I had lunch Monday with Senate Majority Whip John Cornyn (R-Tx) who has introduced the Mental Health and Safe Communities Act, which will fund mental health courts and crisis intervention team training, among other things. (More about that bill in future blogs.) On Friday, I will be speaking at a morning conference on Capitol Hill sponsored by House Majority Whip Steve Scalise (R-La.) entitled Addressing Over-incarceration of the Seriously Mentally Ill As Part of Criminal Justice Reform. 

In a press release, Rep. Tim Murphy (R-Pa.) whose Helping Families in Mental Health Crisis Act, is awaiting further markup, noted that House Speaker Paul D. Ryan (R-Wi) said Sunday during an interview on 60 Minutes that our mental health system needs attention.

“The other issue we need to take a look at, and I’m pushing this in the Commerce committee, is Congressman Murphy’s legislation on mental health,” said Ryan. “I think we need to improve our mental health laws so we can address these problems before they get out of control because mental health is a component of these shootings that I think we have not looked at seriously enough. So I think that’s an area that we’re going to be taking a deep look at. We’re moving legislation right now in the House Commerce committee.” 

Clearly, mental health reform is an issue on our elected leaders’ minds, spurred partially because of front page news stories such as this one, which my alma mater, The Washington Post, printed today. 

How one of the nation’s most promising basketball players became homeless

By Terrence McCoy, The Washington Post

On a summer day in 2012, a basketball superstar walked into Jimmy John’s in downtown Washington just as employees were attempting to kick out a homeless woman. Chamique Holdsclaw, who was drafted first overall in 1999 by the Washington Mystics and played in six all-star games, tried to ignore the commotion until she suddenly became part of it.

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On Tuesday (11-10-15), I posted a blog by mental health advocate Leah Harris who opposes Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act , which is making its way through the legislative process. Today, D. J. Jaffe, a strong supporter of the bill, writes about last week’s subcommittee markup session and why he believes Murphy’s bill should be approved without amendments.

Helping Families in Mental Health Crisis Act passes first hurdle

By DJ Jaffe, Executive Director, Mental Illness Policy Org.

The Helping Families in Mental Health Crisis Act (HR2646) was passed by the Health Subcommittee last week. (Unamended version here) But sitting in the room watching, was like attending two separate plays going on simultaneously. One play, about substantive ways to help the most seriously mentally ill was put on by Republicans. Democrats put on the other play. It demonstrated how little they know about serious mental illness and how far they had been misled by the mental health industry. It pains me to say that because I am a Democrat.

The Substance of the Bill

Historically, mental health bills in Congress have thrown money at politically correct, feel-good programs that let mental health industry engage in easy and palatable tasks like “reducing stigma,” “education” or “improving mental health,” but rarely deliver actual treatment to adults with serious mental illness. HR2646 has provisions to improve mental health, but it also has five provisions that start to focus government programs on delivering treatment to adults with serious mental illness. And that makes it important and different. If families of the most seriously ill continue to speak-out, this could be the beginning of a shift towards helping seriously ill adults after decades of shunning them. The support for the shift is coming primarily from Republicans who want to reduce crime, incarceration and tragedies. Democrats tend to avoid those issues for fear of causing stigma. They have been taught to ignore unpleasant truths like not everyone recovers, sometimes hospitals are needed, some seriously ill need the help of families, and yes, left untreated, those with serious mental illness are more violent than others. Following is a preliminary analysis of how the five most important provisions came out of the markup, followed by a discussion of what went on at the hearing.

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Last week’s subcommittee markup of Rep. Tim Murphy’s Helping Families In Mental Health Crisis Act is a step forward in the legislative process that ultimately could restructure our mental health care system. I asked two advocates with opposing points of view to share their thoughts about the more than ten hour markup session and explain why they are either against or support Murphy’s bill. Today (Tuesday – 11-10-15), I am posting a blog by Leah Harris, who opposes the Murphy bill. On Thursday (11-12-15), I will publish a blog written by D. J. Jaffe, who is a staunch supporter. I am grateful to Leah and D. J. for articulating their much different perspectives.

Change is a Choice: Reflections on the Markup of the Helping Families in Mental Health Crisis Act

By Leah Harris, Campaign for Real Change in Mental Health Policy

“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.” — C. S. Lewis

I spent several hours reviewing the House Energy and Commerce Health Subcommittee markup of “The Helping Families in Mental Health Crisis” Act (H.R. 2646). Some supporters of the Murphy Bill claim that Democratic objections to the bill should be dismissed as typical partisan wrangling. But this markup was much less a matter of partisan politics and much more a question of just how to fix our broken system. It is a battle about resources: whether to focus on funding a few costly, late-stage crisis interventions that only apply to a very small subset of people, or to reform the system from the ground up with a focus on preventing the very crises that the bill purports to address. It is a battle between outdated, authoritarian approaches to care, versus collaborative, person-centered approaches that represent the latest in science and good medicine.

At the markup, Democrats put forward the same arguments against the bill that have been made by mental health service users and advocates since the first version of the legislation was introduced in December 2013. The laundry list of objections to the bill are far too numerous to reiterate in this piece, but can be found  here  and  here. Arguments against the Murphy bill have rarely been heard in the mainstream media, which overwhelmingly endorse the bill and fail to include critical perspectives. For this reason, I was heartened to see clear critiques of the bill finally make it into the public record.

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The Disney Media Networks and ABC Television plan to re-air an episode of Modern Family on Wednesday night that is a distasteful example of blatant prejudice against Americans with mental illnesses.

I first wrote about Modern Family:Halloween 3: AwesomeLand the day after it aired last year and thousands of you and The National Alliance on Mental Illness joined me in expressing outrage at the show’s stigmatizing characterization of persons with mental illnesses.

This morning, NAMI’s Executive Director Mary Mary Giliberti issued a strongly worded press release calling the network “Callous” for refusing NAMI’s request that it not show the episode again on Wednesday. NAMI is asking its members to participate in a Twitter conversation at  #unmodernfamily 

In the episode, Claire Dunphy decides to create the most frightening house in her neighborhood by transforming her front yard into a “scary insane asylum” complete with “deranged mental patients,” a “sadistic nurse” and “demented doctor.” The episode features daughter Alex chained to a hospital bed and Luke wearing a straight jacket – images that are intended to make viewers chuckle. Words such as “nut job, Looney Bin, cuckoo” are sprinkled throughout the dialogue — less viewers forget that nothing is more frightening than someone with a mental disorder.

Three men have the authority to stop the showing of this episode and two of them should know better than to air such hurtful garbage.

The trio are Bob Iger, the chairman and chief executive officer of The Walt Disney Company; Ben Sherwood, co-chairman of Disney Media Networks, and President, Disney-ABC Television Group, and Paul Lee, head of ABC Entertainment Group, which oversees the television network ABC and its production arm ABC Studios.

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Dear Mr. Earley,

I am writing about Natasha McKenna and her death in the Fairfax County Detention Center. (I have provided you my contact information so you can confirm who I am and my credentials, but I ask that you withhold my name for reasons that will become obvious.)

Why was she “managed” by trained professionals in a manner that was so callous & inhumane? Why was she shocked repeatedly with a Taser while posing no serious threat to the men who had her on the floor? How were the deputies able to overlook and disregard her pathetic, desperate cries, whimpers and gasps?

How did this happen? There were six men directly involved and several others looking on, only a few feet away. Any one of them could have interrupted what was happening, but there’s no indication that anyone objected. No one said, “Put away the Taser – we don’t need it.” Nobody said, “One time with the Taser is enough!” (or two times, or three, or even four). There was no sign that anyone said, “She’s scared, this isn’t working. Let’s stop and think about a better way to get this done.” Equally important is the fact that the Lieutenant in charge didn’t stop to say, “This is going bad. I’m going to call my Captain for guidance, or my Major, or my Colonel, or the Sheriff.”

Why did this happen?

Are these men (and women) sadists? Are they sociopaths? Are they inexperienced? Are they stupid? Are they racist murderers?

I know them personally, I work with them and my answer to these questions is “No, no, no, no and no.” I’ve had conversations with them in our workplace about our kids, about our jobs, and, in some cases, we’ve shared both laughs and secrets. We are not bad people.  The deputies that did this are not much different truthfully than most of our friends and neighbors – your friends and neighbors too. We are ordinary Fairfax citizens.

So how could these deputies treat another human being this way?

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9-9-15 Anyone who reads  Virginia Commonwealth Attorney Raymond F. Morrogh’s  51 page report about the death of Natasha McKenna, the 37 year old African American woman with schizophrenia who died after being repeatedly stunned with a taser while in the Fairfax County Detention Center, can’t help but be appalled.

For those of us with a loved one with a mental illness, his report is painful and frustrating to read because it shows how difficult it is for someone who is clearly sick in Fairfax County to get meaningful help. Except for one doctor, Lydia Haile, MD., most others named in this report dealt with McKenna poorly, some might say callously.

Morrogh’s report is the first detailed account by an official about what happened to McKenna from January 7 — when she was transported by ambulance to INOVA Alexandria Hospital and showed signs of being psychotic — until her death on February 7th.

Prosecutor Raymond F. Morrogh Relies on Excited Delirium In His Findings

Moorogh concludes that no one is criminally at fault. In fact, he praises the deputies involved. While there may be no legal culpability, the report reveals countless failed opportunities when McKenna could have and should have received help but didn’t.

The most detailed information in Morrogh’s report is about McKenna’s physical altercations with the police and sheriff’s deputies. He gives blow-by-blow, in some times, second-by-second accounts of how McKenna kicked, attempted to bite, and spit at officers. He quotes officers claiming that McKenna had super human strength.

Sergeant Timothy said, “For me it’s probably the most difficult inmate I’ve ever had to deal with in that capacity, male or female… And I’ve dealt with… men on PCP fighting… it’s like she didn’t feel pain…” Deputy Guevarez said, “.. I remember it was … a struggle. I mean.. .I’m not a weak guy but she, she was wearing me out; she was wearing us all out. Deputy Holmes said, “.. .in my 19 years, that was the worst inmate.. .1 have ever dealt with. I’ll be honest with you… she was the real deal. Seriously, she was the worst… the hardest inmate.. .I’ve dealt with big guys, I’ve dealt with other females, smaller guys, guys in gang[s]. She was the toughest person that… I have ever dealt with to get her in that chair and with a struggle.” Deputy Viola said, “[Ms. McKenna was] probably one of the most aggressive CO inmates I’ve ever had to deal with .. .in my experience.” Deputy Barb recalled that, “.. .She was pushing with the most force I’ve seen in the… six years I’ve worked there.. .1 had never seen anybody push like this.. .”

In another sentence, Morrogh quotes an officer stating:

I hate to describe it like this, like a demonic possession because she was growling the whole time.

Because McKenna is dead, there is no one to speak on her behalf about what happened. The deputies’ statements go unchallenged and dovetail perfectly with the conclusion of Dr. Jocelyn Posthumus, M.D., a forensic pathologist with the Office of the Chief Medical Examiner who performed an autopsy on McKenna two days after she died and found that she was not the victim of foul play but of excited delirium, which Morrogh explains thusly:

Most persons suffering from excited delirium are hyper-aggressive, impervious to pain, and demonstrate unusual, “superhuman,” strength. They engage in a lengthy period of struggle, followed by a period of quiet and sudden death.

His conclusion: no one is legally at fault — no one that is, except Natasha McKenna. She brought this all on herself.

How easy it is to blame someone with mental illness. How easy it is to claim that everyone followed the rules except the person who was mentally ill. How easy to cry crocodile tears.

Let’s take a look at Morrogh’s use of the “excited delirium” conclusion of Dr. Posthumus.

Morrogh quotes liberally from a report issued by  a task force of the American College of Emergency Physicians that states that excited delirium is real. There’s no mention that excited delirium is not a currently recognized medical or psychiatric diagnosis according to either the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) of the American Psychiatric Association or the International Classification of Diseases (ICD-9) of the World Health Organization.

But here is an even more interesting note: if you check the 2012 and 2013 annual statistical reports issued by the Office of the Chief Medical Examiner in Virginia you will not find a single mention of excited delirium as a cause of death in the state. It is not listed as a cause of any death in Virginia during 2013 in the 128 in-custody deaths that were examined by that office. Not  one incident. Nor is it cited in the deaths of 60 persons with mental illnesses who were examined. Not one incident. In the entire 238 page annual report in 2013, there is absolutely no mention of a death in Virginia that was attributed to excited delirium.

As the Washington Post has pointed out repeatedly, nearly all deaths associated to excited delirium happened while the deceased was in police custody, which has caused civil rights activists to claim that it is simply an excuse used to justify excessive force and avoid lawsuits.

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