(1-16-17) Twenty four days after President Barack Obama signed into law what was billed as the most major mental health reform bill in decades, a gunman pulled a semi-automatic pistol from his checked luggage in the Fort Lauderdale-Hollywood International Airport and began shooting, murdering five and injuring six others.

It is fair to ask if any of the reforms in the mental health bills that were merged into the 21st Century Cures Act would have stopped Esteban Santiago-Ruiz from committing murder.

Sadly, I believe the answer is no.

Yes, the Helping Families in Mental Health Crisis Act, the Mental Health and Safe Communities Act, and the Mental Health Reform Act, included promising initiatives. The bills call for better law enforcement training, more support for early identification and intervention programs, greater use of Assertive Community Treatment, more peer provided services, additional funds for community mental health programs and for continued funding for Assisted Outpatient Treatment.

Having police officers who have been Crisis Intervention Team trained can intercede and stop violence, having peers available to help persons with mental illnesses who encounter the police can help stop violence, access to better services can stop violence, and outpatient treatment can stop violence.

But none of these programs can make a difference if the person who is sick either doesn’t believe he/she is ill or rejects help. Whether by persuasion or coercion, there is no legal way in America today to stop a mentally distributed individual from buying or owning a gun unless they are or have been ruled a danger to themselves or others, or previously hospitalized.

Click to continue…

(1-13-16) FROM MY FILES FRIDAY – Next week, I will be posting a blog about the recent shooting inside the Fort Lauderdale airport, but today I am reposting an Op Ed of mine published by The Washington Post on September 27, 2013 after a similar rampage at the Washington Navy Yard here in D.C. These shootings continue to spark frustration and anger but little preventive action. This editorial garnered about 100 comments, many agreeing but others strongly challenging my views.)

Getting the mentally ill the help they need

By Pete Earley, published in The Washington Post

When should society intervene if a person shows signs of mental illness?

As with the shooters at Virginia Tech, in Tucson and in Aurora, Colo., there were ample warnings that Aaron Alexis was experiencing mental distress before he killed 12 people at Washington’s Navy Yard.

Police in Newport, R.I., did nothing to help Alexis when he complained about hearing voices and being zapped by skin-vibrating microwaves.

In 1975, the Supreme Court ruled in O’Connor v. Donaldson that the state “cannot constitutionally confine. . . a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”

That decision established our legal threshold of posing a danger to one’s self or others.

Click to continue…

(1-10-17) Who will president-elect Donald Trump nominate as the new Assistant Secretary for Mental Health and Substance Abuse?

Hearings begin today for the controversial big name cabinet posts so it will be a while before the Senate gets around to the White House’s choice for this new job in the Department of Health and Human Services, but four names already are being circulated on Capitol Hill.

Even before the $6.3 billion 21st Century Cures Act  was signed into law last month (that’s the omnibus bill that contained mental health reforms), I began lobbying for Miami-Dade County Judge Steve Leifman.

The others being mentioned are Dr. John Wernert, who runs Indiana’s mental health system; Dr. Robert Heinssen, a program director at the National Institute of Mental Health; and Dr. Ellie McCance-Katz, the chief medical director in Rhode Island.  Of course, other candidates might surface in the coming days and it’s also possible that Trump could pull a name out of hat that surprises everyone.

But I hope not.

It will take a strong, knowledgeable and accomplished leader to implement the hard-fought reforms that became law primarily because of Rep. Tim Murphy (R-Pa.) and Sens. John Cornyn (R-Tx.), Chris Murphy (D-Conn.) and Bill Cassidy (R-La.)

Click to continue…

judgment

(1-6-17) FROM MY FILES FRIDAY: Four years ago, I wrote about how quickly people often are at judging others, especially those who face tough decisions because they love someone with a mental illness or a brain disorder.  This blog was published January 16, 2012, after the Washington Post published an article about a woman who fell in love with someone else after her husband became mentally incapacitated and about the anger aimed at the parents of Jared Loughner, the Tucson shooter, after I defended them in a USA TODAY story. It is a reminder of how easy it is to judge when you are on the outside looking in.)

Two unrelated stories last week caused me to think about how easy it is to blame others without “walking in” their shoes.

The first was an incredible magazine story published by The Washington Post written by Susan Baer. I once worked at the magazine and knew the subject of the cover story, Robert Melton, although certainly not well. Melton suffered a stroke that drastically reduced his cognitive abilities. He was married and his wife, Page, continued to love and take care of him even though he had become a stranger who had little understanding of their marriage or her.  Eventually, Page fell in love with another man. She divorced her husband to marry him.

What makes this story different is that Page and her new husband did not abandon Robert. Rather, they made him a part of their new family and even moved Robert with them to St. Louis when she joined her new husband to begin their lives together.

The story, which was brilliantly told, was a courageous effort to describe one of the most difficult challenges that a person can face in their lives:  what do you do when someone you love suffers a debilitating brain injury. It is an especially poignant question for those of us who love someone with a severe mental disorder or develops dementia.

Many readers saw the article much differently from me. Writing in today’s Washington Post, columnist Robert McCartney revealed in his column that the story sparked a torrent of mean-spirited comments from readers, especially anonymous ones.

Click to continue…

(1-2-17) I was honored last week to be interviewed by Jennifer Bleyer, a senior editor at Psychology Today. 

A New Day for Mental Health

Author and advocate Pete Earley reflects on passage of mental health reform.

In a year when political discourse seemed to reach all new levels of fire-spitting acrimony, one collaborative bright spot was the recent passage of the 21st Century Cures Act, part of which aims to reform the nation’s mental health care system.

The $6.4 billion legislation received broad bipartisan support in the Senate and House and was signed into law by President Obama earlier this month, and includes provisions intended to improve the diagnosis and treatment of mental health and substance use disorders, increase access to effective, evidence-based mental health services, and shift the seriously mentally ill away from the criminal justice system and into appropriate treatment.

I heard author and mental health advocate Pete Earley speak about the pending legislation in September at a National Press Foundation fellowship seminar, Training Journalists in Mental Health, in Washington. Earley is the bestselling author of Crazy: A Father’s Search Through Mental Health Madness, a 2006 book that tells the story of his own experience after his college-aged son developed bipolar disorder and spent years cycling through hospitals and jails; Earley also reported on life inside Miami Dade County Jail, which like much of the U.S. prison system has become a de facto warehouse for the untreated or undertreated mentally ill.

Since the publication of Crazy, Earley has become a vocal advocate for mental health reform in writing and speeches to stakeholders all over the country. He has testified or appeared before Congress five times, including once in the exploratory phase of the legislation that just passed. I reached out to Earley to hear his thoughts on the new law.

What’s your general reaction to the passage of this legislation?

Overall, I’m hopeful that this bill signals a real shift in where mental health is going. It refocuses programs on evidence-based tools that will look at serious mental disorders such as schizophrenia, bipolar disorder, and severe and persistent depression rather than other DSM-5  disorders, such as restless leg syndrome and problems of the so-called “worried well.” It calls for a serious reexamination of HIPAA with an eye toward allowing caregivers, especially parents of the mentally ill, more access to information and participation in the treatment team, which is good. It calls for additional funding forassertive community treatment, which is perhaps the most effective and cost-efficient way of treating people in our communities, especially when combined with housing. I’m especially thrilled with the emphasis on how to stop the inappropriate incarceration of people with mental illness. What we’ve discovered is it’s cheaper to provide treatment and help people than it is to have them going in and out of jail constantly. So I like the funding that Senator John Cornyn of Texas got for crisis intervention team (CIT) training, which teaches law enforcement and communities how to handle the mentally ill, as well as mental health courts and reentry programs.

Overall, I think the biggest achievement is that it elevates the importance of mental health in the federal government through the appointment of an Assistant Secretary for Mental Health and Substance Abuse. I think that will cause a major shift in [the] Substance Abuse and Mental Health Services Administration, which is what Rep. Tim Murphy (a sponsor of the bill) wanted, making it focus more on mental health and less on programs that Murphy strongly felt are anti-psychiatry and feel-good programs with little value. All of the changes in the new law are positive steps forward, but it will all depend on whether someone strong enough to change the culture at SAMHSA is appointed and whether HHS and the feds put money behind necessary services, which they have never done adequately.

Click to continue…

 

(12-30-16) My grandmother used to say there is a special place in hell for people who commit especially heinous acts. I always thought it was a bit of overkill to condemn someone already destined to an eternity in hell to even worse abuse. But her comment popped into my head when I  read a Buzzfeed News Report by Reporter Rosalind Adams called “Locked On The Psych Ward.”

The article alleges that America’s largest psychiatric hospital chain, Universal Health Services, or UHS, is keeping psychiatric patients longer than necessary to milk their insurance, putting profits above patients’ needs.  The allegations against UHS, which has denied any wrongdoing, should alarm mental health advocates in states where UHS operates — and there are a lot of them, exactly 37 to date. (The Buzzfeed expose lists where UHS hospitals are located.) The company operates 230 psychiatric facilities across the country, admitting nearly 450,000 patients last year alone. According to the Buzzfeed expose, UHS reported almost $7.5 billion in revenues from inpatient care last year with profit margins of around 30%. More than a third of the company’s overall revenue — from both medical hospitals and psychiatric facilities —comes from taxpayers through Medicare and Medicaid.

This expose is especially unnerving because many of us have been pushing for the construction of more crisis care hospital beds. In some areas, there can be as long as a week before someone can get a bed in a hospital. This shortage has lead to psychiatric emergency room boarding and contributes to the inappropriate incarceration of persons who need help. I was outraged last week when I heard that a local hospital here in Fairfax County called the police and had a patient arrested for trespassing because he had a mental illness and kept coming into its emergency room seeking help.

The Buzzfeed expose also provides ammunition to groups that view all mental hospitals as being both unnecessary and evil by definition.

Reporter Adams wrote that former UHS workers and administrators that she interviewed in nine states said they were “under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out.”

Click to continue…