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TOP 10 UNDER-REPORTED MENTAL ILLNESS STORIES, 2007

The Treatment Advocacy Center’s top stories you probably didn’t read about this year

ARLINGTON, VA – In 2007, media coverage concerning people with severe mental illnesses was understandably dominated by the Virginia Tech tragedy. But for every Seung Hui Cho, there are thousands not receiving treatment for schizophrenia or bipolar disorder languishing in back bedrooms, living on the streets, or sitting in jail cells. Those stories don’t lead the evening news.

The Treatment Advocacy Center is the only national organization fighting to get needed treatment for people who are most seriously mentally ill – long before the untreated symptoms of their illnesses make their lives the stuff of headlines. Many of these individuals are unable to make informed decisions about their need for treatment because of brain changes caused by their diseases.

Here is the top 10 list, for 2007, of the most under-reported trends and issues brought about by our nation’s continued neglect of those who are the most severely mentally ill.

Mental health courts are a sign of the failure of the mental health system. Today, our country has 150 mental health courts and many more are planned. The fatal flaw? To get to such a court, you first have to commit a crime. No wonder so many family members must wait until – and even hope that – their loved ones commit a crime to finally get help. Funding mental health courts is akin to subsidizing wheelchairs for people with diabetes after they have a limb amputated. It is too little, too late.

Requiring “dangerousness” before someone can get mental illness treatment is dangerous for everyone. Researchers found the provision of adequate treatment is delayed an average five months longer in jurisdictions that rely solely on dangerousness-based criteria to trigger treatment interventions. Study author Matthew Large: "The requirement to prove dangerousness is both bad law and bad medicine. It is bad law because dangerousness can not be accurately predicted and it is bad medicine because it delays treatment of first episode psychosis and as a result causes a poorer prognosis and a worse outcome for the patient and their family."

Housing isn’t enough for some of the homeless. Handing a homeless person the keys to a new apartment is a futile gesture if they think you are an alien. “Housing First” and similar efforts leave behind those who first need treatment. Minneapolis offered 50 housing vouchers to its most chronic homeless – only five people accepted. The rest remain homeless, braving a Minnesota winter either by choice or – more likely – by untreated illness.

There is a connection between violence and untreated schizophrenia. Date from the CATIE study of antipsychotic drugs demonstrated patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public (19.1% vs. 2% in the general population). Most major mental health organizations continue to deny the increased risk of violence that accompanies symptoms of untreated mental illness.

Psychiatric beds are shifting from civil to criminal. General population beds in psychiatric hospitals are bordering on extinction – increasingly, the only way to get a psychiatric bed is to commit a crime. In Oregon, the state psychiatric hospital system dedicated 59% of its beds for the forensic system. In Colorado, the director of the department of corrections requested nearly $60 million to double the size of a 250-bed correctional facility to house mentally ill inmates.

Medical professionals sometimes opt for neglect rather than treatment. Too often, front-line providers fail to get extremely sick people into treatment. In Iowa, when a mentally ill homeless man was taken to the emergency room, his belligerence led the treating doctor to release him. He later technically died of hypothermia – we call it neglect.

Cops are expensive mental health workers. Putnam County, Tennessee, has two deputies designated for mental health transports. For each transport, the deputies are off patrol for at least 5 hours. Last year, they made 478 transports. Now factor in the periodic use of SWAT teams, helicopters, or closing down a freeway.

Assisted outpatient treatment (AOT) programs make a difference – when they are used. Seminole County, Florida’s AOT program resulted in a 72 percent decrease in jail days – a savings of more than $15,000 per patient. The patients also experienced an overall reduction of 43 percent in hospitalization days.

It is insane to release a killer and not require them to remain treatment compliant. When Ottawa sportscaster Brian Smith was killed by a man with untreated schizophrenia, “Brian’s Law” was passed to make treatment easier to get. Now, 12 years later, the mentally ill perpetrator was freed – and then assaulted a policeman. Why not try Brian’s Law for Brian’s killer?

We are still protecting the right to be psychotic over the right to treatment. Historically, civil rights advocates passed laws protecting the absolute right to self-determination in mental illness treatment. But in their fervor to protect people's rights, they in fact trampled on them. Today, Kenneth Miller is in jail for killing his father because Pennsylvania’s law protected the right to psychosis over the right to treatment.

The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

We take no money from pharmaceutical companies. The American Psychiatric Association awarded TAC its 2006 presidential commendation for "sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients.”

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