Settlement meant to guarantee alternatives to segregation for mentally ill prisoners

A federal judge approved a settlement meant to reduce isolation for mentally ill prisoners in Massachusetts on Thursday.

The lawsuit, filed in 2007, stated that segregation for up to 23 hours a day violated the Americans with Disabilities Act and inmates' constitutional right against cruel and unusual punishment after 11 inmates who were segregated committed suicide in a 28 month period. Eight more suicides occurred in 2010.

The settlement provides for use of alternative placements, psychological help for inmates as well as review of their cases for other options.

Federal Investigators Find that Lab Routinely Gave Impure Drug Injections to Mentally Ill Patients

via The NY Times:

The office under fire, the Kreitchman PET Center, on West 168th Street in Manhattan, has attracted millions of dollars in research funds from the federal government and pharmaceutical companies to study drug actions and the biology of brain disorders, among other things.

Many of its studies focus on patients with disorders like schizophrenia and severe depression, who are especially vulnerable to poorly prepared imaging drugs because the compounds can act on brain receptors involved in their illness.

You can read the rest here.

Judge orders NY to move people with mental illness housed in group homes

A judge who was "disappointed and frankly incredulous" at the state's proposal ordered today that NY immediately begin to move thousands of people with mental illness out of group homes into their own housing. Conditions at the group homes, described as warehouses which resulted in isolation, amounted to violations of the ADA, he ruled.

Only those with the most serious conditions who are a danger to themselves or others will be excluded under the plan, which was backed by the Justice Department. The plan calls for NY to provide 1500 new units of supportive housing annually for the next three years. Supportive housing costs $7500 less a year for a resident than a group home.

Furthermore, Judge Garaufis of Federal District Court in Brooklyn appointed a federal monitor to oversee the process.

“Defendants’ demonstrated resistance to the remedy, as evidenced by their refusal to abide by the court’s findings in crafting their patently inadequate proposal, further highlights the need for a Monitor in this case,” he wrote

Mental Health Ministries presents a guide for faith communities

Mental Health Ministries presents a free guide for faith communities that can be downloaded. entitled Mental Illness and Families of Faith, the guide provides tools for use by clergy, congregation members, families and others.

It can be found here.

Via listserv NJCIM

BBC reports "veterinary approach"used in Greek mental care facilities

A BBC reporter writes that twenty years after a scandal about care conditions in Greek mental care facilities, she witnessed patients tied up in a building in so much disrepair that it appeared to be abandoned.

Chloe Hadjimatheou went to the Women's Clinic at the Dromokraitio Psychiatric Hospital in Athens, which houses about 300 patients. When she saw wide leather straps and buckles next to the beds, the head nurse told her:


"We have to keep some patients tied at night to prevent them wandering around and waking the other patients," Head Nurse Maria Makraki explains.

Dr Astrinakis interrupts her: "Just like a dog you tie up to stop it wandering off… this could be considered the veterinary approach to psychiatry."

He points to buckets below the beds that act as make-shift toilets.

...

Nurse Makraki tells me that staff shortages mean that there are usually only two nurses caring for around 30 patients.

That is half of what is required to provide basic care.

Stella Galianos, a psychologist, estimates that in every clinic at Dromokraitio hospital there are around three to four people tied to their beds.

I ask her if the woman I saw could end up tied to her bed for years.

"Yes definitely."

And, although the Athina Residential Home was pointed out to the reporter as an example of reform, the staff there went unpaid for six months last year. In light of the issues, the European Union has told Greece that "if it does not come up with roadmap for psychiatric reform by next month, EU funding will be cut from social projects across the board."

Conscientious objectors: a history of advocacy in mental hospitals

Syracuse Professor Steven Taylor's article entitled Conscientious Objectors of WWII is featured in the "On Faith" section of the Washington Post. He writes about the history of CO's in advocating for better conditions for those in mental hospitals, noting that it began when approximately 3000 men back in WWII were assigned to work in mental hospitals and training schools and exposed brutal conditions found there. Quakers, Mennonites, Jews, African American Muslims and others worked as individuals and groups to improve conditions any way they could.

He writes:

After the end of the war, the Philadelphia COs established a national foundation to further their aims. Included among their supporters were Eleanor Roosevelt, ACLU founder Roger Baldwin, actress Helen Hayes, and author Pearl Buck. From 1946 to 1950, their foundation published educational materials for attendants and the public, created a legal division to reform state commitment laws, and sponsored radio dramas broadcast nationally on CBS and NBC. Then, in 1950, faced by chronic financial problems and led by a board of directors lacking the passion and zeal of its founders, the foundation formed by the COs merged with two mainstream organizations to create a new mental health organization. Within a brief period of time, the new organization lost interest in institutional conditions and turned its attention to other matters. The institutions became out of sight, out of mind once more. The efforts of World War II COs to reform the nation's care of people with psychiatric and intellectual disabilities have since faded from professional and public memory.

Although Professor Taylor notes that current reform movements are led by those most directly affected, people with disabilities and their families, his article serves as a tribute to all of those who came from different walks of faith and gave valuable service to vulnerable Americans.

You can read the rest of the piece here.

The homeless in Philadelphia

After the recent death of Margaret Jones, Philadelphia is changing the way it tracks homeless people with mental illnesses. Jones was found dead in a transit stairwell in January 2009. Although Philadelphia's mental health system knew she was missing and a homeless shelter knew her whereabouts, neither agency was in contact with each other.

The article states that 70 percent of homeless people have mental illnesses.

**

Witnesses to Hunger, a group of homeless women who were given digital cameras to photograph their lives, traveled to Washington DC this week. They worked with Drexel University's School of Public Health to create the project and were followed by a documentary crew. The exhibit was displayed at the Russell Senate Office Building. A video of the project is below.

Since The Inquirer published a story about their photos last fall, news organizations in Asia, the Middle East and Europe have written about the women and the North Philadelphia world they photographed.
via philly.com

Egypt moves toward community based care under new mental health legislation

Egypt's first new law in sixty years regarding care for mental heath is moving those lost in asylum care back into the community.

The new law also sets time limits for patients' cases to be reviewed, allows them a greater say in their treatment and sets extra safeguards for those brought to the hospital involuntarily.

Patient rights groups have welcomed the new legislation, but misconceptions about mental illness and safety concerns mean the public may be harder to win over.

Abuse Found at NY Psychiatric Hospital

From the NY Times:

After a yearlong investigation, the Department of Justice portrayed the unit at Kings County Hospital Center as a nightmarish place where patients were not treated for suicidal behavior, were routinely subdued with physical restraints and drugs instead of receiving individualized psychiatric treatment, and were frequently abused by other patients.

........

The investigators found that the psychiatric service operated like a prison. The report said that instead of meaningful treatment and diagnosis, the patients received frequent visual checks by the staff, and that even when patients were supposedly under watch, violence and attempted suicides occurred.

A family's fictional journey

Sometimes a first novel comes along that's really excellent- and also deals with a subject that is worth reading about.

Halfway House by Katharine Noel fits the description. Her book is about Angie, a competitive swimmer in high school who suddenly begins to show symptoms of bipolar disorder and has a psychotic break. After being hospitalized , Angie is sent to a farm/treatment hospital for three months and then returns home to restart her senior year of high school.

Not only does the book follow her family and Angie through that difficult time, but also through the years afterward - medication changes, halfway houses, an attempt at going to college and working. The book also explores the effect on the family's relationships - how Angie's diagnosis changes each member, how relationships between Angie and each member change.

Noel writes with ease, but more importantly she doesn't turn the book into a melodrama. Angie's parents' relationship is multifaceted and not all about their daughter. They are given a history as characters and although it would be much easier to write this book as all about Angie, that's not done. Each family member is portrayed individually, so their relationship to Angie and feelings are more credible.

Overall, I'd say this is a very powerful book dealing with a subject that's often handled poorly in fiction.

Mental health crisis in New Orleans

The mental health crisis in the city has been highlighted due to the recent school shooting at Louisiana State University and eight shootings of police officers. The legislature has approved funds to address the issue, which is resulting in sending people with mental health issues to jail rather than getting them treatment.

Now, instead of being treated at Charity, mentally ill criminal suspects often are arrested, burdening the city's overtaxed judicial system, Rouse says. That worsens the problem for patients, who may not get proper medication or monitoring in jail, he adds. The patients usually suffer from schizophrenia, bipolar disorder or depression.

"When your regular mental health treatment system collapses, the patients become criminalized," Rouse says.via UsaToday.com

This article highlights a number of issues causing the crisis:

*Charity Hospital, which used to treat those with mental illnesses, is no longer open.
*Those with mental health issues are being jailed, rather than placed in appropriate treatment facilities
*More people have untreated mental health issues since Katrina
*There are more homeless people, a number of whom have untreated mental health issues

In other news, the House is scheduled to vote on a bill that would require insurers to provide equal coverage for mental health issues as for other conditions. {Update: the bill did pass in the House.}

Their misfortune, not hers

Schadenfreude is a German word meaning 'pleasure taken from someone else's misfortune'. There is a form of private derision or public scorn (referred to as 'Hohn'). I suppose that this topic was on my mind as a result of an exchange I had with a friend.

She remarked about how difficult it was for her sometimes to be around other people, because they knew she had mental health issues and they devalued what she said. People question everything she says, she told me, and treat her as if she has no credibility at all. But worse than that, she explained, is the way they do it. They do it in a way where they act superior, as if her version of reality just doesn't matter. And it came across to her in this one group as gloating, to put it simply, like youths on a playing field who beat up the other team and clap each other on the back after they questioned what she said due to her mental health issues. It was humiliating to her.

What's so interesting about this is that the entire thing arises from misunderstanding and ignorance. Her mental health issues don't involve symptoms of hallucinations or altered reality at all - and , quite frankly, even if they did those would be transient states- occasional symptoms at most. Most people on medication with mental health disorders, contrary to popular belief, are quite grounded anad aware of reality. How do I know? I've worked with people and read volumes of documents about their conditions written by experts describing their disorders. I know people with mental health disorders. I'm familiar with my friend's diagnosis and know that the reaction she's getting isn't based on the right information. Most people don't know that 80 to 90% of people who get treatment for mental health disorders can function the way they used to. And what stops them from doing so? Stigma. How do we fight stigma? Through advocacy, public education and contact with those who have mental health issues.

My friend is certainly aware of it when others treat her differently. Her feelings are hurt when she is patronized, her reality is questioned and she's told she's imagining things. Not only does this serve to lower her self esteem and stunt her social opportunities - it goes much further. It dehumanizes her and attempts to turn her from adult status to the role of a child.

Schadenfreude is the German word for only some of the behavior she's describing. It's interesting to read over at Wikipedia the various ways this phrase is used in other countries. It describes a broad range of responses, from what may be called gloating to a sense of retribution. In some places, it can be about "better you than me" or "you deserve that" even if the reason isn't clearly articulated.

No one deserves to be treated in the ways my friend is describing. Yet I've seen this before - and will see it again. It isn't called by this name and some will disagree when I do so, but I think it's time to speak up about these issues honestly. We can call it bullying or we can call it teasing or we can even benignly say kids are like that (or adults are like that in a group, etc.) and the person is being 'thin skinned'.

But what's at the bottom of it is a sickening sense of false superiority described very well by this term, a pleasure taken by right of entitlement at the sake of someone who's perceived as "different". I don't think of disability as misfortune, but they do. The only misfortune going on here is that they fail to see what a wonderful, big hearted, generous person my friend is.

It is everyone's loss and there is nothing, nothing at all to gloat about.

Another tasered passenger dies

..this time in Vancouver Canada.

The media is saying that the Vancouver case involved a passenger who couldn't communicate with personnel at the airport because he spoke a different language. He was frantically looking for information about his elderly mother from airport personnel. No interpreter was provided. The passenger became more and more agitated, throwing objects. 50,000 volts of electricity were sent into the Vancouver passenger who was taken to the floor where an officer used his body to pin him at his neck according to a nearby passenger.

These airport cases always raise the possibility of mental health issues. It reminded me of the case of Troy Rigby, who died in February 2006 after he was tasered on an airport tarmac. Rigby had bipolar disease and schizophrenia.

"Rigby had boarded Continental Airlines Flight 408 bound for Newark, New Jersey, where family members live and where he said he planned to get treatment for his mental illnesses.

Witnesses later told reporters that, as the plane was delayed near the runway for about 30 minutes, Rigby told fellow passengers he was claustrophobic. Then he suddenly got up and ran toward the front of the plane, yelling "Let me go. Let me go. Let me out of here."

Rigby repeatedly slammed his body against the cockpit door, saying he needed to get out of the plane. At least four passengers and one flight attendant tried to restrain Rigby, who bit the hand of one of the passengers.

Rigby then opened a passenger door and dropped 10 feet from the moving plane to the tarmac. As Rigby headed toward the terminal, sheriff's deputies approached and tried to arrest him. When he resisted, one deputy shot him at least four times with a Taser stun gun before they finally subdued him.

Family members later said he had stopped taking his medications." via inclusiondaily.com

It's not clear in the Vancouver incident if this passenger had any mental health issues.

I watched the video in the Vancouver incident. The image of four stocky officers approaching the Vancouver passenger is burned in my brain. The Vancouver passenger turned away from them, not understanding their language as they approached him. This wasn't the reaction they wanted, although he was certainly outnumbered at that point and could have been subdued by these burly guys. So they tasered him.

Pundits will argue that he threw objects. He did. They'll argue he acted dangerously. But if you watch the video and check out what happened, right before they tasered him they really had enough personnel there to contain him without tasering him.

My concern in these cases is the use of tasers isn't being policed. A taser was used four times on Troy. I, for one, wouldn't want this tasering decision made on a loved one unless other alternatives were explored and considered. These tasers are strong and cause injuries resulting in death. There are other alternatives. Because tasers haven't always been around.

Protecting bystanders is an important consideration. However, the larger the circle we draw around permissible cases of using a taser, the smaller the group of the others becomes and the larger the group of the tasered become. And even assuming we want to allow that to happen (a fact I'm not willing to concede), shouldn't we at least be asking if there are less injurious alternatives for airport security and officers to use?

NPR: Study shows care for mentally ill lacking

An audio of the Morning Edition deals with this issue. Click above.

"A new study in The Lancet, an independent voice in global medicine, shows no country does a particularly good job caring for those with serious psychiatric illnesses. Among findings: in Africa, there's one psychiatrist for every 2 million people; while in Europe, there's one for every 10,000. Still, there are things poor countries can do to help the mentally ill." Via NPR

"The Mentally Ill - Jailed and Desperate for Help"

In this CNN article, the plight of those on the ninth floor of the Miami-Dade county jail - the mentally ill who await their court dates -is discussed. Most of them face drug charges or charges that result from a run in with police. Judge Leifman speaks about why the situation has become so desperate for so many.

"Leifman says 200 years ago people were considered "lunatics" and they were locked up in jails even if they had no charges against them. They were just considered unfit to be in society. Over the years, he says, there was some public outcry, and the mentally ill were moved out of jails and into hospitals. But Leifman says many of these mental hospitals were so horrible they were shut down.
Where did the patients go? Nowhere. The streets. They became, in many cases, the homeless, he says. They never got treatment.
Leifman says in 1955 there were more than half a million people in state mental hospitals, and today that number has been reduced 90 percent, and 40,000 to 50,000 people are in mental hospitals.
The judge says he's working to change this. Starting in 2008, many inmates who would otherwise have been brought to the "forgotten floor" will instead be sent to a new mental health facility -- the first step on a journey toward long-term treatment, not just punishment."

Via CNN

Hearing Our Voices: A documentary on schizophrenia and homelessness

The website (click above) for this documentary is worth visiting. It's beautifully done, with photos and stories introducing the participants and explaining what home is to them. I tried to recap what they said but I simply can't - you need to see their words over there - and hear them.

A poster on the site is simply entitled Searching for Sanctuary. It is a sanctuary most people take for granted, yet our society still needs to overcome the many barriers it has toward providing opportunities for housing for schizophrenics and many others with disabilities.

Video clips are available.

Disability, Connectedness and Redefining Social Integration -The Need for Community Education

I've linked to a summary of an article last month in a psychiatric journal discussing the connectedness and social integration of people with psychiatric disabilities, emphasizing the need for services to consider this aspect of care and the skills needed by the folks who have psychiatric disabilities.

But what about community education?

Articles like this always get me thinking about the other side of the equation - the obstacles faced by people with disabilities when they try to integrate into society. One of our most vulnerable populations is people with mental health issues. Many of us with disabilities realize from real life experience that having social skills if you are a person with a disability isn't the entire answer. If it was, the solution would be simpler. But we have to be careful not to discount the fact that social integration is dependent on the response of others - and society.

I remember years ago talking to a vet in a wheelchair at a tennis tournament. He had used a wheelchair for over 25 years and I was newly disabled. I explained to him how I was surprised at the social difficulties I was running into in some places and with some people and he replied "Well you're going through shock right now." He went on to explain that it wasn't shock from being disabled, but shock from realizing that the reactions of some people were going to be so different because I was in a wheelchair. I tried to talk him out of that position but he wouldn't budge.

Up to that point, I had blamed myself for every interaction that went wrong. Whenever I ran into a situation where I was excluded, I blamed myself. Then I read a few books about disability studies and began to understand better what that vet was trying to tell me that day - that barriers exist because of attitudes and other factors in our society.

I applaud and support those in the field of disability studies as they strive to introduce a consideration of the societal factors as related to disability into all academic fields. An article such as this , which discusses raising the expectations for integration of people with psychiatric disabilities, calls out for a discussion from those of us advocating for the rights of the disabled about the myriad of factors involved so that we can determine what needs the system can and should address. Some of the services do need to address the skill level of the person with the disability, but some of the services also need to address community education to create a more equal playing field for those who are de-institutionalized and about to enter our communities.

"Understanding Empathy: Can you feel my pain?"

In this NY Times article, a therapist writes about the conundrum facing many of the patients he's seen over the years - can others understand our pain without experiencing it? He believes they can. Click above to read his article.

NAMI provides resources on mental health issues and Virginia Tech

"The tragedy raises sharp issues about the nation’s fragmented mental healthcare system, which NAMI has raised for years. Some of them are now being debated in the news media and legislatures, including Congress. They range from stigma, privacy rights, court-ordered treatment, gun control, mental health and suicide prevention screening programs, and mental health services on college campuses.

The purpose of this Web site page is not to engage in debate at this time, but to provide information and resources to people who are still seeking to understand and cope with tragedy—and to direct them where they can express support to the Virginia Tech community."

Via NAMI website

National Alliance on Mental Illness consists of individual living with mental illnesses, their families and friends.

Safety on college campuses : Let's not form a lynch mob yet

It was supposed to be a social occasion, just having a meal together.

But my able bodied acquaintance decided that the main topic of conversation should be the shooting at Virginia Tech and whether there should be more laws about how to deal with students with mental illnesses. Laws that exclude such students, laws that take away the privacy rights of such students, laws that cut away at the hard fought for provisions of the Americans with Disabilities Act, and laws that increase the stigma such students already have faced.

After listening to my companion's argument, I took another sip of coffee. I swallowed. I thought about how I just wanted to eat my breakfast. But as a person with a disability I know that many others are thinking and saying these same things.

So I brought up the danger of knee jerk reactions to fixing problems, the tendency to point the finger at the entire group of students with mental illnesses for the behavior of one and the folks who chained themselves to court houses and other places to get those of us with disabilities the rights we have that still are not being enforced.

"As a group, we have legal rights but not social or cultural ones in many cases," I said quietly.

I was cut off. She was too angry to listen to me. "I knew you would say something like that, something vague," she said triumphantly, sitting back.

"And," I continued, "this is why many of us are forced to resort to the court system to handle situations which adds to a backlash against our rights. Then the stereotype of the angry and bitter and unreasonable disabled litigant crops up. Suddenly everyone else becomes the 'victim'. Even though we are the ones who cannot get access to buildings, churches, schools and other institutions, the finger is pointed at us when we try to enforce our rights."

"I'm not talking about your rights," she said. "I'm talking about everybody else's rights."

Ahh, the us versus them argument. I refused to take the bait. I did have more coffee. "So you think we need to cut away the rights of students with mental illnesses because of the behavior of one student," I repeated. She nodded. "So let's follow through with this. If one college football player rapes another student, should we test all college football players to see if they are sexual predators?"

"No, of course not. That would be a violation of their rights. We'd be punishing them for who they are, not what they've done."

"Maybe test all college athletes or students who weigh over a certain amount? Maybe we should do it on the basis of other attributes?"

She shook her head vehemently. "Absolutely not."

"Then I don't follow your reasoning. What you're saying is that only students diagnosed with mental illnesses shoot other students, right?"

"No, I didn't say that."

"And you're not saying other students should have their rights taken away?"

"Definitely not."

"Then how is that different than the college football player argument?" I asked.

"We all know that college football players aren't crazy."

"But some football players have commmitted crimes," I point out. "There have been several trials for rape by Naval academy cadets this year and three of those students were football players. But I heard no outcry about treating college football players differently."

"Well it's not right to pick on student athletes as a group. Look at how they picked on those Duke lacrosse players," she said hotly. "They were innocent and people made assumptions."

"And those assumptions hurt those players," I said quietly. "Our country was all indignant at the assumptions that were made against the Duke students just a few days before this shooting. We were all talking about the need not to rush to judgment, weren't we?"

Neither of us said anything for a few minutes. "There is that side of things too," she agreed.

I'm reminded of the mob scene in Frankenstein, where the villagers run out of their houses to get the monster. Torches alit, they go through the streets, looking for him, determined to make themselves "safe". Except in this instance the "monster" has been defined as students with mental illnesses.

Before we form a lynch mob, folks, let's calm down and consider how the prejudices that society still holds against those with mental illnesses are affecting our judgment. And let's take a look at the role stigma plays in how we treat this issue before we judge people on who we think they are rather than by what they have done.