone” Patriarca, who was said in 1967 to have placed a $300,000 bounty on Barboza’s head.

The killer-turned-informer was sequestered under armed guard on a desolate island off the coast of Massachusetts until the Mob discovered his location. They planned to ram a boat loaded with dynamite into the shore but Barboza had already been taken to another hideaway.

A posse of hitmen waited for Barboza outside the courthouse as the trial began, unaware that he had been smuggled into the building three days earlier and stashed in a basement storeroom. One stole a police officer’s uniform and was stopped trying to enter the courtroom. Barboza’s attorney lost his right leg to a car bomb.

Barboza remained alive and Patriarca was convicted of conspiracy to murder. Once Barboza had testified against other mafiosos, he and his family were sent for their safety to Fort Knox.

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DJ Jaffe with a copy of his book, “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.”Credit…Paula Orndoff

(9-23-20) Fans and friends can attend a virtual memorial service for D. J. Jaffe tomorrow (9-24-20) hosted by the Manhattan Institute from 1 p.m to 2 p.m.. (Register here.)  During the first half hour, I’ve been asked to speak about the impact of D. J.’s advocacy along with several others, including John Snook, executive director of the Treatment Advocacy Center. The second half hour will be a discussion about policy changes that he promoted.

The Manhattan Institute has posted comments honoring him by Dr. Elinore McCance-Katz, Dr. E. Fuller Torrey, and his other friends here. 

“The passing of DJ Jaffe is a great loss—the loss of an important leader and untiring advocate for the seriously mentally ill, but also the loss of a teacher and a friend. His contributions will live on and those of us who shared his vision for addressing serious mental illness in our country will do our best to continue in the footsteps that he forged,” Dr. McCance-Katz, the assistant secretary at HHS for mental health and substance abuse wrote.

I am reprinting D.J.’s obituary from the New York Times.
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HOW DOES YOUR STATE RANK? 

(9-21-20) A report released today by the Treatment Advocacy Center entitled Grading the States: An Analysis of U.S. Psychiatric Treatment Laws has reached the same conclusion that most of us have experienced in person.

There is no national, standardized mental health care system.

Involuntary commitment laws differ wildly, as does available treatment. From the report:

“The U.S. mental health system is not one single broken system, but many…We are effectively running 50 different experiments, with no two states taking the same approach. As a result, whether a person receives timely, appropriate treatment for an acute psychiatric crisis or chronic psychiatric disease is almost entirely dependent on what state that person is in when the crisis arises.”

I would take this a step further. Not only do different states use different commitment standards, different counties and cities do too.

Fairfax County, Va. where I live, historically has been much more reluctant to involuntarily commit an individual who is in crisis than its adjacent counties. The state law is the same but the administrative law judges in charge in Fairfax are more hesitant.

The 160 page report lists each state’s criteria for involuntary commitment and describes how that state accesses dangerous.  It contains useful information about inpatient commitment, who can petition for emergency evaluations, and outpatient commitment along with how long a state can “hold” someone.

TAC used a 100 point grading scale, according to Lisa Daily, the report’s primary author.  TAC was initially founded to push for adoption of Assisted Outpatient Treatment laws but has expanded its mission to “eliminate barriers” to all treatment. Recently, it has been lobbying for more crisis care beds.

“The report specifically focuses on laws rather than implementation. Some states have notable gaps between strong laws on the books and poor implementation and access,” according to the TAC press release issued with its report.

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Daniel Prude, 41, apparently stopped breathing as police in Rochester, N.Y. were restraining him in March 2020 and died when he was taken off life support a week later. Photo provided by Roth and Roth LLP.

(9-18-20)  Most of the media attention about Daniel Prude’s death in Rochester has been focused on the police response. What hasn’t been answered is why did a treatment center discharge him hours earlier? Cheryl Roberts, a former judge and executive director of the Greenburger Center for Social and Criminal Justice, asks that question and suggests in a recent editorial that America’s health-care system may be ” just as racist” as the criminal justice system. I look forward to reading your thoughts on my Facebook page.

Hard lessons from Daniel Prude’s death: The Rochester tragedy didn’t need to happen

By CHERYL ROBERTS

This editorial first appeared in the NEW YORK DAILY NEWS

Daniel Prude represents the most at-risk group of Americans to be killed in an encounter with police: a Black male living with a serious mental illness.

When police are summoned to so-called Emotionally Disturbed Person (EDP) calls, the results are often deadly. Nationwide, at least a quarter and maybe as high as half of those killed by police had mental illness. But the police alone do not own this statistic. The mental health system can be ineffective and racist too when it comes to African-Americans in mental health crisis.

Like Darrien Walker, killed by police only hours after release from a short-term stabilization center, Prude was seen by medical personnel shortly before his fatal encounter with police. While the hospital has promised a thorough review of the procedures and personnel involved, there will likely never be a complete public accounting should it be found that medical professionals were also at fault or that implicit bias was at the heart of why Prude was released that day without receiving help.

In many ways, America’s health-care system is just as racist as its criminal justice system, but there are no body-worn cameras to document how many times Blacks are dismissed or ignored by the health-care system or its professionals. A 2018 Commonwealth Fund study documented disparities in treatment and outcomes between Black and white patients; poorer disease outcomes, instances of physicians not taking time to explain diagnoses and options, disrespectful front-desk staff, and general lack of support in dealing with complications involving Black patients.

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(9-16-20)  Dr. Elinore McCance-Katz, Assistant Secretary of Health and Human Services for Mental Health and Substance Use, has been accused in an article posted on a popular health news website of repeating President Donald J. Trump’s pandemic statements for political reasons and politicizing the Substance Abuse and Mental Health Services Administration.

Writing in STAT, an American health-oriented news site read by medical professionals, journalist Alison Insinger reports that current and former SAMHSA officials have complained that Dr. McCance-Katz is “politicizing the office and reinforcing administration arguments about Covid-19 that aren’t supported by sound scientific evidence.”

The STAT article, entitled, “Top health official echoes Trump’s Covid-19 views, drawing accusations of politicizing mental health agency,” was written after Dr. McCance-Katz spoke during an hour long podcast posted Friday on the HHS website.

STAT noted that Dr. McCance-Katz did not respond to an emailed request for comment, nor did spokespersons for SAMHSA and HHS.

In that podcast interview, Dr. McCance-Katz can be heard describing Covid 19 as “a very contagious infectious disease which in most people, by the way, is a mild and asymptomatic disease if you are below age 45 and younger…” She adds that Covid is not a life threatening illness for a majority of children, saying at one point, “What is this nonsense that it is unsafe for children to be in school?”

The interview was conducted by Michael Caputo and when he states, “I don’t think the U.S. media gives a damn about public health information,” Dr. McCance-Katz replies: “I don’t either.” She adds that “it appears to me that they (the media) make things up.”

A psychiatrist with a Ph.D. in infectious disease epidemiology from Yale, McCance-Katz argues that the harsh steps taken to contain the pandemic in the spring were excessive and have caused an increase in suicides, drug and alcohol abuse, and mental illnesses.”We used a sledgehammer when I think we needed a scalpel.”

Dr. McCance-Katz’s statements mirror those of the president’s. He appointed her to serve as the head of SAMHSA and as the first assistant secretary at HHS for mental health and substance abuse in September 2017.

“She drank the Kool-Aid,” an anonymous source is quoted stating in the article.

I would strongly suggest that you form your own opinion by listening to the podcast.

During the first 20 minutes of the interview, Dr. McCance-Katz talks about her priorities at SAMHSA and promising steps that she has taken to reduce deaths caused by opioid abuse. 27 minutes into the interview, the subject turns to COVID.

“The people who make these decisions – the people who say it’s safer at home, stay at home, they tend to be people who are fairly affluent,” she states about isolation and the lockdown. “Yeah, it probably is safer at home for them because they go to some nice house, some big house with all the amenities…to get additional isolation and protection but for the majority of Americans, they can’t do that.”

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