Working4the Mentally Ill

A KEY QUESTION for 2013:  

Is it okay NOT TO TREAT mentally challenged individuals?

In 2013… every time  you read about a person being suspected of having a mental illness AFTER being arrested for a violent crime, it’s important to remember this fact:  on average a person with a mental illness is NOT VIOLENT.  Often when someone with mental health issues commits a serious crime, that person is often NOT receiving or taking medication.  Violent people with mental health challenges are typically those who are NOT in treatment. 

BUT… now hear this:  TREATMENT WORKS; it’s a good preventive intervention.  So the next logical question is – why isn’t our society doing more to prevent violence, in the first place; that is to say… why isn’t more being done to insist on medical treatment for individuals with severe mental illness?  Why do nearly half of the people diagnosed with a mental illness not get the medicine and treatment they need?  Where are the preventive services?  Why are too many mental health services and other related resources the first to suffer when budgets are cut. Two answers:  STIGMA & IGNORANCE!

The stigma of mental illness limits national and local discussions.  But stigma is driven by ignorance. And, of course, that explains the lack of OUTRAGE when legislators and policy makers continue to make mental health issues a low priority.  How strange that the typical response to violent crimes in Newtown, CO and Colorado is not more action, but less, when it comes to guns.  Those opposing MORE GUN CONTROL are likely to also be those not interested in reforming our nation’s mental health system!  How ironic… even mentally ill shooters must have their Second Amendment rights protected.

And a Baltimore Sun editorial (11/27/2011) shows just how much education remains to be done to destigmatize mental illness.

First,  an article on inmate deaths at a state mental hospital pointed out that Baltimore Sun editors endorsed a new CEO there. They called him “the right man to lead the institution on the long road to emotional recovery.”  But I was stunned when the editors pointed out that “most of the extremely mentally ill patients at Clifton T. Perkins state mental hospital”  had “never received treatment for their illnesses before they came to Perkins.”  Excuse me? Did I miss something here? Is that true? Are these Baltimore Sun editors  not really bothered by the fact that those declared “not criminally responsible” by a court never received TREATMENT FOR A MENTAL ILLNESS before either being arrested or ending up in a mental hospital?  Wow!!!  Are we really being well-protected in our society?  

Second, the need for education about mental illness is apparently clear when  Sun editorial writers…  point out that –  most of the 239 Perkins’ patients who are diagnosed with schizophrenia, schizo-affective disorders, and severe mood disturbances, as major depression and bipolar disorders, DID NOT receive psychiatric treatment before they arrived there.

Now that is one scary thought?  Is it just me or do you find it amazing that the media and policy makers are not alarmed? Do too many of us  just accept that some mentally ill people are going to have to commita  crime in order to get treatment for their broken brains?

As a certified teacher for Maryland’s National Alliance on Mental Illness (NAMI), I have taught hundreds of  caregivers for the mentally ill at area hospitals.  The first fact they learn is that treatment works.   Caregivers of the mentally ill come to class already knowing that stigma hurts!

NAMI’s free 12-week education program – Family2Family (F2F) – is taught throughout Maryland and the country.  It is pivotal for helping parents, spouses, and other caregivers understand brain disorders (mental illness), prescribed medicines, and psychiatric rehabilitation services.

Research shows that it is particularly difficult  to get coordinated services around the country and in Maryland – a state that withholds treatment for mentally ill individuals, unless they are a danger to “self or others.” That limited law is often missing from stories about the mentally ill. In other words, by not focusing on how so many untreated mentally ill adults end up at the Clifford T. Perkins Mental Hospital, the Baltimore Sun also reinforces the myth that the mentally ill are dangerous.

But that is not the case.  What is dangerous is for a society tolerate so many untreated mentally ill citizens.

So…  without a powerful and sustained outcry from the mentally ill and/or their caregivers… little will change.  Mental health budgets will get cut; mental health services will get pushed even farther to the back of the agenda.  Already suffering from fatigue from just trying to survive without housing, jobs, and treatment, individuals with mental health issues can’t be expected to march on the State House or the White House.

Mental health caregviers who have graduated from NAMI’s Family2Family courses continue to be appalled by a mental health system held together with plastic tape or bubble gum. It is also sad to discover that our beautiful state is one of the seven worse places ( Connecticut, Maryland, Massachusetts, Nevada, New Jersey, New Mexico, and Tennessee) for getting better coordinated mental health care.  In the name of individual rights, these seven states use a narrowly defined law (danger to self or others) to permit mentally ill persons to refuse treatment, in the name of individual rights.  Yet, the law flies in the face of science.  Research clearly demonstrates that the brain of a mentally ill person can’t be trusted to make good judgments early on in the disease.  Denying a mental illness is a part of the disease itself.  This neurologically based brain disease is called – anosognosia.

According to the Treatment Advocacy Center, anosognosia – is believed to be the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. It is caused by damage to specific parts of the brain, especially the right hemisphere, and affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder. When taking medications, awareness of their brain illness tends to improves in many patients.

In addition, Oliver Sacks who wrote The Man Who Mistook His Wife for a Hat, notes that it is difficult, for even the most sensitive observer… to picture the inner state of the mentally ill  because the experience itself  “is almost unimaginably remote from anything” most of us know.

The fact that Maryland is one of only seven states lacking court-ordered assisted or outpatient treatment means that the only way our mentally ill loved ones can get treatment against their wishes… is to commit a crime!  Remember the guy who travelled across country to fire shots at the White House late last year?  Was that a mental health call for help?

It is thus hard to ignor that F2F caregivers lack important and much needed safety nets for helping relatives with severe  mental illnesses.  We can’t force them to take medicine or undergo even outpatient treatment, even when these things would make them less likely to be violent. Except for seven states, a history of not taking medicine counts because the law has been expanded beyond it’s narrow interpretation of danger “to self or others.” 

Until Maryland reforms the mental health law, family members of the mentally ill are left to struggle with their untreated relatives being frequently released from Emergency Rooms and psychiatric facilities because no one has been hurt or killed, yet!

 While the singular and narrowly defined law of “danger to self or others” is cost effective for the state, in the long run it is costly for our society.  Other states get that and have expanded the law to include other special conditions.  The result is that care is coordinated and mentally ill persons receive court ordered care BEFORE crimes are committed.

  Those who argue that individuals should not be deprived of their rights, under any circumstances, have probably not been held hostage by a loved one with a mental illness.  While it makes sense, ideally, to have mentally ill patients participate in their treatment, timing is important.  Is it really a good time to give an individual in the middle of a rage like episode the right to make decisions about treatment?

Without a court order to initiate treatment, many of us end up with mentally ill relatives walking around the house saying there is nothing wrong with them. We live in dread and wait for the other shoe to drop; we live in uncertainty and fear the arrival of news that our loved one has been found on the streets or homeless or arrested and even, killed.

So while treatmentfor the mentally ill remains a philosophical and political issue, what can’t wait is that the one in five suffering from a mental illness need help NOW!

Because there is more to the story than the Cliford T. Perkins state mental hospital getting new leadership, I write to make sure that we do not forget that the patients at Perkins are  there because they didn’t or couldn’t get mental health treatment BEFORE committing a crime.

So a final question for 2012 – Is it really humane or in the COMMON GOOD for so many of our citizens with compromised minds to be denied the very interventions that would prevent them from being homeless, jobless, violent, in detention centers, prisons or state mental hospitals, such as a Perkins? If you could hear the stories from families members that I hear, you would clearly know that the answer is a resounding “NO!”

Family2Family members have a renewed chance in 2012 to let legislators know ALL IN NOT WELL… we need coordinated mental illness care in Maryland AND that is not going to happen without reform and a change in the law to move beyond a standard of “danger to self and others.”

“The National Institute of Mental Illness (NIMH) in 2010 estimated that 7.7 million Americans suffer from schizophrenia and severe bipolar disorder – approximately 3.3% of the US population when combined. Of these, approximately 40% of the individuals with schizophrenia and 51% of those with bipolar are untreated in any given year.”  (Source: Treatment Advocacy Center)

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