Benedict Carey
The New York Times
Originally published March 5, 2018
Here is an excerpt:
The third, and perhaps most critical, point of agreement in the asylum debate is that money is lacking in a nation that puts mental health at the bottom of the health budget. These disorders are expensive to treat in any setting, and funds for hospital care and community supports often come out of the same budget.
In his paper arguing for the return of asylums, Dr. Sisti singled out the Worcester Recovery Center and Hospital in Massachusetts.
This $300 million state hospital, opened in 2012, has an annual budget of $80 million, 320 private rooms, a range of medical treatments and nonmedical supports, like family and group therapy, and vocational training. Its progress is closely watched among mental health experts.
The average length of stay for adolescents is 28 days, and the average for continuing care (for the more serious cases) is 85 days, according to Daniela Trammell, a spokeswoman for the Massachusetts Department of Mental Health.
“Some individuals are hospitalized for nine months to a year; a smaller number is hospitalized for one to three years,” she wrote in an email.
Proponents of modern asylums insist that this kind of money is well spent, considering the alternatives for people with mental disabilities in prison or on the streets. Opponents are not convinced.
The article is here.
Showing posts with label Mental Health System. Show all posts
Showing posts with label Mental Health System. Show all posts
Friday, March 30, 2018
Thursday, December 22, 2016
Hard Time or Hospital Treatment? Mental Illness and the Criminal Justice System
Christine Montross
The New England Journal of Medicine
2016; 375:1407-1409
Here is an excerpt:
When law enforcement is involved, the trajectory of my patients’ lives veers sharply. The consequences are unpredictable and range from stability and safety to unmitigated disaster. When patients are ill or afraid enough to be potentially assaultive, the earliest decision as to whether they belong in jail or in the hospital may shape the course of the next many years of their lives.
It’s now well understood that the closing of state hospitals in the 1970s and 1980s led to the containment of mentally ill people in correctional facilities. Today our jails and state prisons contain an estimated 356,000 inmates with serious mental illness, while only about 35,000 people with serious mental illness are being treated in state hospitals — stark evidence of the decimation of the public mental health system.
When a mentally ill person comes into contact with the criminal justice system, the decision about whether that person belongs in jail or in the hospital is rarely a clinical one. Instead, it’s made by the gatekeepers of the legal system: police officers, prosecutors, and judges. The poor, members of minority groups, and people with a history of law-enforcement involvement are shuttled into the correctional system in disproportionate numbers; they are more likely to be arrested and less likely than their more privileged counterparts to be adequately treated for their psychiatric illnesses.
The article is here.
The New England Journal of Medicine
2016; 375:1407-1409
Here is an excerpt:
When law enforcement is involved, the trajectory of my patients’ lives veers sharply. The consequences are unpredictable and range from stability and safety to unmitigated disaster. When patients are ill or afraid enough to be potentially assaultive, the earliest decision as to whether they belong in jail or in the hospital may shape the course of the next many years of their lives.
It’s now well understood that the closing of state hospitals in the 1970s and 1980s led to the containment of mentally ill people in correctional facilities. Today our jails and state prisons contain an estimated 356,000 inmates with serious mental illness, while only about 35,000 people with serious mental illness are being treated in state hospitals — stark evidence of the decimation of the public mental health system.
When a mentally ill person comes into contact with the criminal justice system, the decision about whether that person belongs in jail or in the hospital is rarely a clinical one. Instead, it’s made by the gatekeepers of the legal system: police officers, prosecutors, and judges. The poor, members of minority groups, and people with a history of law-enforcement involvement are shuttled into the correctional system in disproportionate numbers; they are more likely to be arrested and less likely than their more privileged counterparts to be adequately treated for their psychiatric illnesses.
The article is here.
Tuesday, September 20, 2016
State mental hospitals were closed to give people with mental illness greater freedom
but it increased the risk they’d get no care at all.
By The Spotlight Team
The Boston Globe
Originally posted August 28, 2016
Here is an excerpt:
The result is a system that’s defined more by its gaps and gross inadequacies than by its successes — severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe. It is a system that prizes independence for people with mental illness but often ignores the accompanying risks to public safety. A system that puts blind belief in the power of antipsychotic drugs and immense trust in even the very sickest to take them willingly. A system that too often leaves people in mental health crisis with nowhere to turn.
It was never supposed to be this way. President Kennedy and his allies recognized the grim state of America’s mental institutions — which at their peak housed nearly 560,000 people — and promised a robust, humane system of community-based treatment in their place.
The article is here.
By The Spotlight Team
The Boston Globe
Originally posted August 28, 2016
Here is an excerpt:
The result is a system that’s defined more by its gaps and gross inadequacies than by its successes — severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe. It is a system that prizes independence for people with mental illness but often ignores the accompanying risks to public safety. A system that puts blind belief in the power of antipsychotic drugs and immense trust in even the very sickest to take them willingly. A system that too often leaves people in mental health crisis with nowhere to turn.
It was never supposed to be this way. President Kennedy and his allies recognized the grim state of America’s mental institutions — which at their peak housed nearly 560,000 people — and promised a robust, humane system of community-based treatment in their place.
The article is here.
Friday, April 1, 2016
Assisted Outpatient Treatment: APA’s Position Statement
Renée Binder
Psychiatric News
Originally posted February 29, 2016
Here is an excerpt:
Opponents contend that even if someone has a chronic mental illness and has a history of hospitalization or incarceration, they still have the right to decide if they want to comply with treatment, barring an emergency. AOT supporters argue that AOT is consistent with the principle of beneficence and tries to intervene before someone meets the criteria for involuntary hospitalization to prevent deterioration based on past history. After reviewing the arguments on both sides, the APA position statement supports the use of AOT and opines that it is ethical when used appropriately.
The article is here.
Psychiatric News
Originally posted February 29, 2016
Here is an excerpt:
- Is AOT ethical? Some opponents of AOT feel that it is unethical to force patients into treatment except for emergency treatment, that is, when a patient is a danger to self, a danger to others, or unable to care for basic needs. They argue that AOT goes against the principles of autonomy and right to self-determination.
Opponents contend that even if someone has a chronic mental illness and has a history of hospitalization or incarceration, they still have the right to decide if they want to comply with treatment, barring an emergency. AOT supporters argue that AOT is consistent with the principle of beneficence and tries to intervene before someone meets the criteria for involuntary hospitalization to prevent deterioration based on past history. After reviewing the arguments on both sides, the APA position statement supports the use of AOT and opines that it is ethical when used appropriately.
The article is here.
Saturday, March 19, 2016
How America's criminal justice system became the country's mental health system
By German Lopez
Vox.com
Originally published March 1, 2016
Here are two excerpts:
It's a terrifying statistic: Someone with an untreated mental illness is 16 times more likely to be killed by police than other civilians approached or stopped by law enforcement, according to a 2015 report by the Treatment Advocacy Center.
(cut)
If people were getting comprehensive care and support, police most likely would not need to get involved in many of the circumstances that end up in horrible tragedies. But very often in the US, that's not happening.
Before Kevin broke into a neighbor's house and was arrested by police, Pete tried to take steps that would have prevented the whole encounter. Kevin had just suffered a psychotic episode in 2002, and Pete raced Kevin to emergency care to hopefully get Kevin into some form of long-term care, potentially against Kevin's will if necessary.
But doctors said they couldn't do anything because Kevin, an adult, didn't appear to pose a threat to himself or others in the four hours they sat in an emergency room. So he was let free, and within 48 hours, he went through the episode in which he broke into the neighbor's house.
The article is here.
Vox.com
Originally published March 1, 2016
Here are two excerpts:
It's a terrifying statistic: Someone with an untreated mental illness is 16 times more likely to be killed by police than other civilians approached or stopped by law enforcement, according to a 2015 report by the Treatment Advocacy Center.
(cut)
If people were getting comprehensive care and support, police most likely would not need to get involved in many of the circumstances that end up in horrible tragedies. But very often in the US, that's not happening.
Before Kevin broke into a neighbor's house and was arrested by police, Pete tried to take steps that would have prevented the whole encounter. Kevin had just suffered a psychotic episode in 2002, and Pete raced Kevin to emergency care to hopefully get Kevin into some form of long-term care, potentially against Kevin's will if necessary.
But doctors said they couldn't do anything because Kevin, an adult, didn't appear to pose a threat to himself or others in the four hours they sat in an emergency room. So he was let free, and within 48 hours, he went through the episode in which he broke into the neighbor's house.
The article is here.
Friday, January 15, 2016
Outsourcing the Mentally Ill to Police
By Rich Lowry
The National Review
Originally posted January 1, 2016
Here is an excerpt:
In its analysis of 2015 police shootings, the Post found dozens of cases in which the police were called as a means of getting treatment. Shirley Marshall Harrison called the Dallas police when her schizophrenic, bipolar son was out of control. He was shot down while allegedly charging police with a screwdriver. “I didn’t call for them to take him to the morgue,” she said of the cops. “I called for medical help.”
It’s a poignant lament, but why do the families of the severely mentally ill need to rely on the police for medical assistance? When someone has a heart attack or gets cancer, we don’t call the police.
The opinion piece is here.
The National Review
Originally posted January 1, 2016
Here is an excerpt:
In its analysis of 2015 police shootings, the Post found dozens of cases in which the police were called as a means of getting treatment. Shirley Marshall Harrison called the Dallas police when her schizophrenic, bipolar son was out of control. He was shot down while allegedly charging police with a screwdriver. “I didn’t call for them to take him to the morgue,” she said of the cops. “I called for medical help.”
It’s a poignant lament, but why do the families of the severely mentally ill need to rely on the police for medical assistance? When someone has a heart attack or gets cancer, we don’t call the police.
The opinion piece is here.
Monday, May 25, 2015
A shocking number of mentally ill Americans end up in prison instead of treatment
By Ana Swanson
The Washington Post
Originally published April 30, 2015
Here is an excerpt:
For various reasons, these community treatment plans proved inadequate, leaving many of the mentally ill homeless or in jail. According to the Department of Justice, about 15 percent of state prisoners and 24 percent of jail inmates report symptoms meet the criteria for a psychotic disorder.
In its survey of individual states, the Treatment Advocacy Center found that in 44 of the 50 states and the District of Columbia, the largest prison or jail held more people with serious mental illness than the largest state psychiatric hospital (see map below). The only exceptions were Kansas, New Jersey, North Dakota, South Dakota, Washington and Wyoming. "Indeed, the Polk County Jail in Iowa, the Cook County Jail in Illinois, and the Shelby County Jail in Tennessee each have more seriously mentally ill inmates than all the remaining state psychiatric hospitals in that state combined," the report says.
The entire article is here.
The Washington Post
Originally published April 30, 2015
Here is an excerpt:
For various reasons, these community treatment plans proved inadequate, leaving many of the mentally ill homeless or in jail. According to the Department of Justice, about 15 percent of state prisoners and 24 percent of jail inmates report symptoms meet the criteria for a psychotic disorder.
In its survey of individual states, the Treatment Advocacy Center found that in 44 of the 50 states and the District of Columbia, the largest prison or jail held more people with serious mental illness than the largest state psychiatric hospital (see map below). The only exceptions were Kansas, New Jersey, North Dakota, South Dakota, Washington and Wyoming. "Indeed, the Polk County Jail in Iowa, the Cook County Jail in Illinois, and the Shelby County Jail in Tennessee each have more seriously mentally ill inmates than all the remaining state psychiatric hospitals in that state combined," the report says.
The entire article is here.
Friday, April 25, 2014
U.S. Prisons Becoming De Facto Home of the Mentally Ill
A new study reveals that prisons in America house ten times as many mentally ill as the state-run psychiatric wards that could actually treat them.
By Abby Haglage
The Daily Beast
Originally published April 10, 2014
Here is an excerpt:
While TAC’s study—titled The Treatment of Persons With Mental Illness in Prisons and Jails—isn’t the first of its kind, it’s notable for two reasons: it’s the first to analyze the data by state, and it’s the most recent illustration that the problem is growing more acute. One of the worst offenders is New York, where the law mandates mentally ill inmates be sent to psychiatric hospitals (which—given the lack of available beds—is mostly useless). A 2011 study estimated that of the 12,200 inmates at Riker’s Island, ⅓ of the men and ⅔ of the women are mentally ill.
The entire article is here.
By Abby Haglage
The Daily Beast
Originally published April 10, 2014
Here is an excerpt:
While TAC’s study—titled The Treatment of Persons With Mental Illness in Prisons and Jails—isn’t the first of its kind, it’s notable for two reasons: it’s the first to analyze the data by state, and it’s the most recent illustration that the problem is growing more acute. One of the worst offenders is New York, where the law mandates mentally ill inmates be sent to psychiatric hospitals (which—given the lack of available beds—is mostly useless). A 2011 study estimated that of the 12,200 inmates at Riker’s Island, ⅓ of the men and ⅔ of the women are mentally ill.
The entire article is here.
Friday, March 22, 2013
New Hampshire's mental health system: From leader to failure
By Annmarie Timmins
The Concord Monitor
Originally published March 10, 2013
During his 1971 inaugural address, then-Gov. Walter Peterson identified seven goals for his next term. First on the Republican’s list was improving mental health care.
Peterson wanted to stop warehousing people with mental illness at the state’s psychiatric hospital and begin treating them in local communities. “A state mental institution,” Peterson told lawmakers 42 years ago, “is, more than anything else, a symbol of failure to help people in time.”
Two decades later, the state had become a national leader in mental health care by beginning what Peterson had envisioned. Lawmakers had established 10 community mental health centers and put money into local housing and local treatment. And under the leadership of then-Gov. John H. Sununu, the state had opened a modern 316-bed state hospital in place of the 19th-century-era institution, once called the New Hampshire Asylum for the Insane, that had housed nearly 2,000 people.
At the time, Donald Shumway, then director of the state’s Division of Mental Health, said the national recognition showed “our plan is really heading in the right direction.”
The acclaim would be short-lived.
Today, everyone from mental health advocates to lawmakers to Gov. Maggie Hassan describe the state’s mental health system as broken.
In a scathing 2011 critique, the federal government said mental health care here is “in crisis.” Federal officials accused the state of violating the Americans with Disabilities Act by starving the community care system in favor of unnecessary hospitalization. Last year, several patients made the same allegation in a federal lawsuit against the state that the federal government has joined.
Meanwhile, people in crisis languish in emergency rooms, sometimes for days, waiting for a hospital bed. The state’s jails and prisons have become the new mental health “‘asylum,” with an estimated 65 percent of the state prison population having a mental illness, according to a prison spokesman.
The entire article is here.
The Concord Monitor
Originally published March 10, 2013
During his 1971 inaugural address, then-Gov. Walter Peterson identified seven goals for his next term. First on the Republican’s list was improving mental health care.
Peterson wanted to stop warehousing people with mental illness at the state’s psychiatric hospital and begin treating them in local communities. “A state mental institution,” Peterson told lawmakers 42 years ago, “is, more than anything else, a symbol of failure to help people in time.”
Two decades later, the state had become a national leader in mental health care by beginning what Peterson had envisioned. Lawmakers had established 10 community mental health centers and put money into local housing and local treatment. And under the leadership of then-Gov. John H. Sununu, the state had opened a modern 316-bed state hospital in place of the 19th-century-era institution, once called the New Hampshire Asylum for the Insane, that had housed nearly 2,000 people.
At the time, Donald Shumway, then director of the state’s Division of Mental Health, said the national recognition showed “our plan is really heading in the right direction.”
The acclaim would be short-lived.
Today, everyone from mental health advocates to lawmakers to Gov. Maggie Hassan describe the state’s mental health system as broken.
In a scathing 2011 critique, the federal government said mental health care here is “in crisis.” Federal officials accused the state of violating the Americans with Disabilities Act by starving the community care system in favor of unnecessary hospitalization. Last year, several patients made the same allegation in a federal lawsuit against the state that the federal government has joined.
Meanwhile, people in crisis languish in emergency rooms, sometimes for days, waiting for a hospital bed. The state’s jails and prisons have become the new mental health “‘asylum,” with an estimated 65 percent of the state prison population having a mental illness, according to a prison spokesman.
The entire article is here.
Tuesday, January 29, 2013
Hickenlooper's Gun Control
The Colorado Governor's plan to fix mental health, not firearms alone.
Review and Outlook - The Wall Street Journal
Originally published January 15, 2013
Gun control has been the exclusive political fixation of President Obama's Washington after Newtown, so perhaps readers will be surprised to learn that some states are being more constructive. One of them is Colorado, where Governor John Hickenlooper is promoting an innovative overhaul of his state's mental health-care system.
In his State of the State address last week, the Democrat said that "our democracy demands" a debate over guns, violence and mental illness—not least in the aftermath of James Holmes's attack on an Aurora movie theater that killed 12 and wounded 58 in July. "Let me prime the pump," Mr. Hickenlooper said. "Why not have universal background checks for all gun sales?"
There was a lot of media attention for that line, but much less for what followed. As Mr. Hickenlooper continued, "It's not enough to prevent dangerous people from getting weapons. We have to do a better job identifying and helping people who are a threat to themselves and others." His office spent the last five months developing a detailed $18.5 million plan to modernize civil commitment laws while expanding community-based mental health treatment.
The rest of the story is here.
Review and Outlook - The Wall Street Journal
Originally published January 15, 2013
Gun control has been the exclusive political fixation of President Obama's Washington after Newtown, so perhaps readers will be surprised to learn that some states are being more constructive. One of them is Colorado, where Governor John Hickenlooper is promoting an innovative overhaul of his state's mental health-care system.
In his State of the State address last week, the Democrat said that "our democracy demands" a debate over guns, violence and mental illness—not least in the aftermath of James Holmes's attack on an Aurora movie theater that killed 12 and wounded 58 in July. "Let me prime the pump," Mr. Hickenlooper said. "Why not have universal background checks for all gun sales?"
There was a lot of media attention for that line, but much less for what followed. As Mr. Hickenlooper continued, "It's not enough to prevent dangerous people from getting weapons. We have to do a better job identifying and helping people who are a threat to themselves and others." His office spent the last five months developing a detailed $18.5 million plan to modernize civil commitment laws while expanding community-based mental health treatment.
The rest of the story is here.
Warning Signs of Violent Acts Often Unclear
By BENEDICT CAREY and ANEMONA HARTOCOLLIS
The New York Times
Published: January 15, 2013
No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.
That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.
But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.
“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”
The entire story is here.
The New York Times
Published: January 15, 2013
No one but a deeply disturbed individual marches into an elementary school or a movie theater and guns down random, innocent people.
That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York.
But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said.
“Anytime you have one of these tragic cases like Newtown, it’s going to expose deficiencies in the mental health system, and provide some opportunity for reform,” said Richard J. Bonnie, a professor of public policy at the University of Virginia’s law school who led a state commission that overhauled policies after the 2007 Virginia Tech shootings that left 33 people dead. “But you have to be very careful not to overreact.”
The entire story is here.
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