Want Better Govt. Mental Health and Substance Abuse Programs? Let Us Help!

Bumper sticker on Pete’s old truck

(2-8-21) Let’s hope the Biden Administration takes advantage of a wonderful tool that could help the federal government better coordinate and prioritize its mental health programs.

The Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) was created in December 2016 by Congress to foster collaboration and shared accountability for the 8 federal agencies that deliver services to adults with serious mental illnesses (SMIs) and children and youth with serious emotional disturbances (SEDs) and their families.

Within a year, ISMICC’s first report was sent to Congress. Titled: The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, the report offered 45 recommendations in five categories, that were drafted by ISMICC’s fourteen public members.  As a parent representative on ISMICC, I focused on much needed criminal justice reforms.

Among the recommendations that I helped write:

  1. support implementation of the sequential intercept model that identifies key moments when incarcerated individuals with SMI and SED can get into treatment,
  2. support jail and prison diversion programs,
  3. train all first responders on how to work with individuals with SMI and SED,
  4. improve and streamline competency restoration services,
  5. support therapeutic justice dockets for SMI and SED individuals,
  6. require universal screening for SMIs and SEDs for every person booked into jail,
  7. limit or eliminate solitary confinement, seclusion, restraint and other forms of restrictive housing for SMI and SED prisoners,
  8. support post conviction recovery services,
  9. support federal programs created to reduce incarceration of SMI and SED Americans.

These are lofty, but achievable goals.

After that report was issued, my 13 public colleagues and I got right to work with the 15 representatives from the government agencies and departments that administer SMI and SED programs.

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Is Conspiratorial Thinking A Psychiatric Sickness? What Are The Boundaries Between Rational Thought And Illness?

(2-5-21) In this guest blog, Joseph Meyer, the parent of an adult with a serious mental illnesses, ponders psychiatric illnesses, conspiratorial thinking, public policy and criminal justice.

Illness, Crime and Punishment

Guest Blog By Joseph Meyer 

I think it was Ronald Reagan who said more than 40 years ago that some people make the choice to live homeless under bridges and in public squares. I have been reflecting on Reagan’s words and the history of psychiatric institutionalization as a political weapon used by authoritarian governments of the past. Together with a desire to cut taxes, a concern for the civil liberty of free choice is partly responsible for laws that make it difficult for family members of adults with psychiatric illnesses to get them off the streets and into treatment for delusions and their sometimes conspiratorial thinking that makes them reject help. 

Whether motivated by free choice or psychiatric illness, conspiratorial thinking that preceded and catalyzed behaviors like the recent invasion of the US Capitol building is going to have legal or psychiatric consequences for the individuals actively involved.

Today, beliefs in conspiracies promoted by QAnon and like groups can be thought of as ‘delusional.’ Others often use that word in informal conversation to describe odd thinking and a Google search returns this definition from the Oxford English Dictionary:

‘An idiosyncratic belief or impression that is firmly maintained despite being contradicted by what is generally accepted as reality or rational argument, typically a symptom of mental disorder.’

During the political divide of the last four years or longer, that definition of delusional thinking would seem to fit conspiratorial thinkers, whether or not they have a psychiatric illness. 

Recently, a large group of clinicians concerned about the psychiatric health of Donald Trump signed onto a letter calling for a rethinking of the Goldwater Rule that considers it unethical for psychiatrists to assess the behavioral symptoms of public figures who are not their patients from a distance and without a formal examination. Today’s conspiratorial thinking and activism raises questions about the difficulty of setting boundaries between what is normal and abnormal behavior.

How does one decide where the boundaries are between rational thought and clinical illness? How does the boundary affect public policy?

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Drs. Torrey and Satel Urge White House To Continue Policies Enacted By Trump’s SAMHSA -AOT, IMD Waivers

(2-1-21) I posted a blog in December by several peer leaders urging the Biden Administration to reverse a slew of actions that Dr. Elinore McCance-Katz implemented while Assistant Secretary for Mental Health and Substance Abuse. Not surprisingly, two of her biggest political backers, Dr. E. Fuller Torrey and Dr. Sally Satel, are urging the new administration to do just the opposite – to continue and build on her policies. Their argument was published today in The National Review and also sent to me.

Don’t Undo The Trump Administration’s Mental Health Reforms

By Dr. E. Fuller Torrey and Dr. Sally Satel

Those with the most severe mental illnesses had a great friend in Trump’s Department of Health and Human Services. President Biden must build on that legacy.

As the executive orders pile up and President Biden seeks to distance his administration from President Trump’s, he should be careful to preserve and learn from the things Trump got right.

One such positive legacy is the work of Dr. Elinore McCance-Katz on improving services for people with serious mental illnesses. McCance-Katz resigned in early January after almost four years as the first assistant secretary for mental health and substance use and the director of the Substance Abuse and Mental Health Services Administration (SAMHSA), which runs point on federal mental-health policy.

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Crisis Intervention Team Training vs Alternatives Without Police: Which Is Better?

Major Sam Cochran explaining Crisis Intervention Team training program. (Photo courtesy of NAMI Tennessee)

 

(1-29-21) Should the police be the first responders when someone with a mental illness is in distress? Recently, Crisis Intervention Team programs have come under fire because of incidents such as the killing of Patrick Kenny who had paranoid schizophrenia. The four Springfield, Oregon police officers involved in his death all had CIT training and one was a CIT instructor. Jeff Fladen, executive director of the Tennessee state chapter of the National Alliance on Mental Illness defends CIT programs, and sees them as necessary even if communities develop alternatives to having the police respond.  You can read here about the history and effectiveness of the estimated 400 CIT programs currently in the U.S.. 

CIT is Foundational (and We Need Co-Response Too)

Guest blog by Jeff  Fladen

As a leader of my state’s effort to expand CIT (Crisis Intervention Training) for law enforcement and other first responders, I have been hearing the same story nearly every day.

Instead of CIT, what about Co-Response and Alternative Response models, where mental health professionals assist the police during a mental health crisis either in person such as a social worker ride along or remotely from a control room or crisis center.

The Cahoots (Crisis Assistance Helping Out On The Street) program, launched by the White Bird Clinic in Eugene, Oregon some 30 years ago, is often brought up as an example of a successful co-response, although this program does not include social workers “riding along” with law enforcement. Cahoots features two-person teams consisting of a medic (a nurse, paramedic, or EMT) and a crisis worker who has substantial training and experience in the mental health field.

The program developed as an alternative to law enforcement acting as the mental health crisis first responder and offers an alternative approach to non-emergent issues. Other Co-response models include the Boulder Early Diversion Get Engaged (EDGE) program in Colorado, and the Boston Police Co-Responder Program, in existence since 2011. Additional programs around the country have developed  or have been announced in the past year.

I am deeply concerned that this is sometimes framed as an either/or discussion when it comes to CIT.  It shouldn’t be.

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Mental Health Groups Receive PPP help: 2 Get More Than $1 Million

(1-27-21)  What mental health organizations received a loan from the Small Business Administration through its Paycheck Protection Program to keep its workforce employed during the Covid 19 crisis?

The federal government has made 4.8 million PPP loans, worth a staggering $521,483,817,756. A second round is now in the works.

In the beginning, there were numerous complaints about who received forgivable tax dollars. Tampa Bay Buccaneers Quarterback Tom Brady, who signed a two year $50 million football contract, got nearly a $1 million loan for TB12, a company that hawks his t-shirts and other Brady items.  Evangelist Joel Osteen collected $4.4 million in PPP funds for his megachurch. The Los Angeles Lakers got $4.6 million but were  shamed into returning it.

The SBA moved to tighten rules and Congress took steps to insure that the bulk of funds went to smaller businesses that desperately needed loans to avoid laying off workers. The average amount of a PPP loan is currently $107,000.

If you type the words MENTAL HEALTH into the Washington Post data base that lists loans more than $150,000, you can learn if your local mental health provider is listed.

Here’s what several national mental health organizations received, including two that garnered more than $1 million.

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Washington Post Podcast Contains Oregon Man’s Pleas With Police During Mental Health Crisis Before He’s Fatally Shot

Patrick Kenny before he was fatally shot by police.

(1-22-21) Kimberly Kenny wrote a powerful blog last July for me describing how Springfield, Oregon police officers chased and fatally shot her brother during a mental health crisis. Shockingly, the four officers involved had undergone  Crisis Intervention Team training. The Kenny family received a $4.55 million settlement from the city — the largest lawsuit settlement involving police in Oregon’s history. The local prosecutor refused to file criminal charges and the department said its officers did not violate any laws or department policies.

After her blog was posted, the Kenny family told their story to The Washington Post: Fatal police shootings of mentally ill people are 39 percent more likely to take place in small and midsized areas.

And just before the year ended, the paper produced a podcast about the killing: Policing mental health crises: What can go wrong when police are the ones responding to mental health crises…

The disturbing 32-minute podcast narrated by investigative reporter Kimberly Kindy is difficult to hear because it contains recordings of Patrick Kenny pleas with police before his death. His sister told me in an email that she wants her brother’s death to be a wake-up call. A report, published by the Ruderman Family Foundation, found that nearly half of all fatal police shootings involved someone with a mental illness or disability.

We need alternatives to having the police be the first-responders when someone is in crisis.

Here is Kimberly Kenny’s original blog.

Crisis Intervention Training Didn’t Prevent Four Police Officers From Assaulting and Killing My Brother

 by Kimberly Kenny

The entire incident took less than five minutes.

It happened a little before 9 pm on a Sunday, near a hardware store Patrick liked to go to sometimes.

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