Identifying And Treating Severe Mental Illness
http://thedianerehmshow.org/shows/2012-12-20/identifying-and-treating-severe-mental-illness
The vast majority of mentally ill people are not a danger to themselves or society, but for those who are, treatment is critical. Diane and her guests discuss the challenge of identifying and treating severe mental illness.
Guests
Dr. Liza Gold
clinical professor of psychiatry at Georgetown University Medical Center and vice president of the American Academy of Psychiatry & The Law.
Pete Earley
father of an adult son diagnosed with Bipolar Disorder, author of "Crazy: A Father's Search Through America's Mental Health Madness," former Washington Post reporter and author of several others books, including "The Hot House."
Dr. E. Fuller Torrey
president of Treatment Advocacy Center.
Leslie Weisman
client services entry bureau chief at Arlington Community Services Board.
Comments
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This bears repeating on ea page of comments:
Diane,
Asperger Syndrome is not a mental illness. It is a neurological disorder. Please, educate your listener about the difference. As parents of an adult son with AS it disturbs us to hear it described as a mental illness.
Topic: Availability of mental health care and public availability of violent weapons relative to prison populations
Even though the program is over, I want to draw attention to the relationship between the numbers of people in prisons and the availability of prison beds relative to the numbers of people in mental health care and the availability of hospital beds for them. The ratio is obviously imbalanced,
and indicative of the crisis we are in today. A program with representatives
in leadership positions from both of these sectors could be very powerful.
Also, one of the guests on today's program said that he feared in three months this crisis of mental health needs and violent crimes would be forgotten. What would it be like for the Diane Rehm show to commit to a
program on this topic every three months, to help make sure that it is not
forgotten. Maybe the pattern would set a trend, and we would see a three- month reflection and monitoring of progress towards improving this toxic
mix of social denial and high-powered gun clips occuring in many places in our society.
Have a wonderful holiday season,
Mary Maxine Browne
Purdue University
jmandel fully understands our present situation. The Newtown incident occurred because we have let our concerns for individuals within our communities disappear. Thank you.
Respectfully, I just want to say that every state has state mental hospitals. Every county in the US has free mental and behavioral health services available. Every county has vocational services available. Every emergency room is equipped with medication to treat people who may be a danger to themselves or others due to mental illness. All people who are not working due to chronic and severe mental illness are eligible for federal benefits including Medicare or Medicaid.
Getting the person committed is really difficult but isn't an end point by any means. The patient can refuse medications or worse -- only agree to a minimal (no hope of therapeutic value) dose. At that point if he hasn't actually set the house on fire or jumped off the roof the hospital won't bother trying to get a court order to force treatment since he's not a risk for setting the house on fire when he's out of the house, etc.
The subtherapeutic dose is a particularly bad case because they can't even argue that he is refusing treatment. Then when he gets discharged (assuming we are talking about an adult) he can cancel his follow up appointments, and if they force him to have a follow up he find a new doctor and start with on,y the discharge instructions as his medical history, explain that this whole incident was because people were against him (insert semi plausible delusion) and he doesn't have a problem or need medication, as clearly evident from the highly subtherapeutic dose of medication he was prescribed. The doctor has no contact with the patient's friends or family or neighbors, and likely no contact with the team from the hospital.
So instead they get to wait until the next time he's going to jump off the roof or set the house on fire and try again, and again.
I'm not sure how the jail thing would work for someone who isn't actually breaking any laws (by any stretch of the imagination) and is highly functioning enough to point that out.
Diane, Jon Brock is a long-time mental health advocate and a peer counselor for the Alabama Department of Mental Health. When I alerted him about today's show, this is part of his response:
"i wished for the participation of some capable csx figures such as dan fisher---particularly to speak of peer provider programs, that engage some issues that were spoken of on today's d.r. show."
I hope this is something you will consider for a future show. The number of people who meet the Lanza profile -- male, odd, interested in guns -- is in the hundreds of thousands, maybe even millions. We can profile, but we can't predict, because almost all of the people who fit the profile never even imagine an outburst similar to Lanza's. But many of these people can be helped by peer counselors. These are people like themselves, might even fit the same profile, but who are trained to share their own experiences and their training with people who may be terribly afraid of the mental health system.
billtmore wrote:
"put the blame exactly where it belongs...the GOP trying to save a buck . Reagan closing the state facilities in the early 80s because running institutions costs money and by God the GOP hates spending money on throw away people, 30 years later they are at it again. You want a better country stop spending on war and spend on health and life"
You make me want to vomit. You want to take murders by a deranged kid whose mother gave him access to guns and make a political statement with it?!
When Reagan became President, he set about recovering our economy from the disaster that was Carter. That required spending cuts. But that's not even the point. THAT WAS MORE THAN 30 YEARS AGO. Democrats have had control of Congress AND the Presidency at least twice since then, but have done NOTHING.
I'm sure your little liberal friends here will lap up your rhetoric, but it is foul and disgusting, and worst of all false.
aalve wrote:
"Respectfully, I just want to say that every state has state mental hospitals. Every county in the US has free mental and behavioral health services available. Every county has vocational services available. Every emergency room is equipped with medication to treat people who may be a danger to themselves or others due to mental illness. All people who are not working due to chronic and severe mental illness are eligible for federal benefits including Medicare or Medicaid."
Now, now, aalve. You don't want to be confusing anyone with the facts!
I once directed a workshop series "[Mental Health] Consumers as Trainers" for physicians in residency and other mental health professionals. In each series I polled the participants as to what side effects would cause THEM to discontinue a drug -- weight gain, sexual disfunction, memory holes, chronic tiredness, lack of appropriate emotional response to the events in their lives, etc..
These are all common side effects of the medications used to treat mental illness. In each series 100 per cent of the participants found reasons why they would personally and RATIONALLY discontinue the drugs under consideration.
Our job is to convince the people experiencing mental illness or brain disorders that the mental illness is worse than the side effects of the drugs, and we can't do that until we realize ourselves that the decision to discontinue their drugs is a reasonable decision and that most of us would do likewise.
One of your guest psychiatrists just made the comment that it's not guns that are responsible for killings by mentally ill people, that they could kill with a knife. This passed without response on your show, but to me this is a ridiculous observation. A person can kill with a rock as well, but it is the ease with which a gun is used and the fact that a gun will be lethal from a distance which makes a significant difference. In the awful Sandy Hook disaster the principal in lunging at the attacker would have resulted in a vastly different result had the attacker come with a knife. For that matter he could not have shot through the locked door to enter in the first place. I think that it would be far more unlikely for a knife to be picked up with murderous intent in the first place, as the sanitized film and video game shootings often make death by gunshot seem a clean and bloodless matter.
Secondly, I believe the attention to mental health in this instance is partly a way of deflecting attention from the main threat, which is the ubiquitous presence of the type of weapon which can kill dozens of people quickly and easily. Much of the current discussion about mental illness and the danger of violence has little relevance to the Sandy Hook killer, Adam Lanza. Note the Mayo Clinic information guide to dealing with Aspergers Syndrome: "...there is no current medication prescribed." Emphasizing mental health issues relative to this attack further stigmatizes the illnesses.
I would like to know how the availability of services and the amount of qualified counselors, psychologists and psychiatrists are related. Are the medical schools to provide these professionals full. Are there enough applicants? How many people are turned away due to space limitations? Is the insurance industry, which is a for profit industry, affecting the desire of people to become counselors, doctors, etc.? Would a 'Planned Parenthood' style service for people and families of the mentally ill be plausible?
My brother, Brian Mitchell, who kidnapped Elizabeth Smart, was mentally ill and wandering about as a homeless person for 10 years before he kidnapped her. He needed mental health treatment but was delusional and believed he was Gods true prophet. Now he's sitting in a federal prison for life. He did great harm to a young person and her family. If this had been an earlier time he might have got treatment to prevent this terrible tragedy.
I am the father of an adult son who has been diagnosed with Paranoid Schizophrenia and also with strong sociopathic tendencies. He is college educated with a BS in IT. After attempting suicide he has been in over 25 hospitals and institutions in 5 states in the last 2.5 years. Because of HIPPA rules there has been absolutely no tracking between all these incidents. Each time he enters a facility they start over with a diagnosis and then he is usually released after 5-7 days. My family has had to relocate and move across the country to have anything close to a normal life. Most all of my family members have attempted intervention, spending thousands of dollars for insurance, care, lawyers and mental health care... to no avail. Each institution / facility releases him with a handful of drugs and a new prescription and no mandatory follow up. I keep saying our Mental Health system is sicker than those they are treating. We pray for a miracle or rescue angel each day.
Thank you for this interesting program. I would like to hear from the Fairfax Co. Community Services Board regarding the state of emergency mental health treatment. I am a former emergency service staff member and the program I worked in has no resemblance to that described by your guest.
The emergency service program was long established and staffed by well educated, experienced, and dedicated people. I would be very saddened to know this quality service no longer exists and would like to know how that happened.
I agree with many of your listeners who have commented about the multi-faceted problems with mental health treatment. First, most therapists and psychiatrists are not well trained in crisis intervention. Many are poor diagnosticians, many overreact or under-react to crises. Insurance companies resist paying for meaningful treatment, favoring medication and cursory evaluations. Medication is over-prescribed, causing serious drug induced medical problems and often ineffective treatment of mental health symptoms.Political policies have resulted in homelessness for the mentally ill and a dearth of treatment, especially crisis intervention. The mental health laws need an overhaul so that they remove barriers to needed treatment.The system is a mess. So much more to talk about!
My son is 24 years old and diagnosed as Bi-polar. Today, I do not have any contact with him because he is violent. He tells me me he has an AK47 and is collecting guns. Not good news. I live 4 hours away in a different state and hope he will not come here when he is feeling homicidal. He does not think he has a treatable problem, he won't cooperate with out patient counselors and he won't take his medicine. It is not because his parents were negligent.
His mental illness became acute when he was 17,
Since he was first diagnosed as clinically depressed, I have been instrumental in having him admitted to inpatient care 7 times. Of these admissions the police have picked him up 5 times to prevent suicide or homicide; the last time he tried to kill his girlfriend.
No real treatment exists in the state of Florida, private or public as his father and I have tried them all.
If parental rights can be extended in these cases until our children become 21, I think we could have gotten his illness treated.
After my son turned 18 years of age the HIPPA laws gave him the right to refuse treatment. His father and I were denied discussion about his diagnosis, treatment and the discharge plans in spite of the fact that he was violent and had no means of support except us. After a few hours or days he was released once again to return to his frightening world of drugs, guns and imagined injustices with out any income or prospects.
The Pensacola attorneys told us the courts have no facilities available for long term care and that long term incarceration may be the best we can hope for. He is living back with the girlfriend he tried to kill, She is the one who now is most at risk. God protect her.
Thank you for your important show today. DO NOT GIVE UP ON THIS CAUSE.
I think you missed the point of this radio show. Even if reality was as you believe, success would depend on compliance from the defiantly mentally ill we are talking about. Our most disturbed and dangerous youth have the right to refuse treatment when they turn 18 years of age and a significant number of these do just that. My 24 year old son who is severely mentally ill has just been awarded Medicaid for ONE YEAR after a very difficult process made worse by his phobia against talking on the phone or meeting new people. This may assure that he can get on the long waiting list to see a psychiatrist but it doesn't mean he will come out of his isolated world to see the doctor or take the medication he needs. I would like to see the law changed so that parents could have the right to provide care, involuntarily if needed, to our mentally ill children until the became 21 -- it might help. Then we need to assure that the kind of facilities and safety net you describe are actually in place so our children have a chance to be stable adults.
You and your guests have completely glossed over valid reasons why there aren't enough treatment beds. First, many of the old hospitals were terrible places, and were closed down because of the scandals of patient abuse. Which one can easily find with a little research into newspaper and magazine articles of the time. Second, the beds that are left are often full because psychiatric hospitals and their staff have a long history of falsifying medical information in order to fill them. See the "Profitable Addictions" series in the Houston Chronicle 1990s archives. Nor have you and your guests acknowledged that these abuses have made people with mental illnesses justifiably fearful of becoming trapped in them.
Your guests fit the treatment advocacy agenda, and did not represent the full range of reality, that many commitment laws are bad not because they keep people from necessary treatment, but because they force people into treatments more dire than their need, without any checks and balances, or adequate and zealous legal representation to avoid false commitments. You have behaved as if forced treatment is the only way, and made the unsupported assumption that all people with mental illnesses, in or out of crisis, have no self-restraint or discipline whatsoever to keep from harming others. Arrogance is not treatment.
Diane
I have just listened to your very good show on mental health and Sandy Hook. I worked for 30 years at the Juvenile Court in Phoenix and I (and my colleagues) can attest to the increasing number of mental health cases in the juvenile justice system. Too many children are dumped there, only because it is the only place they can get services - they have to commit a crime to be served. The laws in most states are less complicated for juveniles to get in-patient mental health care for juveniles, than for adults. But not all these children need to be confined. Juveniles diagnosed and treated earlier can be prevented from turning into Jared Loughners and Adam Lanzas.
I strongly suggest you do a show on juvenile mental health, like yesterday's show on adult mental health.
Mitch Halfpenny.
Help please: Who was the man whose son was mentally ill, maybe bipolar, had lots of problems getting him help, and he eventually stabbed his mother (or stepmother?) to death? I heard this story several yrs ago on NPR and can't remember the family's name. I think they may have lived somewhere in New England. Just can't remember and can't find anything online about this. Thanks!
Thank you Diane for bringing this topic to the forum, as a former detention/corrections officer in Montana I have witnessed the gut wrenching revolving door cycle of mental illness, substance abuse and the criminal justice system. Not only as an officer but within my own family as well. If we want the violence to stop then we have to take this topic seriously and get our elected officials talking about it as well. This is not a private family matter as I have all to often seen it treated as. The problem affects every one of our communities across the country.
Prof. John Monahan fully documented that inability to predict dangerousness over 30 years ago in his book, The Clinical Prediction of Violent Behavior. Today's talking heads and voices, and even Supreme Court Judges, still act as if that is not a fact. In many states, the only standard for commitment is the professional opinion of "two mental health professionals", neither of whom have to demonstrate with any peer-reviewed scientific method that they can actually predict anything about dangerousness.
It is not apparent here, but my last comment was written in reply to Steve S., Dec 20, ~10:40AM
It's not at all difficult to get someone committed, as Mr. Earley, I think it was, noted. In many states, all you have to do is lie. If a person admits to a mental illness, any malicious liar can get him or her committed without much real investigation by police. The person with a mental illness is assumed to be delusional and in the wrong. Whereas the average involuntary stay may be 5 to 10 days, that can be extended to months if a person who was falsely accused keeps protesting innocence. And yet you complain that there aren't enough beds available? Small wonder why.
"Gary Maskarinec wrote:
One of your guest psychiatrists just made the comment that it's not guns that are responsible for killings by mentally ill people, that they could kill with a knife. This passed without response on your show, but to me this is a ridiculous observation. A person can kill with a rock as well, but it is the ease with which a gun is used and the fact that a gun will be lethal from a distance which makes a significant difference. In the awful Sandy Hook disaster the principal in lunging at the attacker would have resulted in a vastly different result had the attacker come with a knife...
December 20, 2012 - 12:28 pm"
"In the awful Sandy Hook disaster the principal in lunging at the attacker would have resulted in a vastly different result had the attacker..." needed to reload or change firearms.
An excellent argument against high capacity magazines. Many such shooting sprees are halted exactly that way, thanks to the courage or temporary insanity of those Heros who appear out of nowhere, often in the form of very ordinary Men and Women.
Monte Haun mchaun@hotmail.com
"ecgberht wrote:
billtmore wrote:
"put the blame exactly where it belongs...the GOP trying to save a buck . Reagan closing the state facilities in the early 80s because running institutions costs money and by God the GOP hates spending money on throw away people, 30 years later they are at it again. You want a better country stop spending on war and spend on health and life"
You make me want to vomit. You want to take murders by a deranged kid whose mother gave him access to guns and make a political statement with it?!
When Reagan became President, he set about recovering our economy from the disaster that was Carter. That required spending cuts. But that's not even the point. THAT WAS MORE THAN 30 YEARS AGO. Democrats have had control of Congress AND the Presidency at least twice since then, but have done NOTHING.
I'm sure your little liberal friends here will lap up your rhetoric, but it is foul and disgusting, and worst of all false.
December 20, 2012 - 12:17 pm"
Let's see-
1) he had to do it to recover the Economy
2) it was 30 years ago anyhow,
3) the Democrats didn't fix it anyhow,
4) he really didn't do it anyhow.
You have a very serious case of Reagan/Bush Derangment Syndrome.
Furthermore, since many of aalve's claims are false on their face, I have a strong suspicion that he/she might be pulling your leg. Would that be called Irony, Professor of Rhetoric eggie?
Monte Haun mchaun@hotmail.com
mchaun, your reading comprehension continues to let you down. The subject was mental health funding, not the eonomy. Reagan made the cuts he did (about 25% of MH spending) because of the economy that Carter left him. Democrats had AT LEAST TWO opportunities to RESTORE THE FUDNING when they controlled both chambers and the White House. They didn't do it - and now people like biltmore can b-t-h about something that happened 30 years ago that the Democrats could have fixed! Get it? Is that plain enough for you?
"Furthermore, since many of aalve's claims are false on their face, I have a strong suspicion that he/she might be pulling your leg. "
Yet you don't list a single one or any support for your contention that aalve's claims are false (par for the course for you), which makes your statement ... well ... pure rhetoric. I'll let aalve speak for him/her self as to whether he/she was "pulling my leg".
Leaving aside the arguments of identifying who may become violent, doesn't humanity alone dictate that we make all efforts to treat those who aren't able to make sound decisions for themselves? We don't allow children to make health care decisions for themselves. We don't allow parents to withhold health care from children, we mandate levels of care to those seeking insurance, we have laws prohibiting the discrimination of the disabled, but once a person reaches there 18th birthday if suffering from a disorder that causes them to not recognize there illness we quit? What does it say of us that unless someone poses a risk to our safety we don't care about the tormented life that person lives? To argue that treating such people is violating there civil rights is absurd, Isn't "general welfare" one of the cornerstones of the entire purpose of having the constitution?
I hope today's show is just the beginning of the discussion on how to go about humanly ensuring that all who need get treatment. Let's get over the blame game of how we got where we are and instead focus on using the lessons learned to examine weather the arguments for allowing the ill to 'opt out' of treatment have in fact protected there civil liberty's.. Based on today's discussion and the recent headlines that have grown all to common I believe they most assuredly they have not.
Early in the show there is a reference to an alleged shooting in Connecticut.
The typical reporting standard is that a person is alleged to have committed a crime until/unless a court rules. Of course, since this alleged shooter is dead, there never will be a court case so I guess he will always be the "alleged" shooter.
However, the claim was that there was an alleged shooting at the Sandy Hook School. I don't think there is any question as to the fact that people were shot - only who might have done it. If it is still an alleged shooting today, I guess it might not have happened... and we will never know for sure until a court rules.
.
Our agency (Fonthill Counseling) was so happy to hear Diane and her guests discussing some of the important gaps in service we fill. Parents, teachers and even other professionals often have the best intentions but don't know where to start and what questions to ask. That is where a good therapist, counselor or case manager comes in. They should ultimately provide a comprehensive map of what's call the 'continuum of care.' They should walk with a family through each transition into higher or lower levels of care. They should hold regular team meetings (ie. Psychiatrist, therapist, school counselor, parents) and hold everyone accountable to a role and goal. They should be the person or agency that is the consistant even when professionals and treatment changes. They should also be on call 24/7 since emergencies and parenting concerns typically do not respect business hours and holidays. Help really is out there.