(2-23-17) A tweet by Dr. Jeffrey Lieberman, the chair of the Psychiatry Department at Columbia University, announcing that Miami-Dade Judge Steven Leifman has been appointed as the first Assistant Secretary for Mental Health and Substance Use Disorders is premature. No final decision about the appointment has been made.

“Thrilled with appt. of Judge Steve Leifman as First Asst. Sec. of Mental Health in US History,” Lieberman tweeted.   

While Judge Leifman is a strong candidate for taking charge of the Substance Abuse and Mental Health Services Administration (SAMHSA), which has a $3.5 billion budget, Health and Human Services Secretary Tom Price has not officially announced which candidate he will recommend to the White House. The new Assistant Secretary will then have to be vetted and approved – either by President Trump or his staff – before his appointment is sent to the U.S. Senate for confirmation.

For his part, Judge Leifman is not commenting publicly about the tweet or his possible appointment.

Judge Leifman is considered to be the leading candidate because, in my opinion, he is the most qualified and clearly the best choice for the job, a sentiment widely agreed on in Washington.

But he still faces hurdles. When Vice President Mike Pence was governor of Indiana, he appointed Dr. John Wernert to overhaul Indiana’s state mental health system. That could cause problems if Pence decides to get involved. There are still some who are lobbying for a psychiatrist, not a judge, to be put in charge of  SAMHSA.

Being a psychiatrist or someone with an equivalent medical background was one of the requirements that Rep. Tim Murphy (R.-Pa.) originally put in his Helping Families in Mental Health Crisis Act (HB- 2646), which started the effort in Congress to reform our mental health system after the Newtown shootings. But that requirement was dropped when Murphy’s bill reached the Senate. Senators didn’t want their hands tied when it came to the confirmation process and they also wondered if a psychiatrist would have the management skills needed to run a large bureaucratic organization.

I have always supported Judge Leifman because I have seen first-hand how he has transformed the mental health care system in Miami-Dade County from one of the most horrific in the nation to one that is now  nationally  recognized as a “gold standard” model being copied by other progressive communities.

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(2-20-17) I often feel as if I am preaching to the converted because many of the speeches that I give are to mental health or law enforcement groups. So I was especially thrilled last week to speak at an event that focused on more than mental health – the Lake Nona Impact Forum outside of Orlando, Florida. Many of the 250 “thought leaders” who attended were not familiar with the mess that our nation’s mental health system is in.

Sanjay Gupta, MD, Chief Medical Correspondent for CNN, moderated the panel that I was on with fellow mental health advocate Margaret Trudeau, the former wife of Pierre Trudeau, 15th Prime Minister of Canada and the mother of Justin Trudeau, 23rd Prime Minister of Canada; and with Dr. Andrew Nierenberg, Director of the Bipolar Clinic and Research Program at Massachusetts General Hospital and Professor of Psychiatry, Harvard Medical School.

Ms. Trudeau’s description of her personal struggles with bipolar disorder was self-effacing, poignant and often funny. Best of all, her recollections came from her heart and deeply touched those fortunate enough to hear her. Of course, Dr. Nierenberg is one of the nation’s leading experts on treatment-resistant bipolar depression and the longitudinal course of mood disorders and he offered easy to understand explanations to difficult medical problems.

All three of us were invited to the event because of Muffy Walker, one of the founders of the International Bipolar Foundation and one of my favorite examples of an individual who decided to put her creative talents to use by helping found and finance a non-profit organization that calls attention to bipolar disorder and funds research.  (Read her inspirational story here.)

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(2-13-17) Officials at Rapid City Regional Hospital in South Dakota need to re-read the Hippocratic Oath and ask themselves if they are proud of how they are treating individuals with mental illnesses in the Black Hills region.

Unless someone in a mental health crisis also has an “acute medical need,” the hospital is turning them over to the police to be held in jail for 24 hours even though they have not committed any crimes.

A hospital spokesman explained that psychotic individuals often are disruptive and frighten other patients so they are not welcomed at the hospital. South Dakota allows law enforcement to temporarily detain individuals in jail up to 24 hours without charging them with a crime.

Rapid City Police Chief Karl Jegeris criticized the hospital, according to Mike Anderson, a reporter with The Rapid City Journal, who disclosed the hospital’s new policy.

“This is the biggest step backward our community has experienced in terms of health care for mental health patients. And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”

The Rapid City hospital is not the first to turn away pesky psychotic individuals. Consider the angry call that I received in Fairfax County, Virginia, where I live, from an outraged parent who said a local ER here called the police and had her son arrested for trespassing after he showed up seeking psychiatric help.

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(2-8-17) House Republicans in Virginia today moved to fire the state’s sitting Inspector General for issuing a vanilla investigative report about the death of Jamycheal Mitchell that avoided answering tough questions. Mitchell was the 24 year-old African American with schizophrenia who was found dead in a Hampton Roads Regional jail cell while waiting 101 days for a bed in a state hospital. An autopsy showed he had died because of a heart attack caused by starvation. Mitchell had been arrested for allegedly stealing $5.05 worth of snacks from a 7-11 store.

Along with other mental health advocates, I sharply criticized State Inspector General June W. Jennings for issuing a report that failed to explain how a prisoner could starve to death while under near constant surveillance by correctional officers and being checked daily by a nurse hired to provide health care at the jail. Instead of questioning jail officials thoroughly and digging out details about what transpired, Jennings explained that she’d decided to not investigate who might have been responsible, nor “every element of prior investigations.”  Instead, her report focused on “system errors”rather than “human ones.” The result was a largely useless document that surely pleased jail officials (who already had investigated themselves and found no wrongdoing) and appeared to have been written to help protect the state from being found liable in a civil lawsuit.

After Jennings issued her report, a whistleblower in her office and two other contract employees alleged in a complaint to the state Attorney General, that IG investigators hadn’t even bothered to go to the jail when Mitchell first died, but instead did a “desk review,” which meant they called jail officials and asked them to fax them copies of their official reports. The whistleblowers also charged that Jennings and her staff intentionally mislead me when I filed a Freedom of Information request.

Hours after that complaint was filed, a spokesman for Virginia Governor Terry McAuliffe announced that the complaint was being rejected because the governor had full confidence in Jennings. The whistleblowers noted that the governor’s office took this action without bothering to interview any of them. In the midst of that dust-up, a newspaper reported that Jennings and her top assistant, Patricia Smith, had personal ties to the state hospital that misplaced Mitchell’s paperwork, causing him to remain in jail rather than be transferred. Those connections raised questions about whether either Jennings or Smith could be objective, but the governor stuck with her.

And after today’s vote, Governor Terry McAuliffe, a Democrat, doubled or I should write, tripled down. In an angry statement, he defended Jennings while accusing Republicans of game playing. Click to continue…

 

(2-3-17) From My Files Friday — If we ever want to stop the inappropriate incarceration of individuals with mental illnesses, we need to set concrete goals and work toward achieving them.

That was some of the message that Ron Manderschied, the executive director of the National Association of County Behavioral Health and Developmental Disability Directors, gave last weekend at a conference hosted by the Institute for Behavioral Healthcare Improvement in San Antonio, Texas. Manderschied mentioned that he and I had discussed reducing the number of prisoners in jails and prisons with serious mental illnesses (367,000) by 20% to 25% by 2020.

I first began discussing that idea with Dr. Manderschied after Steven Kussmann, a Washington D.C. management consultant, cited the importance of clear goals in this blog that he wrote and I first published last February.

Unfortunately, neither Dr. Manderschied nor I have had much success in rallying national mental health organizations together behind a 25% reduction by 2020 goal, although several have their own jail diversion campaigns.

I was honored to give the keynote at the San Antonio event, and enjoyed hearing from such experts as Leon Evans and Gilbert Gonzales, who have turned Bexar County, Texas (San Antonio) into the gold standard for jail diversion, and Judge Steven Leifman, who spoke about how he is creating a system that will use “predictive analytics” to help individuals in Miami stay on track in their recovery programs. Assisted Outpatient Treatment was lively debated by Marvin Swartz, the head of Social and Community Psychiatry at Duke University and long time consumer advocate, Harvey Rosenthal, executive director for the New York Association of Psychiatric Rehabilitation Services.

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.

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