My friend, Judge Steven Leifman, runs one of the most successful mental health courts in the US

(11-15-16) I am a strong advocate for mental health courts.

Why should someone such as my son, who broke into a stranger’s unoccupied house to take a bubble bath while he was psychotic, have to go through the regular criminal justice system when it is obvious that it was his mental illness and not some criminality that prompted him to break the law? Getting him into meaningful, court-supervised treatment would have made more sense than incarcerating him, especially because we know that individuals with mental disorders are more likely to have more charges pressed against them when they are in jail.

In a specialized mental health court, court-affiliated mental health professionals would have assessed him and developed a treatment plan and the judge would have monitored his adherence to community-based treatment. While he might have faced sanctions – including jail – for failing to engage in treatment, he might also have had his charges reduced or dismissed after a sufficient period of demonstrating his commitment to remaining stable and law-abiding. Instead, he is forever marked as a criminal because his sentence in Virginia cannot be expunged.

A handful of jurisdictions launched mental health courts in the late 1990s. Today, there are more than 400 mental health courts, another 1,500 drug courts, and more than 3,000 other treatment oriented courts of various kinds, such as veterans courts, DUI courts, juvenile drug courts, and family dependency drug courts. In a 2015 literature review of mental health court data, 15 articles examined recidivism rates; of these, 13 found significant reductions in new arrests and days spent incarcerated.

So what was I to think of a scholarly article authored by Carol Fisler, director of Mental Health Court Programs at the Center for Court Innovation in New York, published last year in the American Bar Association’s  Judges’ Journal, that challenged many of our assumptions about mental health courts?

It is important to note that Ms. Fisler, who directed the planning and implementation of the first specialized court for offenders with mental illness in New York and has provided training and technical assistance to mental health court planning teams across the country, ultimately concludes that “research to date consistently supports the notion that mental health courts ‘work.'”

But, she cautions, that the reasons why they “work”  appear to have little to do with some of the basic assumptions that we believe when we create them.

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Illustration from NAMI Kenosha County

(11-18-16) Before the presidential election, Patrick Kennedy was urging Democrats in the Senate to delay passing the Mental Health Reform Act of 2016. so they could rework it once Hillary Clinton was president and the Democrats gained more control in Congress.

Oops.

Now that Donald Trump is president-elect and Republicans have won majorities, well, that strategy has been flipped on its head.

Some Democrats are now concerned it will be the Republicans who delay passing mental health reform so they can restore tougher language that was in House Republican Rep. Tim Murphy’s original Helping Families In Mental Health Crisis Act.  

(For those of you who have lost track – Democrats blocked passage of Murphy’s bill until Rep. Fred Upton (R-MI) rewrote it earlier this year. It was further reworked in the Senate by Senator Lamar Alexander (R-Tenn.) who is shepherding it through the chamber with help from Sen. John Cornyn (R-Tx.), the powerful Senate Majority Whip. Kennedy complained that the bill has been so “waterdowned…it will do more harm than good.”)

Don’t worry about the Republicans trying to delay things, Sen. Cornyn assured reporters and officials from the National Alliance on Mental Illness this week.

He and Sen. Alexander still “hope” to get mental health reform passed during the lame duck session this month. They are saying “hope” because the latest strategy is to attach the mental health bill to another bill rather than introducing it as stand alone legislation. Both think that will improve its chances of passing.

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Photo courtesy of eideard.com: Patients campaign for the Death with Dignity Act.

(11-16-16) Should psychiatrists participate in euthanizing individuals with mental illnesses?

A Maryland psychiatrist, author and popular blogger, is raising an alarm about the role of psychiatry in the growing number of “Death with Dignity” laws being adopted across the nation. On Tuesday, the District of Columbia joined six states in approving laws that allow doctors to prescribe fatal drugs to terminally ill residents so that they can choose to end their lives.

Dr. Annette Hanson, co-author of the recently released book, COMMITTED, contacted me before the D.C. vote to explain why she believes assisted suicide laws may have unintended consequences when it comes to persons with mental illnesses or brain disorders such as dementia. In an email, she wrote:

I first became alarmed after California created the first law to mandate that public institutions must provide fatal care. (Title 9 of the California Code of Regulations, Section 4601, requires state psychiatric hospitals to provide assisted suicide services to seriously mentally ill patients) Upon receipt of a court order, a hospital must facilitate a patient’s suicide and even carry out the death on site. Doctors who refuse to participate could face fines or even incarceration for contempt of court.

These laws will have a devastating effect on efforts to care for very sick people. Some psychotic people refuse psychiatric medication because they believe the pills are poison—now there is a valid reason for that belief. Trust is essential to provide care to these patients, and the knowledge that the hospital helps people kill themselves would destroy that trust.

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Photo of Brad Ambrose from NBC Channel 4’s Changing Minds series. 

(11-9-16) Gary Ambrose, a retired Air Force brigadier general, recently received the Gartlan Award for Leadership and Advocacy in Virginia. I was asked to say a few words about General Ambrose’s many accomplishments, but it was his speech about his son, Brad, that deeply touched listeners.

Like many others, our family became mental health advocates by necessity.

We were advocates for our son and brother, Brad, who, for 17 years, lived with paranoid schizophrenia and the voices that urged him to take his own life.

Brad was intelligent, articulate, well-read, and charismatic. We shared a sense of humor. Of course, we loved him. But more than that– we liked him. He was our son, but he was also a friend. During “good times,” when he was medication compliant, he was a pleasant companion.

He was a peer mentor in the NAMI Peer To Peer program and the first chairman of the Mental Health Subcommittee of the Fairfax County Re-entry Council. In the spring of 2014, he was the first person with mental illness to be highlighted on Channel 4’s “Changing Minds” segment. He was passionate about improving life for people with mental illness.

He had potential.

But, he had also spent many of the 17 years of his illness cycling through the healthcare and legal systems, and was, much of the time, a danger to himself.

Brad’s illness took him from us in 2014.

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(11-7-16) Ken Gladieux was diagnosed with a mental illness when he was 28. Even so, he finished medical school, became a psychiatrist, married and started a family. In 2009, he moved to Lynchburg, Virginia to a new practice. Thirteen days later, he ended his own life.

His daughter, Meg, was only eight years old when he died. Today, she is a high school sophomore and, along with her mother, Barbara, a vocal advocate for suicide prevention and mental health education. Recently Meg read a story during an interview on The Mike Show, broadcast on a Lynchburg radio station, to promote the Lynchburg Out the Darkness Walk that was held October 1st.  

“My kids are doing well today and they are very successful,” Barbara explained in an email. “Ken and I built a fine life and a foundation for our kids based on love and care.  We have had much support from Kids Haven, a local non profit place, for grieving kids.  I hope the continued nurturing will help them deal with life in the future.  Our family believes in helping others and reaching out for help!”

Please listen to her five minute statement. It is inspiring. Great job Meg! Thanks for speaking out.

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Photo by Christian Science Monitor

(11-4-16) Mental Health Activist and former Rhode Island congressman Patrick Kennedy says Congress should delay passing a mental health reform bill this month during its lame duck session.

His statement could be another setback for Rep. Tim Murphy (R-Pa.) and his Helping Families In Mental Health Crisis Act, which Murphy has been trying to get signed into law since the 2012 Sandy Hook Elementary School shootings.

You might recall that Democrats blocked passage of Murphy’s original bill until Rep. Fred Upton (R-MI) rewrote it earlier this year, eliminating its most controversial features. That version sailed through the House. Now, everyone is waiting for the Senate to pass its version —the Mental Health Reform Act of 2016. It was introduced by Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R.-La.) as a companion bill to Murphy’s,  but it also has been extensively revised to appease critics. Senator Lamar Alexander (R-Tenn.) is now shepherding the Senate bill with help from Sen. John Cornyn (R-Tx.), the powerful Senate Majority Whip.

Their game plan was to bring the bill up for a vote during the lame duck session that begins November 15th and get it passed (without additional debate and no amendments) so it could be immediately merged with Murphy’s House bill and delivered to the White House for President Obama to sign into law before leaving office.

However, in a recent interview with POLITICO’s Brianna Ehley, Kennedy said he is urging lawmakers to wait until the next Congress to pass any mental health reform legislation. Although he is no longer in Congress, Kennedy has considerable clout when it comes to mental health topics, especially among Democrats.

Kennedy said having the Senate pass legislation during the lame duck session would “do more harm than good,” adding that Murphy’s bill is now “so watered down” that it does nothing more than “reallocate money around block grants.”

“Passing that bill will take the wind out of the sales for real reform,” Kennedy added. “Kick it to the next Congress and the new administration to do this the right way.”

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