(12-27-19) More than 44,000 Americans living in Los Angeles will spend tonight sleeping on the streets.

They are homeless.

Twenty-five percentage of them have a serious mental illness. Roughly, 45 percent have a diagnosable mental disorder. Some 38% of homeless people are dependent on alcohol and 26% abused other drugs.

The homeless population in L.A. now is larger than 18,720 American cities, towns and villages. 

That is unacceptable.

Dr. James J. O’Connell, who has spent more than three decades as a street doctor in Boston, recently sent me an email after spending time conducting “street rounds” in L.A. with friends working for the  Los Angeles County and USC School of Medicine.

I quickly learned the task is impossible with the meager resources devoted to this endeavor, but the time I spent with these young physician assistants and their team was as heartwarming as heartbreaking.

Folks with cancer and deep bone infections living under concrete bridges, tents too numerous to count along most of the major roads.  I have been very familiar with Skid Row over the years (and would go there if I were just starting my career now!), but I was not ready to see how the problem has burst past those blocks and now has spread all through LA..

I can’t tell you how many folks we try to care for on the streets who have been discharged from inpatient (short!) psychiatric care because either (1) they are deemed competent to leave and/or (2) there are simply no beds in any facilities that should be caring for them.  

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(12-23-19) From our home, I wish you a Merry Christmas, Happy Hanukkah, and a blessed holiday season! May 2020 bring you much joy and good mental health.

(12-20-19) President Donald J. Trump made an unscheduled appearance yesterday at the White House Summit on Transforming Mental Health Treatment to Combat Homelessness, Violence, and Substance Abuse.

On the day after he was impeached by the House, Trump began his remarks by quipping that there was “Not much going on around the White House – you know, we’re not too busy.” Many in the by-invitation only crowd of about two hundred responded with laughter.

Trump used his appearance to announce an increase of $328 million in new spending for mental health programs, including $19 million for Assisted Outpatient Treatment and $7 million for Assertive Community Treatment programs.

Sticking mostly to a prepared script, Trump noted that “Of the 11 million Americans living with severe mental illness, 4 million receive no mental health service of any kind.  Four million people.” He added that the nation needed to  “give major consideration to building new institutions” but offered no specifics.

Trump recalled how as a child in Queens, he noticed “massive buildings” that housed persons with mental illnesses. “And all of a sudden, you go and you don’t see them anymore.  And you say, ‘What happened to all of those beds?  What happened to all of that work?  And where are those people?’  And in many cases, those people are living on the streets.  It’s much different..but we have to take care of our mentally ill.  We have to help people that are having problems…At the same time, we need to keep very dangerous people off our streets.  And we want to take care of the mental illness, but we have a lot of very dangerous people on our streets.”

Health and Human Services Secretary Alex Azar, Housing and Urban Development Secretary Ben Carson, and Presidential Senior Counselor Kellyanne Conway all spoke yesterday at the event along with Dr. Elinore McCance-Katz, assistant Secretary at the Substance Abuse & Mental Health Services Administration (SAMHSA.)

While Trump and his senior leadership claimed the center spotlight, a major unheralded star of the summit was an invitee sitting quietly in a front row seat – Dr. E. Fuller Torrey.

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(12-18-19) Daniel H. Gillison Jr., has been named Chief Executive Officer of the  National Alliance on Mental Illness, the nation’s largest and wealthiest grassroots mental health organization.

His selection was announced today at 2 p.m., shortly after the national staff was informed.

He takes the reins from Angela Kimball, who became acting CEO after the abrupt resignation of previous CEO Mary Gilliberti in April. Kimball was widely credited by NAMI insiders for keeping up morale in the national office located in Arlington, Va., after Giliberti was asked by the board to resign. Kimball had been a candidate for the CEO job.

For the past three years, Gillison has directed the American Psychiatric Association’s Foundation, the philanthropic and public education arm of the APA.  He is NAMI’s first African American CEO.

Before he joined the APA, Gillison worked for the National Association of Counties (NACo) where he led corporate and philanthropic fundraising efforts and directed the educational programming of the NACo Research Foundation. During Gillison’s time at NACo, corporate support more than doubled and the NACo Foundation substantially expanded its educational offerings in mental health and criminal justice. He has previously held positions at Sprint, XO Communications, and Wesley Brown & Bartle.

The NAMI board has a history of micro-managing the national office, which will test GIllison’s leadership abilities. As I reported Monday, NAMI became the nation’s dominant mental health player during Giliberti’s five year tenure, raising $17.6 million in revenues last year, according to its most recent Form 990 filings. It reported net assets or fund balances of $15 million.  Giliberti was paid $202,095 in salary and received $39,583 in additional financial benefits. We’ll have to wait for the next Form 990 reporting to learn what Gillison is being paid.

While at NACo, Gillison supported the national Stepping Up Initiative, created to divert individuals with mental illnesses from jails and prisons into community treatment, which is a promising sign. Sadly, the American Psychiatric Association has been pusillanimous when it comes to focusing on the serious mentally ill.

 

 

 

(12-16-19) All of us receive requests at year end from mental health organizations seeking much needed charitable donations. Before writing a check, I always find it helpful to examine each charity’s IRS Form 990, which is available on the Guidestar website.

I check three numbers: the amount of revenues that were received, the amount of net assets that the organization lists at year end, and how much a nonprofit group pays its CEO. Mental health groups must be competitive so it is not surprising that most CEO salaries are in the same $200,000 range here in Washington D.C.. That is higher than the national average. CEOs who manage organizations with multimillion dollar budgets are generally better compensated.

A quick Internet check found this thumbnail guideline:

An operating budget of a nonprofit organization under $500,000 corresponded with a CEO salary of $60,206. The highest category matched an operating budget of $50,000,000 with a CEO salary of $317,024. The average nonprofit CEO makes a little more than $120,000 a year, according to the 2016 Charity CEO Compensation Study by Charity Navigator.

Of course, there is other useful information on the tax forms. Forms reported in this blog are from the latest available reports on Guidestar.

So how do mental health nonprofits compare?

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(12-13-19) Advocate and Author D. J. Jaffe is pushing an agenda with both the White House and Democrats that calls for creating more hospital beds for the seriously mentally ill, increasing the use of Assisted Outpatient Treatment, and revising HIPAA regulations that often prevent caregivers from obtaining information.

Jaffe’s fingerprints were all over Democratic presidential candidate Sen. Kamala Harris’s mental health policy, which I recently posted. After she dropped out, I learned that her staff had been in the midst of rewriting that policy because of concerns raised by the Bazelon Center for Mental Health law and others, who generally oppose Jaffe’s agenda. A compromise version was in the works but became moot once Sen. Harris ended her campaign. Yesterday, Jaffe posted an Op Ed in The Hill newspaper urging other candidates to adopt the plan that Harris originally released.

Jaffe will be presenting his ideas Dec. 19th at a White House Summit on Transforming Mental Health Treatment to Combat Homelessness, Violence & Substance Abuse. Here is part of a press release about by-invitation-only event.

DJ Jaffe, who has a seriously mentally ill family member, will make the case that due to mission-creep, the mental health system no longer focuses on the most seriously mentally and that explains why homelessness and incarceration are increasing in spite of increased spending. He will describe ideas states, and ideas localities can use to replace politically correct but ineffective programs with ones that will help improve care for the seriously ill. He will describe the need to increase use of Assisted Outpatient Treatment (AOT), increase the availability of hospital beds and free families of seriously mentally ill from the HIPAA Handcuffs that prevent them from helping mentally ill loved ones.

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