(1-11-21) I asked Dr. Elinore McCance-Katz to review her four years as the first-ever Assistant Secretary For Mental Health and Substance Use now that she has resigned. Her response follows:

Dear Pete,

I can’t imagine that anyone was more surprised than me when I was nominated to the political appointment of the first Assistant Secretary for Mental Health and Substance Use.

I have never been active in any political party although I have worked in government for many years—for both Republicans and Democrats.

I have done this because I believe it is imperative that healthcare practitioners have a real ‘place at the table’ and provide subject matter expertise and experience working with those who suffer from illnesses to the government which regulates the delivery of healthcare services in this nation. I have three major tenets that influence my approach and decisions in behavioral health.

Health Care Is  A Right, It’s Cruel To Not Help SMI, And Families Matter

The first is that healthcare is a right—that people have a right to treatment of mental and substance use disorders. The second is that it is not honoring a person’s civil rights to allow them to suffer from brain diseases such as schizophrenia, schizoaffective disorder, bipolar disorder, and drug and alcohol addiction because they are too ill to realize they need medical care—rather it is cruel. That approach condemns affected people too often to live unsheltered, without adequate food, isolated and alone, at risk for violence, abuse, injury and sometimes death. For far too many it results in imprisonment for minor infractions of the law further stigmatizing and isolating them. I believe that a society is judged by how it treats its most vulnerable and, from my perspective, there are none more vulnerable than those who are terribly impaired by severe mental and substance use disorders. I believe families are the real backbone of the safety net system for those living with these serious mental illnesses and that they should be communicated with by healthcare providers when someone too ill to know to contact family members is admitted to a hospital—to not do so is callous. For the great majority of those with serious mental illness family members are the consistent caregivers and as such, should be included in care plans developed by clinicians unless there is evidence for mistreatment or abuse. In my experience, that is rarely the situation.

These principles have guided me through these last four years in federal service.

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New York Times photo

(1-7-21) Dr. Elinore McCance-Katz resigned tonight as the first Assistant Secretary of Mental Health and Substance Abuse at the Department of Health and Human Services Administration because of the violent attack by Trump supporters yesterday at the U.S. Capitol.

McCance-Katz’s term was due to end January 20, when President-Elect Joe Biden is scheduled to be sworn in. But in a statement released this evening, she wrote that yesterday’s “behavior was totally unacceptable and, in my own heart, I simply am not able to continue. I believe that we are given certain life situations where we must make the difficult decisions and we get one chance to do it the right way… I cannot support language that results in incitement of violence and risks our very existence.”

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Treatment Advocacy Center campaign to end IMD exclusion

(1-4-21)  John Snook is resigning as executive director at the Treatment Advocacy Center after six years. In this Q. and A. departing interview, he discusses the role of TAC.

Question: Why do we need TAC? What makes TAC unique besides the fact that it doesn’t accept Big Pharma money?

TAC plays a role that no other mental health organization does – it’s the only organization focused exclusively on the care of those with severe mental illness. Those with severe mental illness unfortunately don’t have a lot of champions; it’s TAC’s job to ensure that their needs aren’t ignored by policymakers or the mental health community.

The sad fact is that it’s much easier to make the case for mental health than it is for mental illness reform. People don’t want to be reminded of the homeless woman on the street corner or the psychotic man trapped in solitary confinement. And so we often see the conversation drift to talk about everyone’s mental health and away from tough issues like the role of untreated mental illness in fatal encounters with law enforcement.

TAC is there to remind us that unless we have those difficult conversations, nothing is going to get better and those most in need will continue to be left behind. 

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The Definition of Insanity Film Documents The Success Of Judge Leifman’s Reforms In Miami Dade

(12-7-20) Miami Dade Judge Steven Leifman is my choice for the most impactful player in mental health during 2020.

For a decade, Judge Leifman has worked tirelessly to reform how our criminal justice system interacts with individuals with mental illnesses. He has traveled across the nation educating judges, prosecutors and defense attorneys about the so-called Miami Model that has become the gold standard in our nation for reducing violence, unnecessary arrests, and inappropriate incarceration. The model encourages recovery, reduces stigma, and gives individuals hope.

Judge Leifman’s approach has a proven and impressive track record.

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(10-12-20) Ernie & Joe: Crisis Cops, a powerful documentary created for HBO, is now being made available for group screenings. If you belong to a chapter of the National Alliance on Mental Health, Mental Health America, or other mental health organizations or you are involved in police/judicial training and have not yet seen this film, you need too!

This superb documentary follows Ernie Stevens and Joe Smarro, two officers in the San Antonio, Texas, police department’s mental health unit, as they defuse potentially violent encounters with individuals in the midst of a mental health crisis and direct them into treatment instead of jail.

At a time when police violence, especially against individuals with mental illnesses, is making national headlines, it’s important to show that compassionate officers are working on our streets and effective diversion programs can be implemented.

Crisis Intervention Team training (the Memphis Model) is the most common de-escalation tool used in law enforcement. San Antonio trains all of its officers in its own crisis de-escalation training program, which differs slightly from the Memphis Model. All 2,191 officers on the force go through its CIT style training. At the time the film was made, there were 10 officers assigned to the department’s mental health team. Now, there are 20. The unit acts as in house experts in training officers and community first responders as well as being on-call to their fellow officers.

In an email, the film’s director, Jenifer McShane, told me: “An interesting by-product of making mental health training a priority within the department is that officer wellness is now a stronger focus and more officers are willing to approach the mental health officers with their own mental health struggles and seek treatment.” This is important because nationally in 2019, 228 current or former officers died by suicide, compared with 172 in 2018, setting a new high record.

As of last year, the University of Memphis Crisis Intervention Team Center reported 2,700 CIT programs were being offered in the United States. By comparison, there are 17,000 local and state law enforcement agencies.  Hopefully this powerful documentary will encourage those departments without de-escalation training to begin such training. As the film points out most police departments spend 60 hours in their academies on teaching officers how to use a gun but only 8 hours on mental health training. Yet, ninety-five percent of police officers go through their career without firing their weapon. Everyone of them who works on the streets deals with an individual in a mental health crisis.

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