(12-28-18) Dr. Elinore McCance-Katz is my choice for the person who has had the biggest impact in mental health during 2018.

Appointed by the Trump administration in September 2017 as the first Assistant Secretary for Mental Health and Substance Use, Dr. McCance-Katz has dramatically changed the focus at the Substance Abuse and Mental Health Services Administration.

She has made serious mental illnesses a priority and has directed SAMHSA to create and fund programs based on clinical results and science.

Her leadership is a much needed breath of fresh air from the previous administrator who was harshly criticized by Congress for reportedly showing little interest in serious mental illnesses and whose leadership resulted in SAMHSA employees ranking morale inside their agency as among the lowest in the entire federal government.

SAMHSA received a budget increase of 35% under the Trump administration, allowing it to more than double the number of grants that it awarded in 2018 from 600 to 1,300. Simply distributing money is no solution, especially if it goes to wasteful programs, which is why one of Dr. McCance-Katz’s first orders was a thorough review of what constitutes an evidence based practice worthy of funding. Given that some so-called evidence based practices in the past were based on little or no real evidence, this was a major directional change. At the same time, SAMHSA streamlined its application review process, cutting the application from 25 pages to 10 and the number of questions for applicants from 25 to a mere 9 so that federal funds could be released more quickly to those programs that deserve them.

Making the process more vigilant, efficient and easier to use might not seem sexy, but awarding grants is how the federal government helps steer states. (For example, SAMHSA recently awarded $61.1 million for suicide prevention programs.) Having someone as assistant secretary who actually is making Americans with serious mental illnesses a prime concern is a godsend.

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(12-24-18) To my readers: thank you for caring about individuals with serious mental illnesses and those who love them. During these holidays, let us not forget the sick, homeless, and incarcerated while celebrating those, including my son Kevin, who are doing well.

Matthew 25:36 “I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.”

This coming year presents us with fresh opportunities to advocate for change.

Margaret Meade:  Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.

Patti and I wish you a Merry Christmas!

(12-20-18) The U.S. Department of Justice has said there is reasonable evidence to conclude that officials at the Hampton Roads Regional Jail in Virginia are violating the constitutional rights of prisoners with mental illnesses. The report refers to  “deliberate indifference to prisoners’ constitutional rights to adequate medical care” and a “deliberate indifference to prisoner health and safety.”

In a 43-page investigative report released late last night, the Justice Department’s Civil Rights Division and the U.S. Attorney’s Office for the Eastern District of Virginia disclosed information about deaths at the jail not previously widely known.

Perhaps the saddest findings are frequent references to the “indifference” jail officials and medical workers showed toward mentally ill prisoners. It noted the jail “does not take prisoner grievances about lack of access to medical care seriously, resulting in significant harm to prisoners, even death.”

The federal government launched its investigation of the Portsmouth regional jail at the request of the National Alliance on Mental Illness, Mental Health America, the NAACP, the ACLU, and the Bazelon Center for Mental Health Law after widespread publicity swirling around the death of Jamycheal Mitchell and Virginia state officials’ bungling of state investigations.

Mitchell, a 24 year-old African American with a diagnosed mental illness, was found dead in his cell four months after he was arrested for allegedly stealing $5.05 in candy and a soda from a convenience store. Mitchell died from a heart attack that a Virginia medical examiner said was caused by “wasting away” syndrome (starvation.) He had lost 40 pounds during the 100 days he was jailed in solitary confinement awaiting transfer to a state mental hospital. In a civil suit filed by his family, attorneys claimed correctional officers denied Mitchell food as punishment, kicked, beat, and pepper sprayed him.

The Justice Department noted that jail officials failed to improve medical services even after Mitchell’s highly publicized death. A second inmate died a year later after his repeated pleas for medical help were ignored.

Although the Justice Department concluded there is reasonable evidence to suggest the jail was and continues to violate prisoners’ 8^th and 14^th Constitutional rights and the Americans with Disability Act, no official was cited for discipline and no criminal charges apparently will be filed against any individuals.

The Hampton Road Jail holds more prisoners with mental illnesses in Virginia than most jails. The report cited 25% as compared to 9.55 percent in other jails. It also had the second highest number of military veterans, of which, 47% had a mental illness.

The report disclosed other deaths inside the jail that had not been publicized, including these examples:

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Parents describe need for residential housing in Arizona for severely ill sons and daughters

(12-17-18) Can everyone who is seriously mentally ill be helped through community-based services or are some individuals so impaired that they need longer term residential care, possibly for life?

It’s a question being asked more frequently as our jails and prisons continue to fill up with more and more seriously mentally ill Americans whose real crime is that they became ill.

Because of our asylum past, it’s also a question that sparks strong debate.

In Phoenix, several parents of severely ill children have formed a non-profit called the Association for the Chronically Mentally Ill (ACMI). The group argues that community-based services often are inadequate to help their family members who have been diagnosed with serious mental illnesses, as well as, other issues such as addictions, ADHD, and additional significant mental disorders.

Laurie and Dr. Chuck Goldstein helped found the Arizona non-profit after spending fifteen years and hundreds of thousands of dollars trying to help their son, Daniel.  You can read more about ACMI at the end of this blog, but first I’ve asked Laurie to explain why she and her husband are advocating for long term residential treatment beds. She answered by telling me about her son.

Our Son Daniel  by Laurie Goldstein

Our son was born in 1987 to a 15-year-old birth mother who did not seek prenatal care and denied she was pregnant even while she was in labor.

He began exhibiting atypical behavior as a child and was soon diagnosed as having atypical ADHD symptoms. We knew Daniel was bright as soon as he joined our family, but he could not follow directions, and, as he grew older, he began showing significant socialization issues.

At age four, he set fire to furniture in the house.

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(12-10-18) The federal Bureau of Prisons (BOP) is not participating in the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) – a panel created by Congress to implement better mental health care in our country.

This is a mistake.

A Justice Departmental study found that as high as 45 percent of all federal prisoners have a diagnosable mental illness. The Washington Post recently published a study by The Marshall Project that faulted the  BOP’s treatment of inmates with mental illnesses. This troubling study is simply the most recent in a long string of exposes that have documented abuses and failures in the federal system.

How can the federal government work to improve mental health services nationally if it can’t clean up its own house?

In the late 1980s, I spent two years off-and-on inside the U.S. Penitentiary in Leavenworth, Kansas watching everyday events unfold. I was doing research for my best selling book, The Hot House: Life Inside Leavenworth Prison.  What I discovered then is still true today. The BOP operates largely as an island within the U.S. Department of Justice free from interference by its leaders.

It’s time for the U.S. Attorney General to direct the BOP to begin participating in the five year, congressionally mandated ISMICC process.

‘NO ONE TO TALK YOU DOWN’

Inside federal prisons’ dangerous failure to treat inmates with mental-health disorders

Story by Christie Thompson and Taylor Elizabeth Eldridge | The Marshall Project, first published in The Washington Post

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