(9-13-16) A gadfly is a person who interferes with the status quo by posing novel, potently upsetting questions, usually directed at authorities. Mental health gadfly D. J. Jaffe, who along with Dr. E. Fuller Torrey frequently stirs up controversy in mental health circles, claims that Democratic presidential hopeful Hillary Clinton’s mental health plan, which I cited in an August blog, isn’t as good as the mental health legislation that could be voted on in the Senate this week. Meanwhile, Clinton’s rival — Republican Donald Trump — has not offered any ideas about fixing our mental health care system.

In addition to attacking Clinton’s plan, Jaffe and John Snook, executive director of the Treatment Advocacy Center (which was founded by Dr. Torrey), have criticized   greater federal funding of Mental Health First Aid, an eight hour course that helps ordinary citizens recognize mental illnesses. Some communities are using Mental Health First Aid rather than the 40 hour Crisis Intervention Team training for law enforcement.

Hillary Clinton’s mental health plan doesn’t compare to the bipartisan plan already on the table

by DJ Jaffe

Donald Trump has not introduced a mental health plan, so we can’t evaluate it. But Hillary Clinton did introduce a mental health plan. Unfortunately it is not  as good as the bipartisan Helping Families in Mental Health Crisis Act (H. R. 2646), which passed the House by a vote of 422-2, and should be taken up by the Senate this week. It is not even as good a bill as combining Senator Alexander’s Mental Health Reform Act (S2680) with Senator Cornyn’s Mental Health and Safe Communities Act (S2002) would be. 

The Clinton plan largely focuses on improving mental wellness in everyone, rather than helping the most seriously mentally ill. There are forty-three million Americans who have a mental health issue, but only ten million, have “serious mental illnesses” including schizophrenia and bipolar disorder. 140,000 of the seriously ill are homeless, 365,000 are incarcerated, and 95,000 who need hospitalization can’t get it. That is the problem we have to focus on.

 More money may not be the immediate answer. The federal government already increased mental health spending to $147 billion but at the same time, it made the ability to get care inversely related to the severity of the illness. The easiest to treat go to the head of the line for services and the seriously ill go to jails, shelters and morgues.  The Substance Abuse and Mental Health Administration (SAMHSA), encourages spending to go to irrelevant and useless programs and some that are actually harmful. H.R. 2646 puts a doctor at the helm of SAMHSA to try to stop that. The Clinton plan ignores the issue.  

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(9-12-16) Distraught, a Fairfax County resident threatening suicide seeks help.  Nearly four hours later – after being told no bed has yet been found – the resident is asked if he/she still feels suicidal. When the resident replies “no,” the resident is told that he/she could elect to go home or continue to wait until a bed can be found.

The resident leaves.

The family is frustrated. It wanted the resident to get help, not be sent home untreated. The resident (whose privacy I am respecting) had finally hit rock bottom and reached a point where he/she appeared willing to seek and accept help.

But that opportunity was lost.

After the tragic death of Virginia state Sen. Creigh Deeds’ son, Gus, who was sent home untreated because no local bed was available, the state created a bed registry that could be used to locate where beds were available. Since its creation, I have been assured that Virginia has sufficient beds. In fact, I was recently told that there are nights when there are empty beds.

But as this Fairfax example shows, people in need of treatment are still not being readily admitted. Based on emails and telephone calls that I have received, this seems especially true if an individual arrives at a mental health facility or hospital voluntarily seeking help and not because of a detention order issued by a magistrate that requires the local community service board to find a hospital bed.

Having patients wait for hours is one way to discourage them from being hospitalized. It also is a way to avoid admitting someone by declaring that a patient sitting in a waiting room no longer poses a risk and, therefore, doesn’t need to be admitted.

Because there is no data readily available that would show how many residents simply give up and leave after waiting for hours, it is impossible to identify who these patients are. But I suspect that many of them are much like the resident whose case I have cited above and verified. They are poor and seriously mentally ill, which makes treating them difficult. Some are intoxicated or high, compounding the problem. They are potentially troublesome patients who, more than likely, will end up costing a hospital money and/or depleting scarce county and state services. Many of them are “high utilizers,” which means they are in-and-out of emergency rooms and crisis centers several times a year.

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(9-8-16) I was disappointed when AJ French described to me in an email how her friend, Bradley Lavite, a war veteran, is currently being treated. I asked her to share the story with you while I am in India touring mental health facilities.

Guest Post by AJ French

How do we thank a Veteran?

In my local community, the answer is: shamefully!

Bradley Lavite is a highly decorated war veteran for his service in Operation Iraqi Freedom I and II. Plus, he has more than twenty years of military service as a reservist.  He was an ideal choice to work as the Superintendent of the Madison County Veteran’s Assistance Commission here in Illinois, just northeast of St. Louis.

Unfortunately, an incident on March 5^th has threatened my friend’s career and damaged his reputation. It also has revealed intolerance and ignorance by our local public officials.

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(9-5-16) Another death in the same Virginia jail where an inmate with mental illness literally starved himself to death has sparked a fresh round of calls for the U.S. Department of Justice to investigate the facility.

In addition to this new death, the Richmond Times Dispatch reported Sunday (9-4) that prisoners being held in the the already under-fire Hampton Roads Regional Jail died nearly nine times more often than in other local or regional jails in Virginia.

Let’s start with the new death.

As first reported by Gary A. Harki in The Virginian Pilot, Henry Clay Stewart, a 60 year-old prisoner being held in the jail for violating parole on a shoplifting charge, repeatedly told jail officials that he needed medical help, in one instance, because he was vomiting blood.

“I have blacked out two times in less than 24 hours,” Stewart wrote Aug. 4 in imperfect English on an emergency grievance form obtained by his family after his death. “I keep asking to go to the emergency room. … I can’t hold water down or food.”

Two days later, he was dead.

Surprise, surprise, the newspaper quoted jail spokeswoman Officer N. Perry saying she could not talk about Stewart’s death because of the federal Health Insurance Portability and Accountability Act.

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(9-1-16)    By Susan Resnick  Guest Post

The call came thirty-three years after I’d stopped hoping for it.

“Hey, it’s Nick,” he said. “Can you file a Freedom of Information request for my FBI files?”

No last name, no context. He acted as though we’d had frequent phone conversations instead of two fleeting ones in the past three decades. Coming from a different old friend, this request may not have seemed strange. I’m a journalist, so presumably I have experience getting classified information. Someone legitimately concerned that the FBI was tracking him might be wise to ask a third party to gather the documents.

Neither of these was the case.

Instead, Nick had misplaced the mind he’d already lost and found at least twice before. He has a serious mental illness, though don’t know exactly which one – schizoaffective? Bipolar II? – because I don’t really know him. He was a kid I made out with a few times, a guy who bought me coffee in an airport once when I traveled through his city. He also may have changed the course of my life.

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(8-30-16) For the first time in my recent memory, a presidential candidate has given a speech about the need for mental health reform and has promised to hold a White House summit about mental health if elected. Regardless of your political views, this recognition of mental health as a major issue is a step forward. 

Liz Szabo, who has done an excellent job at USA TODAY covering mental health, filed this story about Hillary Clinton’s call for better mental health care. Clinton’s rival, Donald Trump, has not yet issued a formal statement about mental health reform. If he does, I will post it. Meanwhile, you will recognize some familiar names in this story.

Clinton rolls out plan to improve mental health care

By Liz Szabo for USA TODAY

Democratic presidential candidate Hillary Clinton called for putting mental health care on par with other types of health care Monday (8-29)  as part of a wide-ranging plan to address key problems in the treatment of people with mental illness.

The proposal calls for expanding early intervention in mental illness; a national initiative to prevent suicide, which kills more than 40,000 Americans a year; increasing training for police who are called to the scene of a mental health crisis;providing mental health care for non-violent offenders to help them avoid going to jail for minor offenses; and investing in brain and behavioral research to develop better treatments.

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