(11-28-16)  Most of us have strong opinions about involuntary psychiatric treatment and tomorrow (TUESDAY 11-29) at 11 a.m., it will be the topic on Diane Rehm’s  popular NPR show.

I’ll be a guest along with Drs. Dinah Miller and Annette Hanson, co-authors of  COMMITTED: The Battle Over Involuntary Psychiatric Care.  

In keeping with NPR’s promise of hearing all sides, Diane will interview two individuals with mental illness; one who has been helped by involuntary commitment and one who was traumatized by it.   Please listen and join the discussion. Here is what the show has posted on its website about Tuesday’s hour long program:

Many mental health experts say forcing someone into psychiatric care against their will can be necessary to protect people dangerous to themselves and others. But in some certain cases it is illegal, and some see involuntary commitment as a violation of someone’s civil rights. A look at how patients can be both helped and traumatized by involuntary psychiatric care, and what the data indicates about its role in preventing violence, suicide and mass murder.

HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT  TO BE VOTED ON THIS WEEK, REP. TIM MURPHY CLAIMS MAJOR VICTORY

Rep. Tim Murphy (R-PA.) announced late last Friday that a version of his Helping Families in Mental Health Crisis Act (HR 2646) and Rep. Fred Upton’s (R.-Mich.) 21st Century Cures Act (H.R. 6) have been merged into one package that will be voted on sometime this coming week, possibly as early as Tuesday. I wrote about this   commingling of bills ten days ago and will be posting an analysis of the bill after it is passed. Meanwhile….

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(11-24-16) Among the many blessings that I have in my life are the relationships that I have developed with fellow advocates for persons with mental illnesses. I know many of these courageous individuals only through emails and Internet posts. 

Laura Pogliano is one such friend and today on Thanksgiving, I am reposting a letter that she wrote to me last year. Laura,  I am thankful for you and so many others who inspire me. 

Hi Pete,

I started to write a reply to you, to thank you for the kind words in your Friday blog about my son, Zac, and my advocacy, but didn’t finish. When I got home from work, I realized why. Hanging on my door knob was a gift from Officer Kim Lankford of the Baltimore County Police Department.

Let me tell you a bit about Officer Lankford. You might recall that Zac decided at one point that he had been shot in the head. He hadn’t but he was convinced because of schizophrenia that he had. I wrote a blog for you about how Officer Lankford had treated my son with respect and had spent time comforting him. Later, it was Officer Lankford who did the welfare check at his apartment when I was concerned and the one who found him deceased and broke the news to me.

I want to tell you about the gift she left on my door knob.

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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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