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RESEARCH: Outpatient Treatment Saves Money

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(June 17, 2013) Outpatient treatment of mental illness reduces arrest rates and saves money was the conclusion of a study from researchers at North Carolina State University (“Treatment of Mental Illness Lowers Arrest Rates, Saves Money,” June 10).

researchersThe researchers studied 4,056 patients who had been hospitalized for severe mental illness during a seven-year period. The research team found that patients who received outpatient services after discharge were less likely to be arrested and cost the government $68,000 for treatment and services, whereas patients who did not receive outpatient services were more likely to be arrested and cost the government $95,000.

“This study shows that providing mental health care is not only in the best interest of people with mental illness, but in the best interests of society,” said Dr. Sarah Desmarais, co-author of the paper and assistant professor of psychology at the university. “Our research shows that people receiving medication were significantly less likely to be arrested.”

At the Treatment Advocacy Center we have always said that treatment works to save lives and money. For those too ill to seek treatment themselves, court-ordered outpatient treatment is a bridge to recovery. Assisted outpatient treatment (AOT) laws have been passed in 45 states. These states need to use their AOT laws so that people who aren’t well enough to choose treatment experience the same benefits as people who are able to choose it for themselves.

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“I Used the Mobile Crisis Kit – and It Helped” – personally speaking

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(June 14, 2013) I don’t know about other parents, but when my daughter is in psychiatric crisis, my brain turns to mush.

 doris-fullerIt doesn’t matter how many times I go through this experience or how recently I’ve reviewed the civil commitment laws and standards in her state. At the height of a crisis, fear and dread flush every last particle of memory from my mind and transform me into a terror-stricken, paralyzed mom.

The last time this happened was two weeks ago. After more than a year of stability and soaring accomplishment, my darling daughter suddenly veered into mania that, for her, inevitably is followed by psychosis. Thankfully, there was a caring and capable adult on call, but the episode unfolded late on a Friday night more than 2,500 miles away. I had to respond by remote control.

As my stand-in described how my daughter was acting, my brain turned to mush. You know how we tell our little children to "remember your words"? I couldn't remember my words.

But then I remembered the Psychiatric Crisis Resources mobile app we had released literally days earlier that I had saved to my smartphone screen.

I opened the app.

I tapped “Emergency Evaluation” and chose her state. 

I read this: “A person may be taken into custody … (or) detained (for emergency evaluation upon) reason to believe that the person is gravely disabled due to mental illness….”

 I hit “Back” to return to the menu and and tapped “Inpatient/Outpatient Criteria” to read the "gravely disabled" definition.

And there it was: If “there is a substantial risk (she) will continue to physically, emotionally or mentally deteriorate to the point that the person will, in the reasonably near future, be in danger….”

My daughter was gravely disabled. She not only should but could under the law be detained for an emergency psych evaluation.

I read the language to my stand-in so she knew what to tell authorities. She managed to coax my daughter into the car and drove her to the ER; we would have called police if that hadn't worked. In the ER, she used the words I'd read to her, and my daughter was admitted for evaluation. She was hospitalized overnight and transferred the next day to the local psychiatric facility for care.

At the Treatment Advocacy Center, we’re always looking for ways to make treatment more accessible to people who need it - as soon as they need it, not dangerously later. We thought equipping families with mobile psych crisis tools might help.

I never anticipated the circumstances that very likely made me one of the first people to use our newest tool. Those of us who live on hope never really do.

But I'm so grateful it was there for me, and I'm sharing this story because we family members need all the help we can get, and our mobile app might help you or someone you know, too.

This is a happy-ending story with a darker lining. My daughter got timely, needed treatment over the next 10 days and has been released, stabilized and symptom-free.   

But she lives in what we call a need-for-treatment state. That means she got treatment because she met conditions that demonstrated she needed it to avoid becoming dangerous, not because she already was. Only about half our states have need-for-treatment laws. We need better laws, and we need the states with good laws to use them. Our loved ones' lives depend on them.

Please download our app and save it to your smartphone screen. If you know someone with a severe mental illness, you never know when it might put the words you need in a crisis at your fingertips.

 And then look up your state. How broad is its law? Would it enable you to get your family member or friend or neighbor care in a crisis?

 If not, help us improve your law. Here are a few ways. 

DORIS A. FULLER
Executive director

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Do You Know Someone Behind Bars and Not Receiving Treatment?

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(June 13, 2013) We can all agree that individuals with serious mental illnesses do not belong in jails or prisons. The reality, however, is that many such individuals are in jails and prisons as a result of the increasingly failed mental illness treatment system.

prison_mental_illnessMaking the problem even worse, there appears to be considerable confusion among families, and even among some jail and prison officials, regarding the legal circumstances under which individuals with serious mental illness can be involuntarily treated in jails and prisons when they are psychotic and unaware of their own illness.

For this reason, Dr. E. Fuller Torrey and the Treatment Advocacy Center are undertaking a state-by-state survey of laws and practices for treating jail inmates who refuse treatment for a severe and persistent mental illness. When it is complete later this year, the survey will be permanently posted on our website and be accessible to everyone, along with the other state-related information we already provide.

As part of the survey, we are reaching out to NAMI leaders across the country and any family member with a story about the experiences of individuals with serious mental illness (e.g., schizophrenia, bipolar disorder, schizoaffective disorder or severe depression with psychotic features) who should have been treated involuntarily while they were in jail or prison but, for whatever reason, did not receive treatment. We are interested in collecting examples of both bad outcomes when involuntary treatment was not provided and good outcomes when it was provided.

Do you or someone you know have a family member in jail or prison and an interest in the involuntary treatment problem?

If so, we would like to hear about that treatment situation. In our report, we will not identify the individuals or the jail/prison by name, only by state, except in cases in which the information is already public.

To contribute information to this survey, please email Dr. E. Fuller Torrey at This e-mail address is being protected from spambots. You need JavaScript enabled to view it before August 1, 2013.

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Remembering a Compassionate Champion for Treatment

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(June 12, 2013) Dr. Dean Brooks – the man author Pete Earley calls “the Dorothea Dix of the 21st century”  has died at the age of 96, leaving the mentally ill without a compassionate champion.

dean_brooksBrooks is most identified with his role as the Oregon state mental hospital director who opened the hospital’s doors to film One Flew Over the Cuckoo’s Nest and appeared in the movie as the institution’s chief psychiatrist. Cuckoo's Nest was described in E. Fuller Torrey’s landmark book, Surviving Schizophrenia, as “the quintessential film for the counterculture: the mental institution as a metaphor for the abuse of authority.” The image of the hospital in the film helped fuel a well-intentioned but misguided policy that has left the US with too few beds to treat people with severe mental illness.

While the film is credited with speeding up the process of deinstitutionalization, Brooks in recent years grew increasingly alarmed by the consequences of wholesale public hospital closings. He called jails and prisons the “new asylums” and said community care was failing to help people who need it the most.

His voice will be missed.

Even though Brooks was an ardent advocate for people with severe mental illness, Oregon still has a severe shortage of public psychiatric beds and jails three times more people with severe mental illness than it hospitalizes, according to our 2010 study, “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals.” 

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Santa Monica Shooter Reportedly Suffered from Mental Health Issues

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(June 10, 2013) The Santa Monica, California, shooter, whose rampage left four victims and the suspect dead, had a history of mental health issues that resulted in a prior hospitalization, according to media reports (“Santa Monica gunman previously hospitalized for mental health,” CNN, June 8).

santa_monicaThe mass killing that occurred Friday spanned several parts of Santa Monica. The suspect has been identified as 23-year-old John Zawahri. Authorities say he killed his father and brother before carjacking a woman's vehicle and firing at a public bus and continuing his rampage.

Currently, California’s largest mental health facility is Twin Towers, which is actually a wing of the Los Angeles County Jail. The state has roughly 14.2 psychiatric beds per 100,000 individuals. The supply was virtually identical in 1850 at 14.1 beds for 100,000 individuals. A person with severe mental illness in California is nearly four times more likely to be in jail or prison than a psychiatric hospital.

But there is hope for residents of California. Los Angeles County has a small pilot project that allows people with a history of violence or previous hospitalizations to be required to comply with treatment as a condition of remaining in the community. The program has demonstrated a 78% reduction in incarceration. The program is not currently available in Santa Monica.

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