(2-23-17) A tweet by Dr. Jeffrey Lieberman, the chair of the Psychiatry Department at Columbia University, announcing that Miami-Dade Judge Steven Leifman has been appointed as the first Assistant Secretary for Mental Health and Substance Use Disorders is premature. No final decision about the appointment has been made.

“Thrilled with appt. of Judge Steve Leifman as First Asst. Sec. of Mental Health in US History,” Lieberman tweeted.   

While Judge Leifman is a strong candidate for taking charge of the Substance Abuse and Mental Health Services Administration (SAMHSA), which has a $3.5 billion budget, Health and Human Services Secretary Tom Price has not officially announced which candidate he will recommend to the White House. The new Assistant Secretary will then have to be vetted and approved – either by President Trump or his staff – before his appointment is sent to the U.S. Senate for confirmation.

For his part, Judge Leifman is not commenting publicly about the tweet or his possible appointment.

Judge Leifman is considered to be the leading candidate because, in my opinion, he is the most qualified and clearly the best choice for the job, a sentiment widely agreed on in Washington.

But he still faces hurdles. When Vice President Mike Pence was governor of Indiana, he appointed Dr. John Wernert to overhaul Indiana’s state mental health system. That could cause problems if Pence decides to get involved. There are still some who are lobbying for a psychiatrist, not a judge, to be put in charge of  SAMHSA.

Being a psychiatrist or someone with an equivalent medical background was one of the requirements that Rep. Tim Murphy (R.-Pa.) originally put in his Helping Families in Mental Health Crisis Act (HB- 2646), which started the effort in Congress to reform our mental health system after the Newtown shootings. But that requirement was dropped when Murphy’s bill reached the Senate. Senators didn’t want their hands tied when it came to the confirmation process and they also wondered if a psychiatrist would have the management skills needed to run a large bureaucratic organization.

I have always supported Judge Leifman because I have seen first-hand how he has transformed the mental health care system in Miami-Dade County from one of the most horrific in the nation to one that is now  nationally  recognized as a “gold standard” model being copied by other progressive communities.

I am not the only one who believes Judge Leifman would be the best choice. Widely admired in mental health circles, Judge Leifman has received strong support from Sen. John Cornyn (R-Tx.) the powerful Senate Majority Whip, and Sen. Bill Cassidy (R.-La.) who co-authored the Senate version of the Helping Families in Mental Health Crisis Act. In addition to his overall knowledge about our mental health system, both were reportedly impressed with his management skills, which are going to be invaluable when it comes to revitalizing SAMHSA. The agency has been blasted by critics, especially Rep. Murphy, and was ranked in a nonpartisan survey by its own employees as one of worst federal agency workplaces.

If you have read my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, you will recall that it was Judge Leifman who got me access into the Miami-Dade County pre-trial detention center so that I could chronicle how jails and prisons have become our new mental asylums. But three years before I knocked on his door, Judge Leifman already had begun working on fixing his community’s badly fractured system. Starting in 2000, Judge Leifman persuaded local stakeholders to sit down, share information and begin cooperating. After my book was published, he got voters to approve a multi-million dollar bond issue to finance alternatives to inappropriate incarceration.

In the past 17 years, Judge Leifman has crisscrossed the nation advocating for jail diversion, Crisis Intervention Team training, mental health courts, and jail intercept and re-entry programs. But he’s wise enough to understand that it takes more than keeping ill individuals out of our criminal justice system to help them regain control of their lives. He serves on the board of the nation’s largest and most successful supportive housing organization, is on the board of the American Psychiatric Foundation, and is an enthusiast of  job training, clubhouses, peer support services, and imaginative recovery programs.

Under his leadership, Miami-Dade County has become the first in the nation to investigate how predictive analytics can be applied to mental health and substance abuse services. In addition to working locally, he was appointed a Special Advisor on Criminal Justice and Mental Health for the Supreme Court of Florida. On November 19, 2015, he became the first Floridian judge to receive the William H. Rehnquist Award for Judicial Excellence from U.S. Supreme Court Chief Justice John Roberts – the highest honor that a judge can receive from his peers.

Because judges in Florida are non-partisan, Judge Leifman was able to get both Democrats and Republicans in the state legislature during its last session to pass the most sweeping mental health legislation in the state’s recent history. Hopefully, his ability to work with both parties will help him if he is named and has to undergo Senate confirmation.

Let’s hope that Dr. Lieberman’s premature tweet eventually becomes reality because Judge Leifman is exactly the right leader for the Assistant Secretary job and our best hope for true reform.

The post Tweet Declaring Judge Leifman As Our New Mental Health Czar Is Premature. But Let’s Pray That He Is Selected appeared first on Pete Earley.

Virginia Attorney General Mark Herring at podium with Governor Terry McAuliffe standing behind him.  

(2-28-17) Republic Delegate Robert B. Bell from Albemarle and Democratic state Senator R. Creigh Deeds from Bath continue to demand better mental health services and protections in Virginia.

In the final hours of the legislative session Saturday night, they were able to get language passed that clarifies who is responsible for investigating suspicious inmate deaths in Virginia jails.

Their dogged, bipartisan determination should bring an end to the cowardly behavior shown by state officials surrounding the death of Jamycheal Mitchell, a 24 year-old African American whose lifeless body was found in the Hampton Roads Regional Jail in August 2015. Mitchell, who had been diagnosed with a serious mental illness, had been jailed for allegedly stealing $5.05 worth of snack food from a convenience store. A judge ordered him sent to a state hospital to be restored to competency, but his paperwork was tossed into a drawer and not found until six days after his death.

By that time, Mitchell had spent 101 days in jail. An autopsy showed he had died from a heart attack brought on by starvation. He lost 46 pounds even though he was supposedly under multiple daily checks by correctional officers and a daily health check by a nurse.

The horror of his death was compounded when state officials claimed they either did not have jurisdiction to fully investigate what happened or dodged doing a credible investigation. Instead, they happily accepted assurances from jail officials who declared themselves innocent of any wrongdoing. Not surprisingly, that internal jail probe has never been made public.

At least three state agencies and Virginia’s Governor Terry McAuliffe contributed to this debacle. They include Virginia Attorney General’s office, the Office of State Inspector General, and the disAbility Law Center of Virginia.

According to Richmond Times Dispatch reporter Sarah Kleiner, who has been relentless, along with her colleague, K. Burnell Evans, in demanding answers about Mitchell’s death, a last minute compromise was reached that will put the Board of Corrections in charge of investigating  inmate deaths such as Mitchell’s.

“I think the public was just screaming for some accountability,” the newspaper quoted state Sen. Deeds saying.

He’s right. But clarifying who will investigate suspicious deaths is not enough. State officials who dropped the ball also should be held accountable and that list includes Governor McAuliffe, Attorney General Mark Herring, and Colleen Miller, the executive director of the disAbility Law Center. Two others who were heavily criticized for their handling of the Mitchell case are no longer in charge. Jail Superintendent Col. David Simons retired and Inspector General June Jennings has been ousted thanks largely to Delegate Bell.

Incredibly, her demotion angered Gov. McAuliffe  who went on the radio to claim she wasn’t reappointed because of “sexism.”

Seriously?

According to a complaint about Jennings filed by three whistleblowers, her office did not immediately send investigators to visit the jail but instead performed a “desk review” of Mitchell’s death, relying on reports sent to her by the jail and state mental health department. In their complaint, the whistleblowers claimed that 80 percent of the Mitchell investigation was completed from behind a desk.

Not only did the governor attempt to appoint Jennings for another term, his office also dismissed the whistleblower’s complaint without ever interviewing any of the three who filed it.

And he did this while claiming in interviews that he was deeply concerned about Mitchell’s death and wanted it fully investigated.

Attorney General Mark Herring also should be embarrassed for his role in the Mitchell case. According to an April 24th article in the Richmond Times Dispatch:

“One of the state agencies charged with investigating the death of Jamycheal Mitchell in his jail cell in Portsmouth last year did not interview court employees responsible for his case because the state Attorney General’s Office intervened on the employees’ behalf.”

The disAbility Law Center, a protection and advocacy agency created by Congress to protect persons with mental disorders from being abused in institutions also should be ashamed. The best its director Colleen Miller could muster was a letter to the governor  telling him that he needed to make certain that another Mitchell-like death shouldn’t happen.

She issued her letter after declining to sign onto a letter sent to the Justice Department asking for a investigation of Mitchell’s death that was endorsed by the Virginia and national offices of the National Alliance on Mental Illness, Mental Health America, the American Civil Liberties Union, the National Association for the Advancement of Colored People and the D.C.-based Judge David L. Bazelon Center for Mental Health Law.

Because of the inept handling of Mitchell’s death by state officials, the public’s best chance of actually finding out how a person with mental illness was allowed to starve himself in jail could come when a $60 million wrongful death suit filed by the family goes to trial  (if that day ever comes) or when the U.S. Department of Justice releases its investigative report.

In a bit of good news, the state has awarded nearly $1 million to the jail to improve services at Hampton Roads. But I’m skeptical those funds would have been awarded if not for the public outcry that came only because investigative reporters from several news organization would not let this story die and advocacy groups demanded answers.

Based on their actions, it’s easy to imagine that Gov. McAuliffe, Attorney General Herring, then-Inspector General June Jennings and the disAbility Law Center’s Colleen Miller would have been satisfied accepting the jail’s internal report and avoiding any deeper probes.

Thankfully, we have Delegate Ron Bell and state Senator Creigh Deeds continuing to stand up for Virginians with mental health issues. They deserve our respect, thanks and most of all our support for being true friends of our loved ones.

The post Virginia Legislators Bell and Deeds Deserve Kudos, Governor McAuliffe, Attorney General Herring Deserve Criticism For Inmate’s Death appeared first on Pete Earley.

(3-1-17)  There’s promising news to report in Fairfax County, Va., where I live. Two peers have been appointed to important jobs and individuals familiar with mental illnesses have been named to serve on a panel that will review complaints about police actions.

Peer Jobs Filled

The Fairfax-Falls Church Community Services Board, which oversees mental health care, announced it has hired a Director of Consumer and Family Affairs, a management job specifically created to be held by a peer. That position has gone unfilled since the end of 2015 when David Mangano retired.

Facing budget cuts, Tisha Deeghan, the CSB executive director, initially had hoped to save money by dividing Mangano’s responsibilities among her top staff. But that move upset peers because none of those managers had lived experiences with mental illnesses. Peers argued that they needed one of their own in management, in part, because of the unusual nature of their jobs. Peer specialists often receive services from the CSB while working for it. That can put them in an uncomfortable position when they feel obligated to advocate for their clients against CSB decisions.  (The controversy about filling Mangano’s position ruptured feelings in the peer community, as evidenced by a still ongoing personnel dispute between CSB management and long-time peer advocate Gina Hayes.)

Director Deeghan said the CSB had hired Mark Blackwell to fill the county’s top peer job.

 Mark is a Certified Peer Recovery Specialist, a certified trainer of Peer Recovery Specialists in the state of Virginia and was highly recommended from multiple peer organizations from across the Commonwealth.  Mark holds a Master’s degree of Administration and an Undergraduate degree in Public Administration.   In addition, Mark has a graduate certificate in health services administration.

He most recently worked as a program specialist in the Office of Consumer and Family Affairs in the Dept. of Behavioral Health and Developmental Disabilities (DBHDS), in Richmond.   Prior to that, he held executive leadership level positions at Richmond Recovery Resources, SAARA of Va., and the Rappahannock Council Against Sexual Assault.  

The Community Services Board also has a new peer member after letting that position go unfilled for several months. I first worked with Daria Akers while serving on a county advisory panel and I was immediately impressed with her knowledge of our local mental health system and her skill at making recommendations based on her own experiences. In a press release posted at the time, she was described as:

A mother of two who is successfully living with Bipolar disorder. In 2010, during a manic event, she was arrested and sent to Fairfax ADC.

According to Virginia law:

One-third of the appointments to the CSB board shall be individuals who are receiving or who have received services or family members of individuals who are receiving or who have received services, at least one of whom shall be an individual receiving services.

I’m thrilled that the board now has a peer serving on it, as well as, retired Gen. Gary Ambrose, who is a family member, as its chair. There is still one vacancy on the 16 member panel.

Police Review Panel

Sharon Bulova, the chair of the Fairfax County Board of Supervisors, also announced yesterday the names of nine citizens appointed to a newly created  Police Civilian Review Panel.

The creation of a Civilian Review Panel was recommended by the Ad Hoc Police Practices Review Commission that I served on. Chairman Bulova appointed that commission after two fatal law enforcement encounters that sparked angry protests, including the death of Natasha McKenna, a 37 year-old African American with mental illness who died after being repeatedly stunned with a taser while being removed from a jail cell. 

“The Police Civilian Review Panel will promote further transparency and openness in community policing,” Chairman Sharon Bulova said.

The Civilian Review Panel will review complaints about: the use of abusive, racial, ethnic or sexual language; harassment or discrimination based on race, color, sex, religion, national origin, marital status, age, familial status, or disability;  reckless endangerment of a detainee or person in custody; and serious violations of Fairfax County or FCPD procedures.

 The Civilian Review Panel will not address potentially criminal use of force or police-involved shootings. Cases of that magnitude would likely involve an investigation by the Commonwealth’s Attorney and would be monitored by the newly hired Police Auditor, Richard G. Schott.

I am grateful that Chairman Bulova kept a promise that she made to me about appointing members to the panel who had a background or experience dealing with mental illnesses. Reports show that individuals with mental illnesses are 16 times more likely to be shot by the police and at least one fourth of all fatal police shootings involve someone with a mental disorder.

Two of the nine members have direct mental health ties:

 Jean Senseman, Lorton

Ms. Senseman is a licensed clinical social worker who has spent many years working with clients who experience mental illness, PTSD and substance use disorders. Ms. Senseman has worked in private practice providing treatment and therapy for individuals young and old who experience a wide variety of mental health disorders. Ms. Senseman taught at George Washington University Medical School and volunteers for her Condo Association Finance Committee. Previously, Ms. Senseman worked at the Woodburn Community Mental Health Center and at the Bailey’s Crossroads Community Shelter helping residents of all socio-economic backgrounds receive mental health treatment.

Rhonda VanLowe, Reston

Ms. VanLowe was appointed to the Governor’s Taskforce for Improving Mental Health Services and Crisis Response and served on the Public Safety workgroup. She has devoted much of her community service work to serving those with unique physical, mental, emotional, intellectual or cognitive backgrounds. Ms. VanLowe practiced law in law firm and corporate settings, served as Board Chair of The Northern Virginia Therapeutic Riding Program, Inc., and received the National Women of Color Special Recognition Award at the 2008 STEM Conference. Ms. VanLowe is a 36-year resident of Fairfax County and looks forward to working together with members of the Panel to develop procedures that will set the foundational tone and tenor for the work of the Panel.

 Others on the panel include:

Hansel Aguilar, Fairfax

Mr. Aguilar, originally from Honduras, investigates allegations of police misconduct at the D.C. Office of Police Complaints. Mr. Aguilar is a former police officer for the George Mason University Police Department and previously worked as a case manager and internal investigator for Youth for Tomorrow. He has served with the Vinson Hall Retirement Community in McLean and with the Fairfax County Office for Women & Domestic and Sexual Violence Services. Mr. Aguilar is bilingual in Spanish and English and believes that oversight is an important tenet of maintaining justice and equality in a democratic society.

 Kathleen Davis-Siudut, Springfield

Ms. Davis-Siudut has spent the past 15 years providing training as well policy development and implementation in the areas of sexual violence, human trafficking, and cultural diversity. Ms. Davis-Siudut is of Korean descent and has previously worked for the National Underground Railroad Freedom Center, Polaris Project, and the US Marine Corps. She currently works with the Air Force as a sexual assault prevention and response subject matter expert.

 Steve Descano, Springfield

During his six years as a federal prosecutor, Mr. Descano led numerous investigations conducted by FBI, IRS and USPIS agents. While at the Department of Justice, he analyzed documentary evidence, interviewed witnesses, and reviewed the investigatory work of agents and other prosecutors. Mr. Descano currently works as Chief Operating Officer and General Counsel for Paragon Autism Services and serves on the Criminal Justice Committee of the Fairfax County NAACP. Mr. Descano also serves on the Fairfax County Trails and Sidewalks Committee, is a graduate of West Point, and was nominated by the Fairfax County NAACP to serve on the Civilian Review Panel.

 Hollye Doane, Oakton

A Fairfax County resident for more than 30 years, Ms. Doane spent most of her career as an attorney in Washington D.C. representing an array of clients, including the National Down Syndrome Society and Down Syndrome Research and Treatment Foundation. Ms. Doane has been an advocate for the disability community for more than 20 years and understands the importance of building positive relationships between law enforcement officers and people with disabilities. Her experience as a journalist prior to attending law school gave her an appreciation for clear, timely and transparent communication between government officials and the community. After her retirement, Ms. Doane trained as a mediator and facilitator and currently serves as a lay pastoral minister in her church.

 Douglas Kay, Fairfax

Mr. Kay is a trial lawyer who has handled civil litigation, criminal defense and personal injury cases for over 20 years.  He currently focuses his practice on commercial litigation matters. As a criminal defense attorney, he has represented individuals charged with everything from simple traffic matters to the most serious felony offenses in state and federal courts. Mr. Kay previously served as a judge advocate in the U.S. Navy and Assistant Commonwealth’s Attorney for Fairfax County. A lifelong Fairfax County resident, Mr. Kay attended Fairfax County Public Schools, coaches his son’s youth basketball team, and served on Fairfax County’s Ad Hoc Police Practices Review Commission. Mr. Kay was nominated to serve on the Civilian Review Panel by the South Fairfax Chamber of Commerce and the Fairfax Bar Association.

 Randy Sayles, Oak Hill

Mr. Sayles has over 35 years of law enforcement and criminal investigations experience. He worked as a Federal Agent for the U.S. Drug Enforcement Administration (DEA), U.S. Department of Justice (DOJ), and served as a police officer for the Denver, Colorado Police Department. Mr. Sayles enjoys giving back to the community by volunteering for the Clean Fairfax Council and Creekside Homeowners Association, and was the recipient of a Fairfax County 2016 Environmental Excellence Award for removing 800 bags of trash and over 1200 illegal signs along nine miles of Centreville Road. Mr. Sayles served as a member of Fairfax County’s Ad Hoc Police Practices Review Commission and has continued to work with the Board of Supervisors and Fairfax County Police to implement the Commission’s recommendations.

 Adrian L. Steel, Jr., McLean (Chairman)

Mr. Steel served on Fairfax County’s Ad Hoc Police Practices Review Commission and has continued to work with the Board of Supervisors to implement the Commission’s recommendations. Mr. Steel has been appointed by the Board of Supervisors to serve as the first chairman of the Police Civilian Review Panel. Mr. Steel has demonstrated extensive knowledge and a strong commitment regarding 21st Century police policies and best practices, including civilian oversight. Mr. Steel currently works as a senior counsel at Mayer Brown LLP where he has practiced law for over 35 years, and previously served as Special Assistant to FBI Director, William H. Webster.

The post Top Peer Hired In Fairfax County: Police Panel Also Gets Members With Mental Health Experience appeared first on Pete Earley.

(3-6-17) While serving as the grand marshal of NAMI Collier County’s walk, I was told that Naples, Florida is in the formative stages of opening “Jerry’s House” for persons with mental illnesses.

It will be based on “Dave’s House” in Orlando that was founded in 2009 by Lin and Ron Wilensky, to help others in the world such as Lin’s brother, Dave, who suffered from schizophrenia.

And what inspired the Wilensky’s to begin “Dave’s House.”

That’s right, it was “Laura’s House” that was purchased in 2006 by the Brain Foundation in Fairfax, Va., a non-profit  founded by Trudy Harsh. The house is named after her daughter, Laura.

This is what happens when one determined advocate (Trudy Harsh) inspires two other dogged advocates (Lin and Ron Wilensky) who then inspire the folks in Naples to follow the Dave’s House model.

I’ve written about Trudy’s Harsh and the Wilensky’s before, but if you aren’t familiar with Trudy’s inspiring story, let me share it with you.

Trudy’s daughter, Laura, developed a brain tumor when she was eight years old. Doctors at Georgetown Hospital in Washington D.C. were able to remove it, but they warned Trudy that Laura would only live for six more years at best. 

As often happens to persons who undergo traumatic brain injuries or have parts of their brain removed, Laura awoke from her surgery a completely different person. She was not the bright, sensitive and loving child to whom Trudy had given birth. The parts of her brain that controlled her emotions, especially anger, had been destroyed.

Doctors tried, of course, to use medications to help Laura control her moods, but neither she or her family were able to return to their former lives. Laura was disruptive in school and got into fist-fights with other girls. With an uncontrollable urge to eat, she packed on weight. One day, she was caught at school digging through garbage cans for food. Her Individualized Education Program (IEP) noted that she could not pay attention for longer than three minutes in a classroom.

Laura did not die, as predicted, and when it became clear to Trudy that Laura could no longer attend public schools or live at home, she arranged for her daughter to enter a residential school near Atlanta and later another cutting-edge school in Denver. At age 21, Laura returned home and was able to graduate from Chantilly High School here in Fairfax.

But brain injuries, much like mental illnesses, do not simply go away with time.

Laura continued having violent outbursts and emotional stability problems. Her obesity caused her a myriad of health problems

Trudy wanted her daughter to live as full of a life as possible — despite her brain injury — so she got Laura enrolled in an apartment program in Fairfax County, overseen by the county’s mental health services board.

CAUGHT IN VICIOUS CIRCLE

Mother and daughter soon found themselves caught in a vicious circle. Trudy would fight to get Laura into an already overwhelmed and under-funded program, only to have her get expelled for violent behavior. When Trudy exhausted what Fairfax County had to offer, she went to other jurisdictions and even other states. She was determined that her daughter would not become homeless.

Sadly, Laura never did find a suitable program and she died from health complications living at home with her mother. Laura was 38 years-old.

In her quest to help her daughter, Trudy became a tireless advocate. She volunteered to serve on committees, went to public hearings, read report-after-report, and became totally frustrated with a bureaucratic process that seemed more interested in publishing studies, filing complaints, and talking endlessly about what to do, rather than actually doing anything.

So Trudy struck out on her own.

Luckily, she had her real estate license and understood mortgages, loans, and federal housing programs, so Trudy founded “The Brain Foundation” and began hosting fund-raisers to get enough money to buy a house — just one house — to help persons who had mental illnesses.

Although a tumor caused Laura’s brain injury, her mother didn’t see any difference between brain damage caused by surgery and brain damage caused by mental illnesses. After all, she said, the brain was just another organ and what did it matter whether it got damaged during surgery or by disease?

Hosting parties in her home and asking friends for contributions did not raise enough cash for Trudy to buy a house in the Washington D.C. area market — one of the most expensive in the nation.

Trudy did not give up — the need was too great.

According to a story in The Washington Post, someone with a mental illness could wait up to 18 years before an apartment or group home had an opening.

Trudy approached Wilbur Dove, an entrepreneur who was running his own nonprofit housing group and he agreed to seed her project with $50,000. Trudy used that $50,000 to obtain a $450,000 loan from the Virginia Housing Development Authority, which she spent to buy a four-bedroom townhouse in Fairfax County.

Once she had a house, Trudy cut through red-tape and got Pathway Homes, which provides residential care for persons with mental illness, to move four men into it. Pathway agreed to manage the property and keep track of its tenants, who pay 30 % of their income as rent.

Thus, the first “Laura’s House” was opened. For most people that might have been enough, but not for Trudy. She continued raising money through grants and donations, and buying houses. It has not been easy. In a short sighted move, the Fairfax Board of Supervisors refused to offer the Brain Foundation a property tax break, charging it thousands of dollars for doing what the county failed to do – provided decent housing. But Trudy found a way to keep going.

Today, the Brain Foundation operates nine houses in Fairfax.

OTHER HOUSING ADVOCATES

Early on during my travels, I discovered that a determined member of NAMI developed a housing program in Delaware. More recently, one of my favorite advocates in Pinehurst, Marianne Kernan, opened  Linden Lodge, a 1970’s rambler that was turned it into a seven bedroom residential facility with a garden and a multi-use building for art, music therapy, physical fitness activities and peer support group meetings. Six residents live in the debt free house. The Linden Lodge Foundation accepts no state or federal money.

I often hear people say, “What can I do, I’m only one person?”

I’m glad that Trudy Harsh, Lin and Ron Wilensky in Orlando, the folks who are launching “Jerry’s House” in Naples and Marianne Kernan in Pinehurst answered that question with action, not words.

The post An Idea In Va., Inspires A Couple In Orlando, Who Inspire Advocates In Naples: How Good Ideas Spread appeared first on Pete Earley.

(3-8-17) I don’t like simply reprinting articles, but sometimes I read a story that needs to be widely shared. My former employer has published two such pieces this week. Here’s the first of two.

At the Odessa Gun & Pawn shop, Weathers approached a manager: “Something like what I bought last time.”

The post “I’m begging you as a mother, if she comes in, please don’t sell her a gun.” appeared first on Pete Earley.

(3-9-17) This is the second article from The Washington Post that needs to be shared. It says much about how society devalues the worth of people who are different. Shameful!

Paul Corby, 27, who is autistic and suffers from several psychological conditions, was rejected for a heart transplant by the University of Pennsylvania Health System. (Karen Corby)

By Lenny Bernstein published in the Washington Post on March 4, 2017 

Paul Corby needs a new heart. On that there is no dispute. The same rare disease that killed his father at 27 is destroying his left ventricle. While there is no cure or surgery that might repair the damage, a heart transplant could extend his life considerably.

But Corby, who lives in Pottsville, Pa., is autistic, suffers from several psychological conditions and takes 19 medications. When he applied to the transplant program at the University of Pennsylvania in 2011, he was rejected because of his “psychiatric issues, autism, the complexity of the process . . . and the unknown and unpredictable effect of steroids on behavior,” according to the denial letter sent to his mother.

“I couldn’t even believe this would happen,” Karen Corby said, “that this would be the reason in this day and age.”

In fact, mentally disabled people are turned down for organ transplants often enough that their rights are a rapidly emerging ethical issue in this corner of medicine, where transplant teams have nearly full autonomy to make life-or-death decisions about who will receive scarce donor organs and who will be denied.

Beyond some restrictions imposed by laws such as the Americans With Disabilities Act, the doctors, nurses, psychologists and social workers at 815 U.S. transplant programs are free to take neurocognitive disabilities such as autism into consideration any way they want.

 As a result, there is wide variation from program to program. Some teams weigh mental and psychological issues heavily in deciding whether someone should be eligible for the precious gift of a heart, liver, kidney or lung. Others do not. A few even admit that they automatically rule out people with certain disabilities. Some patients are rejected at one medical center but accepted at another.

“As a society, we want individual transplant centers to maintain discretion about putting people on their list or not. We don’t want government playing doctor at the bedside,” said Scott Halpern, an ethicist at the University of Pennsylvania medical center that rejected Corby. “Having said that, the current system lacks the accountability that we might wish it to have. There are virtually no checks and balances on the decisions that transplant centers make.”

When David Magnus, director of the Center for Biomedical Ethics at Stanford University Medical School, surveyed 50 pediatric heart, liver and kidney transplant programs in 2008, he found that 39 percent rarely or never considered neurodevelopmental delays in deciding whether to list someone as eligible, and 43 percent always or usually did. The results also varied depending on whether the disability was moderate, severe or profound and which organ was being transplanted.

“It does appear that the programs use this psychosocial criterion to distinguish among candidates, although consensus does not exist within the field to guide its usage,” the researchers wrote in the journal Pediatric Transplantation.

Some efforts are underway to change that.

Congress tries to end discrimination 

In October, 30 members of Congress called on the Department of Health and Human Services’ civil rights office to issue instructions that discrimination in organ transplantation violates the Americans With Disabilities Act. They also want the agency to tell transplant teams to account for a disabled person’s support system in deciding whether he or she will be able to stick to a postoperative health-care regimen, which is typically a factor in evaluating patients for a transplant.

An HHS spokesperson said in a statement that the agency is working “to clarify the obligations of covered entities participating in the transplant process and to provide equal access to their programs to individuals with disabilities.”

Four states have passed laws containing similar restrictions. In Pennsylvania, State Sen. John Sabatina (D) has introduced “Paul’s Law,” an attempt to outlaw discrimination in transplant decisions that is named after Corby. And Halpern suggested in the New England Journal of Medicine last month that regional panels should be established to adjudicate disputes over eligibility for a transplant.

When a doctor determines the need for a transplant, patients generally approach the nearest medical center that performs the operations. (Shopping for the best location is not unknown, however, and some people with the resources to quickly get to almost any center when an organ becomes available can be listed at multiple places.) Once eligibility is established, a potential recipient is registered on the waiting list controlled by the United Network for Organ Sharing, a nonprofit organization that contracts with the government to distribute organs.

Though more transplants were performed in 2016 than ever before, available organs are still in drastically short supply. More than 118,000 people are waiting for hearts, lungs, kidneys, livers and other organs. Many wait for years, and 22 people on the list die each day without receiving a transplant.

Deciding who is eligible for an organ can be a wrenching process for the transplant teams at each medical center, experts said. Beyond medical issues, teams assess anything that might influence a transplant’s success or failure — drug and alcohol use, smoking, family support, ability to pay medical bills, the patient’s likelihood of taking immunosuppressant medications faithfully and many other factors.

Experts cautioned that individual decisions often are much more complex than they may seem because teams have access to personal information that is not apparent to outsiders.

But human bias is inevitable. In a much larger survey of adult and pediatric transplant programs that is still being compiled, Magnus and his colleagues have found significant differences in eligibility decisions based on intellectual disability and genetic disorders such as Down syndrome. They also discovered wide variation based on factors such as HIV status and whether an applicant is undocumented.

Teenagers, noted Arthur Caplan, director of medical ethics at the New York University School of Medicine, fare more poorly than adults in transplant outcomes because of the rebelliousness of that age group.

“Yet we don’t exclude them,” he said. “Society’s message has been — whether it’s building a kneeling bus or a ramp at the library or mainstreaming a kid at school — try to do what you can to integrate.”

Bias Seeps In To Decision Making 

People with intellectual disabilities, however, have long fought the belief that their deficits mean their lives are less meaningful than those of non-disabled people. That bias seeps into transplant team decisions, said Samantha Crane, director of public policy for the Autistic Self Advocacy Network.

“They’ve often been steeped in a very medicalized view of disability, in which they see people with disability having a lower quality of life,” she said. “And that’s not true.” The group believes that intellectual disability should never be used as the sole reason to deny a transplant and wants to require transplant decision-makers to consider patients’ support networks when they decide eligibility.

There is little data on transplant outcomes among the cognitively disabled, but the available information shows that they generally fare as well as non-disabled people in the years after surgery.

Paul Corby’s case shows how ethically complex these decisions can be. In addition to his autism and heart disorder, which is a form of cardiomyopathy, Corby suffers from anxiety and other psychological difficulties, according to his mother. As a teenager, he was diagnosed with a mood disorder and impulse-control disorder, according to a letter from his psychiatrist that recommended him for a transplant, which added that he had recovered significantly from mental and emotional disturbances.

At nearly 28, Corby carries a Princess Peach doll wherever he goes. He requires some supervision by other adults. He is prone to occasional outbursts that have created conflict with a neighbor and has moved in with an aunt and uncle a mile from his home.

Yet he manages his medication himself, writes fiction and functions independently much of the time. He communicates well. In the letter, his psychiatrist said “there is no clinical reason why he would not benefit from cardiac transplant” and noted the strong support Corby receives from his family.

“I cut down on the junk food. I use the treadmill. I don’t smoke. I don’t drink alcohol. I don’t chew tobacco,” Corby said in a telephone interview. But the transplant team members who declined to deem him eligible “didn’t care” about his efforts, he said, suggesting it was inappropriate for him to carry a doll and expressing concern that he couldn’t name all 19 of his medications, he said.

The University of Pennsylvania Health System declined to make anyone available for an interview but released a statement from Susan Phillips, Penn Medicine’s senior vice president for public affairs, that said, in part:

“When individuals are referred for transplant evaluation here, all aspects of their medical status are reviewed. This may include the potential impact of other existing health problems on the success of the surgery itself, and the potential interaction between a patient’s existing drug therapies and the drugs that would be necessary to stop transplant rejection. Given the criticality of post-surgery care following any solid organ transplant, the patient’s support system is also taken into account. . . . The ultimate decision about whether transplant surgery is appropriate is, of course, made on an individual basis.”

Corby and his family maintain that the denial was unjust. “It’s insane. It’s crazy,” he said. “I thought that was illegal.”

 

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(3-13-17) What are we to think about Pennsylvania Republican Rep. Tim Murphy’s vote last week in the House Energy and Commerce Subcommittee to repeal the Affordable Care Act?

Ever since the Sandy Hook Elementary School shootings in 2012, Murphy has been a Capitol Hill champion for individuals with mental illnesses and their families. His dogged determination lead to passage of the Helping Families in Mental Health Crisis Act during the lame duck session in December, a major reform of mental health laws.

Yet last week, he voted along partisan lines to reject Obamacare – a move that every, yes, every major mental health organization strongly opposes.

The Republican’s repeal legislation as currently written will end Obamacare’s Medicaid expansion, which covers 1.2 million Americans with serious mental illness and substance abuse problems, as well as, scrap baseline coverage requirements. It also will do damage to mental health parity. These changes mean certain beneficiaries will no longer get coverage for mental health and substance abuse treatments guaranteed under the Affordable Care Act.

There are Republicans resisting Trump Care. Four Senate Republicans told Politico’s Brianna Ehley that they are deeply concerned about their party’s American Health Care Act (AHCA), which will replace Obamacare. In a letter to  Senate Majority Leader Mitch McConnell, they declared  “reform should not come at the cost of disruption in access to healthcare for our country’s most vulnerable and sickest individuals.”

Senator Chris Murphy (D.-Conn.), who championed the Senate version of  the Helping Families In Mental Health Crisis act, predicted dire consequences in Politico if the Medicaid expansion is ended.

“Emergency rooms better start staffing up because their psychiatric units are going to be overflowing.”

Here’s what mental health groups have said about the Republican’s legislation.

The Nation quoted Andrew Sperling, the legislative director for the  National Alliance on Mental Illness  saying:

Though it is unclear what parts of the ACA might be repealed, if the 20 million people who benefited directly from Obamacare lose coverage, mental-health patients would suffer because “there would be fewer plans out there that would be required to comply” with essential-benefit mandates. Parity for zero is still zero. “Obviously, if you don’t have a health plan, you can’t be in compliance with parity.”

In a letter to the House,, NAMI’s executive director Mary Giliberti wrote:

The proposed reforms in the AHCA threaten to undermine the historic progress being made to improve mental health and substance use care… NAMI is deeply concerned with proposed provisions to convert Medicaid financing into a per capita cap model…Current estimates are that the per capita cap provisions would shift an alarming $370 billion in Medicaid costs to states over the next ten years. In the face of budget shortfalls, states will be forced to cut people from coverage, reduce health benefits and access to care, and/or reduce already low provider payments, escalating our nation’s healthcare workforce crisis…

Politico quoted Chuck Ingoglia, senior vice president of public policy at the National Council for Behavior Health saying:

“We are really worried about its implications for people living with mental illness and addiction issues.”

In an action alert sent to its members, it noted:

The (Republican bill) contains provisions that, if enacted, could devastate Americans’ mental health and addiction coverage and care.

Mental Health America’s President Paul Gionfriddo was more blunt. He said a full repeal of Obamacare  “would be akin to Armageddon” for people with mental illness.

The Treatment Advocacy Center noted in a release:

The (Republican) bills would disastrously eliminate mental health as an essential health benefit from Medicaid, and with it the requirements to provide parity between mental health and other medical and surgical benefits… Experience shows us that without access to appropriate care, these individuals often end up receiving more expensive and less therapeutic care — provided by crisis centers, emergency rooms, homeless shelters and jails.

The American Psychiatric Association said in a release:

The American Psychiatric Association (APA) is deeply concerned that the proposed ACA replacement released last night will negatively impact care for people with mental illness and substance use disorders. ..As efforts are made to reform the health system, services for people with mental health and substance use disorders – and their families – must be maintained.

And the list of concerned group goes on-and-on, but wait, there is one organization that deserves special notice. Here is what the American Psychological Association said in a release:

The American Psychological Association voiced serious concern regarding the bill to repeal and replace the Affordable Care Act, arguing that it would reduce mental health and substance use coverage for millions of Americans enrolled in Medicaid and contribute to the loss of coverage for millions more individuals…An estimated 11 million Americans with incomes below 138 percent of the federal poverty level currently have coverage for mental health and substance use disorders, provided at parity with coverage for general medical services through Medicaid expansion plans. The current bill, called the American Health Care Act, would remove the requirement that Medicaid benchmark plans cover essential health benefits, which include mental health, substance use and behavioral health services.

Why is the APA’s concern worth noting?

Because on Friday — two days after he voted to repeal Obamacare in the House subcommittee – Rep. Murphy was honored by the APA for his “advocacy work and legislative accomplishment on mental health issues.” It presented him with the 2017 Outstanding Leadership Award, “given annually to the member of Congress who has done exceptional work on behalf of professional psychology.”

Much to his credit, Rep. Murphy did offer an amendment to the Republican legislation at the subcommittee hearing that would have protected mental health “parity” meaning that mental disorders had to be treated by insurance companies the same way physical health issues are addressed.

It was a bold and brash thing to do because Subcommittee Chairman Greg Walden (R.-Oregon) had said that he didn’t want any Republicans monkeying with the Republicans’ efforts to repeal the Affordable Care Act.

Before the final vote was taken, Rep. Murphy withdrew his amendment and all efforts by Democrats to protect parity were rejected by the Republican seven subcommittee member majority.

Rep. Joe Kennedy 111 (D.-Mass.) zeroed in on parity in the subcommittee hearing. His cousin, former Rep. Patrick Kennedy (D. R.I.), largely drafted and shepherded parity through Congress when he was in office.

The following exchange was between Kennedy and an attorney explaining the Republican legislation.

Kennedy: “Question for the legislative council, just to make sure I fully understand it. Based off of what you were saying, sir, – I understand the fact that this law does not impact mental health parity – but it was the combination of mental health parity and the ACA that included mental health benefits as part of the essential health benefits package. The parity just says if you offer mental health benefits, they have to be offered the same way that physical health benefits are —  it does not mandate the offering of mental health benefits.

With the combination of the repeal language that we see on page 8, it means that mental health benefits are not required now, by federal law — that it would be up to the states to actually impose, so when we look at those essential health benefits, whether it’s mental healthcare or potentially for other health conditions, that is no longer essentially covered, or required to be covered by this version of this text, is that not correct?”

Attorney: “The text before us does remove the application of the central health benefits for the alternative plans in Medicaid.”

Kennedy: “It does remove them — including mental health. Yes, thank you.”

Kennedy then made this statement:

 

The post Guess Who Voted In Favor Of Bill That Every Mental Health Group Claims Will Put Millions At Risk? appeared first on Pete Earley.

(3-17-17) My Monday blog, which questioned why Rep. Tim Murphy voted along party lines in support of replacing Obamacare with the Republicans health bill, didn’t sit well with the Pennsylvania Republican. Every major mental health group is opposed to the Republican plan because it will end Obamacare’s Medicaid expansion, which covers 1.2 million Americans with serious mental illness and substance abuse problems, as well as, scrap baseline coverage requirements. I am printing Rep. Murphy’s response to the criticism that he has received. It was first posted in The Hill newspaper on Thursday and also sent to me. Early today, the Hill published a response to Rep. Murphy’s. Tim Murphy – Republican Health Bill Fails People With Mental Illness was written by Dr. Richard G. Frank, PhD, the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. Here are the pro and con.)

Transforming Mental Health & Addiction Treatment: We’ve Only Just Begun

By Rep. Tim Murphy

As Congress delivers on the promise of delivering relief from the collapsing Affordable Care Act (ACA), we must be forward thinking and avoid re-purposing yesterday’s failed policies to solve today’s problems. In particular, we must include better strategies to advance mental health and addiction treatment.

While promising mental health and addiction insurance coverage, the ACA did little to provide real medical models of treatment for those suffering with mental illness and addiction. The evidence is staggering: skyrocketing rates of suicide and drug overdose deaths are now at all-time highs. 
 
Sadly, only lip service was paid to behavioral health by the previous administration’s whose agenda furthered the familiar pattern of limiting access to treatment, casting millions to the shadows of our healthcare system and dragging their feet on the implementation of mental health laws.

In a calculated move to save money in the Medicare program, the Obama administration attempted to strip the protected drug class status for life-saving psychiatric medications.

Following outrage from advocates and an explosive exchange I had with former CMS Deputy Administrator Jonathan Blum at an Energy & Commerce hearing, the cruel effort was abandoned. But the point was clear: mental illness remains a disease considered less important than physical disease.

In like manner, mental health and addiction coverage parity took a backseat. 
 
After a long-fought battle in Congress, President Bush signed the Mental Health Parity and Addiction Equity Act into law in 2008.

However, not until 2013 would the Obama administration implement parity, leaving millions of Americans with behavioral health conditions still fighting the insurance industry years after the bill was signed into law.

While the Health and Human Services Administration was churning out ACA-related regulation after regulation, Americans in mental health and addiction crisis were treated as second-class citizens.

The narrative regarding parity and mental health and addiction coverage under the ACA is frustratingly false.

The Congressional Research Service, the Library of Congress’s nonpartisan research arm, confirmed the ACA, “did not modify or expand the federal mental health parity requirements.”

And state expansion of Medicaid simply resulted in many governors switching out state dollars for federal dollars.  

The National Alliance on Mental Illness noted in a 2015 report: “Both Ohio and Michigan, who expanded Medicaid by executive order, largely folded mental health services into Medicaid funding.”

With cuts to state mental health budget, however, advocates in both states are concerned that neither Medicaid nor the mental health system will meet the needs of individuals who remain uninsured and hard to reach.

House Republicans are offering a better way for health care with the American Health Care Act (AHCA), a law crafted with determination and thoughtfulness to further mental health and addiction treatment.

During the markup of the bill last week, questions were raised about the provision which sunsets the Essential Health Benefits for Medicaid Alternative Benefit Plans (ABP). While some criticize this as a cut to mental health and addiction treatment, a closer look reveals the truth.
 
Under the AHCA, states are free to cover mental health and addiction treatment in their plans. If they do, existing parity laws – which I helped write – require mental health benefits to be provided at the same level, or “at parity,” with medical and surgical coverage in that same plan.

Beyond that, states have $100 billion from the Patient and State Stability Fund to provide treatment for behavioral health and addiction.
 
Either way, patients will be provided robust mental health benefits with greater flexibility and in a more effective way. Consider, states such as Pennsylvania and West Virginia, hit particularly hard by the opioid epidemic, might decide to cover addiction treatment differently than Wyoming and Alaska, states experiencing the highest rates of suicide in the country.

States know best, and a patient-centered system is the solution.
 
This is not a partisan battle. Our nation wants, and deserves, a system that works. The AHCA preserves two critically important components from the ACA for those with mental health diagnoses: the coverage of pre-existing conditions, including behavioral health conditions, and allowing young adults to stay on their parent’s health insurance until age 26 (75% of all lifetime mental health conditions onset before the age of 24).

Last session of Congress, Republicans stepped up to reform our nation’s broken mental health system. In his first interview as Speaker of the House, Paul Ryan told 60 Minutes that mental health reform was at the top of Washington’s “to-do” list. Months later, we delivered on that promise with the passage of the Helping Families in Mental Health Crisis Act, signed into law last December as part of the 21st Century Cures Act.  

But more work remains.

With a critical shortage of psychologists, psychiatrists and behavioral health workers, our outdated laws prevent access to real treatment. As a result, each year 350,000 Americans die of their mental illness.

We can and will do better.

Republicans will step up again to address the issues that the Obama administration overlooked in their failed health care reform endeavor, putting forth a health care plan that goes further than the current law to help families in mental health crisis. As we do, I will continue to roll out legislative solutions to provide treatment before tragedy.

We’ve only just begun.

Tim Murphy — Republican health bill fails people with mental illness

Representative Tim Murphy (R-Penn.) is correct in writing that helping people with mental illness is not a “partisan battle.”  But we know he is someone who cares about this issue enough to realize this debate must be rooted in facts. The recent article Murphy penned for The Hill offers views that are at odds with basic facts and reality.

We think it is important to hold up some of the claims “of failed policies” in Congressman Murphy’s letter against the facts so that a more productive discussion of behavioral health policy can result. Moreover, the “better way” he argues that is offered by the American Health Care Act would make matters worse, not better, for the populations he champions.

Parity legislation and regulation: At the end of January 2010 the Obama Administration issued Interim Final Regulations for the Mental Health Parity and Addictions Equity Act. Those regulations had the force of law and covered the vast majority of points that appeared in the final regulations of 2013.

 Moreover, starting in 2010 the administration trained Department of Labor inspectors and state insurance commissioner staff on the regulations in order to support enforcement and technical assistance efforts.  The parity regulations improved the coverage for 103 million people starting in 2010.

The Affordable Care Act extended insurance coverage for mental health and substance use disorder treatment by including mental health and substance use disorders services as Essential Health Benefits that must be offered in the individual, small group and Medicaid expansion markets.

The ACA also extended the reach of the parity legislation supported by Congressman Murphy to require parity in individual, small group and Medicaid expansion coverage. The result was to expand coverage and the quality of coverage to about another 70 million people. Thus the total numbers that saw their coverage for behavioral health care improve was over 170 million. This is not exactly relegating behavioral health in the back seat.

The result of the efforts to expand and improve coverage was that about 1.84 million low people used services paid for through the Medicaid expansion and the Health Insurance Marketplaces. That directed estimated $5.5 billion new dollars annually towards treatment of behavior health conditions.

This is roughly five times the size of new spending called for in the 21st Century Cure Act that represented an historical increase in spending on substance use disorders.  The well-being and support for people with mental illnesses and substance use disorders will not be advanced by the American Health Care Act that would result in a loss of insurance coverage for 24 million Americans many of who suffer from these illnesses (an estimated 29p percent). Nor will taking away $5 billion in treatment resources from the nearly 2 million people in treatment today improve the mental health of the nation.

Finally, claiming that the opioids epidemic reflects a simple failure of behavioral health policy of the last administration ignores the data on the trends in drug overdoses. The graph shows that the growing overdose problem pre-dates President Obama’s election.  The trend data shows that the epidemic dates back to the Clinton and Bush administrations and is not the work of recent policy.

The loss of coverage for substance use disorder treatment that the American Health Care Act would cause would take away tools for fighting the opioid epidemic at a time they are badly need. Turning this on-going and changing national tragedy into a reflection on the important gains made over the last 10 years is a disservice to the importance of the challenge we must face together; we know that Congressman Murphy can do better.

Dr. Richard G. Frank, PhD, is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. From 2009 to 2011, he served as the deputy assistant secretary for planning and evaluation at DHHS directing the office of Disability, Aging and Long-Term Care Policy. Dr. Sherry A. Glied is the Dean of New York University’s Robert F. Wagner Graduate School of Public Service and former Assistant Secretary for Planning and Evaluation in the U.S. Department of Health & Human Services.

The post Rep. Murphy Rejects Criticism For Backing Republican Health Bill, Claims It Will Improve Healthcare, But Harvard Doc Disagrees appeared first on Pete Earley.

(3-20-17) The mother spoke clearly and with a sense of urgency and fear in her voice.

“Our son has late occurring Schizoaffective disorder which began to be evident seven years ago. He is now 46.

Before he became ill, he graduated from Clemson University and worked in a responsible position. Since 2010, our son has been through a list of events that include being incarcerated, 90 days of rehab, hospitalization twice and consistently suffering from the side effects of his medications. 

However, he has worked hard to become stable and after two years of treatment, he became stable. This was most notable during the presidential election as he remained focused on the candidates, asked questions and actually voted.”

Her voice was followed by a letter from another concerned parent.

“We have a 34 year-old son, Mariano, who was diagnosed with schizophrenia in 2006. As you can imagine this has brought a lot of suffering, especially to him. He has been under the care and supervision of very competent doctors. But, medical care is only a portion for his wellness. Family and community support are also indispensable to establish a purpose in my son’s life and in the lives of individuals like him.

He is now in a program that offered and still offers him the possibility to relearn and retrain the skills and behaviors that the illness took away. His improvement is shown week to week. And that improvement doesn’t occur only because of the medications, it also comes because of the dedication and knowledge of the counselors helping him… Thanks to their almost individualized attention- there are 4 to 6 clients per group- my son has improved significantly. He realizes he is setting goals that can be attained, even though they will take time, but he is learning to veer all of his energy towards his own betterment.

Why, both women asked, is the county about to close down a program that is helping their sons’ recover from the terrible spiral of debilitating mental disorders? Why is there no money? Why is this particular program that has proven to be effective being terminated?

These mothers are demanding answers from elected officials in Fairfax County, Virginia, where I live, but these same questions are being asked across the nation at budget times because of a lack of public funds for mental health and substance abuse care.

This is not a new dilemma. It is as old as mental illness itself and it is about to get worse. Those who are the sickest of the sick often are in treatment programs that are the most expensive because they require more intensive services. This often makes them the first to be cut because there are fewer parents and patients impacted — meaning it is politically easier to ignore them. Often, it is these people who end up caught in a vicious cycle of streets, jails and/or prisons.

The service in Fairfax that faces elimination is called the Community Readiness and Support Program better known as CRSP.

CRSP has a ratio of counselor to clients or 1 to 3 or 4. In order to save funds, the Falls Church-Fairfax Community Services Board (CSB), which oversees mental health and substance abuse issues, has proposed sending the 32 clients receiving services through CRSP into a similar but not as intense program. That will save approximately $373,303 by cutting four staff position.

The CSB argues the 32 clients can be absorbed by the Psychosocial Rehabilitation Services, Inc. (PRS) program run by a private contractor without additional cost. PRS has a ratio of one worker for 20-25 clients. Much of its focus is on preparing clients for jobs, but the complaining parents claim PRS clients are not as sick as their sons and daughters who need more specialized care.

The PRS does not have a nurse on staff.  In the past, several CRSP clients who were moved to PRS programs have not done well.

“They had to return to CRSP when their mental health deteriorated. There are clients at CRSP who cannot be serviced by PRS. One client is deaf and the other one is on oxygen. What will happen to these clients and others like them in the future when there is no CRSP to take care of them?… As one client stated, ‘Before CRSP, I was constantly being hospitalized. Since my years in CRSP, I have not been hospitalized even once…Two residents…who were PRS clients were sent to CRSP because they have medical and mental disabilities that PRS could not service.”

The parents have been lobbying the Fairfax County Board of Supervisors which oversee the country’s spending to continue funding the CRSP program. In a meeting with Board of Supervisor John Foust, the parents noted that studies done in 2006 and 2011 both concluded that moving the CRSP clients to PRS program “would not be cost effective…We have had no guarantee from PRS that they will take all the CRSP clients and change their large group setting to accommodate the CRSP client needs. Finally, PRS has continued to return clients to CRSP because they were not able to service these clients.”

The CRSP backers argue there has not been a cost-analysis done that will show shifting the CRSP clients to PRS services actually will save money. In fact, they insist shifting CRSP clients could put the community at greater risk and ultimately cost more money because of additional hospitalizations and possible arrests.

The cost of jailing someone in Fairfax is $50,000 per year. Those with severe mental illnesses  traditionally cost two to three times more than others when incarcerated in jails. The cost of a night in a hospital is more than $1,200 per night. Remember Million Dollar Murray? His untreated mental illness cost the city of New York a million dollars a year in other services. The Perryman Group in Texas found that for every dollar spent on mental health care, the state saved seven dollars.

The CRSP backers told me:

“Supervisor Foust quickly zeroed in on exactly our concern.  How is it possible that moving CRSP clients to PRS will not lead to additional costs?  Foust is very familiar with PRS and questions CSB’s statement about cost savings.  He seemed to agree with us that it is disconcerting that CRSP is being closed without a cost analysis… I am more and more convinced we must save CRSP.  It gives hope to those who have lost all hope.  They are the forgotten ones.”

The parents of CRSP clients have been meeting individually with the county supervisors. That’s how democracies work.

They will be speaking to the full CSB board meeting March 22 at 5 pm at the Merrifield Center located at 8221 Willow Oaks Corp. Drive, Fairfax, VA level 3 Room 409A and they will appeal to the full Board of Supervisors April 4th during a budget meeting, at 12000 Government Center Parkway, Fairfax, VA 22035. They asking others to attend and call 703-324-3151 to speak against closing the CRSP program.

But they face an uphill battle.

CSB Executive Director Tisha Deeghan has met with the parents and is sympathetic to their cause. She and her assistant Daryl Washington did not become mental health professionals to turn away people who are sick and require care.

But they have been given a budget and the county and the state legislature have set priorities.

Diversion First, a program that I personally have been fighting in favor of for years to get Fairfax to implement is one of them. Unfortunately, it only became a priority after Natasha McKenna, a young mother with schizophrenia died after being repeatedly stunned with a taser in our local jail. Programs that divert individuals from jails into community treatment have proven to save money.

But they cost money to implement and the money they save doesn’t necessarily flow back into Deeghan’s budget.

The state also has ordered the county to set aside funds to stem our growing opioid crisis that is expanding the pool of county residents who didn’t previously need services.

Next comes supportive housing. It is estimated that 30,000 individuals living in Fairfax County need supportive housing and many have mental health and substance abuse issues. How can anyone get better if they are living on the streets or incarcerated?

Also, Deeghan’s department has new, legally mandated responsibilities to implement a system of services for people with developmental disabilities, traditionally funded through Medicaid waivers.

Fairfax voters rejected a meals tax that the Fairfax Board of Supervisors said was needed to fund additional community services. Other budget starving groups are demanding funds. Teachers are fleeing because they haven’t gotten raises and their salaries are falling below other counties. Roads need repairs. The police need money too.

Virginia refused to become a Medicaid expansion state and that cost it millions in potential federal  funds that could have helped insure individuals with mental disorders. More cuts will be coming under the Trump administration’s plans to scale back services.

And no one likes tax increases.

So what happens to the 32 severely ill sons and daughters who can be helped, who can recover, who can lead promising lives and ideally get jobs and pay taxes?

A friend once told me: “Whenever we put dollars above helping people in our communities to live with a certain amount of human dignity, I believe we lose something of our own humanity.

If one of those 32 individuals in the CRSP program were your son or daughter, how would you feel?

Do not even the “forgotten” deserve our mercy?

The post What Are 32 Lives Worth? What’s The True Cost Of Not Helping Them? appeared first on Pete Earley.

(2-22-17  The National Alliance on Mental Illness has asked its members to contact their U.S. Representatives and Senators and ask them to vote against repealing the Affordable Care Act on Thursday.

In a message sent to its members and leaders, the national office wrote:

One in five Americans experiences a mental health condition, but only half get needed treatment. Coverage for mental health care helps people get treatment when they need it, helping them to stay in school, on the job and in recovery.

But the American Health Care Act (AHCA) would reduce funding for health coverage–from insurance plans to Medicaid–and put mental health care at risk. It caps Medicaid funding, which will lead to deep cuts and jeopardize mental health services.

Tell your U.S. Representative this is unacceptable.

The request by the nation’s largest grassroots mental health organization includes a form that can be easily filled out. I’ve posted NAMI’s rationale at the bottom of this blog.

The clamor in the media about whether President Trump can corral enough Republican votes to secure passage of his bill reminds me of when I was a young reporter on Capitol Hill and the Carter administration was rallying support for its Panama Canal treaty that many saw as the U.S. giving away the canal that it had built.

Just like now, there were many representatives saying they were not certain how they would vote. What I later learned is that most of them actually had made up their minds, they simply knew that if they voted with the President, many of them would risk being booted out of office because they came from districts that didn’t support Carter’s treaty.

Consequently, they were waiting to see what the White House would be willing to give them in the way of pork federal projects in return for a vote.

I suspect some of the jockeying going on is about trade offs. It is how Washington works.

One difference in the Republican bill is that it will give control on mental health dollars back to the states through community block grants. This was the same rationale that was used when President Ronald Reagan pushed through the Omnibus Budget Reconciliation Act that repealed Carter’s community health legislation and established block grants for the states, ending the federal government’s role at the time in providing services to the mentally ill.  Federal mental-health spending decreased by 30 percent.

Just another memory from the past.

Regardless of how you feel, you should let your House member know. Ask how the Republican bill will help or harm persons with mental disorders, then you can make an educated recommendation. Remember, your elected officials work for you.

Here is why NAMI says it is opposing the AHCA (Trump bill.)

Individual and Small Group Health Insurance

• Current federal help to buy health insurance would be reduced, leaving millions of people, including people with mental illness, unable to afford mental health care.

Traditional Medicaid

• Traditional Medicaid would be converted to a “per capita cap” system, which means states would get a fixed amount of federal funding per person. Instead of flexibility, this would lead to deep cuts over time and jeopardize mental health services.
• Federal Medicaid funding would be frozen at current levels, adjusted for inflation. Funding for mental health and substance use services is already inadequate and could not be improved without cutting other needed health care.

Medicaid Expansion

• Nearly 1 out of 3 people covered by Medicaid expansion live with a mental health or substance use condition. This bill would end new enrollment in 2020, leaving people with mental health and substance use conditions without the Medicaid services they need to stay in school, on the job and in recovery.
• Medicaid expansion plans would no longer have to cover mental health and substance use care, abandoning Congress’ commitment to mental health and substance use coverage.
• People covered by Medicaid expansion before 2020 would be dropped from their plan if they have a lapse of coverage of more than a month. For people with mental illness, this is a high price to pay for forgetting to pay a premium while someone is in the hospital or experiencing severe symptoms.

Congress shouldn’t put millions of Americans with mental illness at risk. Cutting corners in health coverage will keep people from getting the treatment they need and will push people with mental illness into costly emergency rooms, hospitals and jails.

Investing early in affordable, quality mental health care promotes recovery and saves taxpayer dollars in the long term by avoiding disability, criminal justice involvement and frequent hospital stays.

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(3-23-17) I am honored to be speaking tonight on behalf of the Richland, Ohio chapter of the National Alliance On Mental Illness at the now closed Ohio State Reformatory.

This historic prison was featured in the movie, The Shawshank Redemption, and seems a fitting place to talk about our nation’s need to end the inappropriate incarceration of persons with mental illnesses.

Having a mental disorder should not be a crime, yet American jails and prisons hold more than 365.000 persons whose major crime is that they became sick. More than 2.2 million individuals with mental disorders, such as schizophrenia and bipolar disorder,  pass through our criminal justice system each year. Nearly all for petty crimes, such a trespassing and theft of a grocery cart, wasting tax dollars that could be better spent on mental health services.

Ohio has been one of the most progressive states in providing mental health care. It is home to my good friend and fellow advocate, retired Supreme Court Justice Evelyn Stratton, as well as, Mark R. Munetz, one of the developers of the sequential intercept model used in jails and prisons, and mental health advocate Dr. Fred Frese.

Despite this, Ohio correctional facilities continue to house five times as many individuals with mental disorders than their hospitals and treatment centers at a cost of $50 million more annually than the price of incarcerating other prisoners.

In the past decade, it often has been courageous judges, jail administrators, police chiefs and sheriffs who have demanded reforms. And I am happy that Fairfax County Sheriff Stacey Kincaid in Virginia has become one of them.

Sheriff Kincaid tossed aside her written speech earlier this week at the Mid-Atlantic Summit on Behavioral Health and Criminal Justice in Washington DC., choosing instead to speak from her heart.

She recounted how she had worked in a jail as a young intern and deputy and had seen first hand “the barbaric way people in jail  with mental illness were being treated.”

She described the Diversion First program that she helped launch last year after the horrific death of Natasha McKenna, a woman with schizophrenia who died from heart failure after being repeatedly stunned by deputies while being removed from her cell.

That death, in particular, turned Sheriff Kincaid into a national advocate for diversion programs.

While budgets are tight, helping people recover is about a different and more important type of capital – Human Capital, she said.

The post I’m Speaking Tonight In “Shawshank Prison” About Diversion: Glad Sheriff Kincaid Is Pushing It Too! appeared first on Pete Earley.

CBS won’t let me post its video, so I posted the transcript of its news story below. Meanwhile, take four minutes to watch this interview with my amazing friend. You won’t be disappointed!

(3-25-17-) I’m proud to serve on the Corporation for Supporting Housing board of directors with Dr. Jim O’Connell, a truly wonderful and kind physician who was featured Saturday night on CBS news.  A year ago, I wrote a blog about Jim and his book: STORIES FROM THE SHADOWS. If you really want to understand homelessness and meet those who walk among us unseen, you MUST read his book. (I’ve posted my blog about Jim at the end of the CBS transcript.)

Nearly 600,000 Americans are homeless, and many have health problems with no access to care. O’Connell and his nationally renowned team of “street doctors” are doing something about it, treating about 700 regular patients.

O’Connell and his team of psychologists and social workers spend their days walking around downtown where his patients live — in parks, under bridges and on the outskirts of town.

During his morning rounds, O’Connell himself usually sees about 20 patients. He knows where most of his patients sleep and knows who to ask if they are missing.

“I feel like I’m a country doctor in the middle of the city, you know?” he said.

O’Connell went to Harvard Medical School at the age of 30. After finishing his residency at Massachusetts General Hospital, he was on his way to a prestigious oncology fellowship when the city of Boston received a grant, along with 18 other cities, to improve their health care system for the homeless.

At the suggestion of his chief, O’Connell took what was supposed to be a one-year position as the founding doctor of the new health care program for Boston’s homeless. That turned into a 32-year career as head of the Boston Health Care for the Homeless Program, now the country’s largest of its kind.

“You start to realize, ‘You know what, I’m just a doctor. And what I can do is I can get to know you and ease your suffering, just as I would as an oncologist,’” O’Connell said. “You could not find a more grateful population.”

O’Connell dispenses just about everything, from stitches for an arm to surgery for the soul. If patients can’t be treated on the street, O’Connell finds them a temporary treatment bed in a shelter.

O’Connell also sees patients at McInnis House, the main shelter of BHCHP. Patients sometimes stay for an extended period of time while they receive treatment.

“He’s like Jesus,” one of his patients said.

“This man is unbelievable!” another remarked. “This is my doctor. He’s been my doctor for life.”

O’Connell said he doesn’t think about what life would be like as a highly paid oncologist.

“I never think about it anymore,” he said.

Some things are more valuable than money. Just ask the man who gets everything from patients who have nothing at all to give.

The post My Boston Street Doctor Friend Featured On CBS News! Talks About Helping The Homeless! appeared first on Pete Earley.

Rep. Murphy’s choice defended Trump describing him as the “embodiment of healthy narcissism.”

(3-26-17) Miami-Dade Judge Steve Leifman appeared to be a shoo-in to become the new Assistant Secretary for mental health and substance abuse in Washington.

Until he wasn’t.

About ten days ago, Leifman got knocked to the bottom of the list even though HHS Secretary Tom Price had approved of him and he was in the midst of a successful White House vetting.

Who stopped Leifman’s appointment? Republican Pennsylvania Representative Tim Murphy.

From the start, Murphy has insisted the newly created post be held either by a psychiatrist or psychologist and because Murphy was responsible for successfully drafting and pushing his Helping Families In Mental Health Crisis Act through Congress last December, he’d earned veto rights.

“Murphy is considered the Republican’s mental health go-to guy,” one source told me. “He’s who everyone in his party turns too.”

Some on Capitol Hill wondered if Murphy blocked Leifman’s appointment because the judge began steam-rolling ahead in the Senate, without anyone showing Murphy the respect that he felt was due him in the process. Nearly every mental health organization was enthusiastically supporting Leifman, who has gained national prominence and popularity because of his efforts to promote jail diversion and community based treatment. As I’ve written before, it would have been difficult to find anyone who was better qualified for the new job than Judge Leifman – a fact widely agreed on in Washington.

Others said Rep. Murphy worried that appointing a former public defender and criminal court judge would send the wrong message to the public by putting someone from the criminal justice system in charge of mental health and substance abuse services.

That argument, if true, seems odd if rumors about Rep. Murphy’s preference are true. Murphy is reportedly pushing Secretary Price and the White House to appoint Dr. Michael Welner as the first Assistant Secretary.

The announcement is expected this week.

Dr. Welner is best-known for his television appearances on news and talk shows and testimony that he has given in several high profile cases as a paid prosecution witness. Here is how a magazine profile called Evil Genius described him:

Welner is a prominent and occasionally controversial forensic psychiatrist who has interviewed some of the most high-profile criminals of the past two decades, generally on behalf of the prosecution. He argued that Andrea Yates, the woman who drowned her five children in a bathtub in 2001, was legally sane; that Brian David Mitchell, the self-proclaimed prophet who kidnapped Elizabeth Smart, was legally sane; that Omar Khadr, the teenager who became Guantanamo’s youngest prisoner, was not tortured and had a high risk of continuing jihad activities if released.

Dr. Welner has focused his career exclusively on forensic psychiatry. He is chair of The Forensic Panel, a group of psychiatrists and other mental health experts – that he brought together – who hire themselves out as professional witnesses in court cases. He is also the primary author of what he calls “The Depravity Standard,” which attempts to standardize for judges and jurors what the appropriate level of depravity is for horrific crimes. (You can take the depravity standard survey here.)

“He’s always been popular with Republicans because he nearly always claims mental illnesses are not an excuse for criminal acts,” one Capitol Hill source told me. “Rep. Murphy has always thought highly of him.”

Apparently, the White House does too.

An early and enthusiastic supporter of President Trump, Dr. Welner defended the president on CNN during the election when a host raised questions about Trump’s mental health, specifically if the president was narcissistic.

Although psychiatrists are discouraged from diagnosing anyone who they have not personally evaluated, Dr. Welner said the president was the “embodiment of healthy narcissism.”

Asked directly if Trump was a narcissist, Welner responded: “He’s an exceptionalist and there’s something about American exceptionalism at its core that sees itself excellent relative to the world and he sees himself excellent compared to the people that he competes with.”

He added that Trump’s attitude was the “embodiment of healthy narcissism, a belief that you are better.” He cited Trump’s “boldness to succeed because he dares” as an example of “where his narcissism is healthy.”

Some mental health groups are continuing to rally around  Dr. Ellie McCance-Katz, the chief medical officer for the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals in Rhode Island, for the job.

She became SAMHSA’s first chief medical officer in 2013 but left after only two years. In a critical essay published in the Psychiatric Times, Dr. McCance-Katz wrote that SAMHSA’s Center for Mental Health Services, which administers federal mental health programs, ignored serious mental illnesses and evidenced based practices in favor of feel-good recovery programs that were politically popular but did little to help persons diagnosed with debilitating disorders. She claimed that SAMHSA was openly hostile toward the use of psychiatric medicine, didn’t focus on helping the seriously mentally ill, and questioned whether bipolar disorder and schizophrenia were even real, arguing that psychosis is just a “different way of thinking for someone experiencing stress.”

There has been some talk of naming Dr. Welner to the top job and appointing Dr. McCance-Katz as his second-in-command as chief medical officer.

Whoever is appointed – whether it will be one of the names making the rounds or someone completely new – what is known is that no one will be appointed unless he/she meets Rep. Murphy’s seal of approval.

The post Murphy Vetoes Judge Leifman’s Appointment, Pushing Popular Television Doctor and Early Trump Backer Instead appeared first on Pete Earley.

Happy dealer holding car keys

(3-27-17)

Dear Pete,

I am the Mother of a son with schizophrenia. I am shell shocked – “war weary” – am suffering from caregiver burnout and am often sad beyond hope because of what individuals and families go through, including what I’ve been through trying to get my son help.

Is it possible for you to ask for stories about positive outcomes of persons living with mental illnesses?

Here is a true story I like to tell about my own son that makes people smile. Sometimes it helps all of us to laugh.

My son, Art, has always loved cars. He went looking at cars at a local dealer’s lot when he was manic. Of course the car salesman came hustling out and said to my son “Hey you like this car? You want to take it for a spin?”

My son said he did and the salesman slid into the driver’s seat and away they went.

We only know what happened because a friend of my daughter worked at this dealership and she told us.

When the car salesman came back my son was no longer riding with him. The car salesman was laughing and shaking his head.

“What’s so funny?” my daughter’s friend asked him.

“Did you see that tall, blonde guy?” he said.

“Yes, actually he is my friend’s brother.”

“Something isn’t quite right with him,” the salesman said.

“What happened?”

“ Well, I got in the car with the guy and he said , “Can you make this car go on the highway? So we drove on the highway.”

Then he said, “Can you make it go right?’ Which I did.”

He asked me, “Can you make it go left than right again, etc. The next thing I know he says to me, ‘Stop!  This is a very nice car…and that’s my house. Thanks for the ride.”

He gets out and waves at me and walked into his house.

Maybe each month you can share messages of hope, joy, success, love, and recovery that have to do with mental illness. I think such positive stories would help all of us have hope.

Sincerely,

Charlene Turenne

The post War Weary, Burned Out Mom Seeks Hope, Sees Bright Side appeared first on Pete Earley.

(3-31-17) My good friend and long time mental health advocate, Betsy Greer, is outraged that an Arlington, Virginia hospital is reportedly turning away 57% of individuals who need psychiatric services but wants Arlington county officials to offer it land to expand so it can build 100 profit-generating surgical beds without improving psychiatric patients’ needs. While this story focuses on a wealthy Washington D.C. suburb, it is not unique as more and more hospitals strive to grow fat while bypassing mental health. Betsy tells me that on Monday, April 3, advocates will be pleading their case at a 7:30 p.m. meeting at the Health Systems Agency of Northern Virginia, 3040 Williams Drive, Room 200, Fairfax, Va.  

ARLINGTON VIRGINIA ADVOCATES FIGHT FOR LOCAL HOSPITAL MENTAL HEALTH SERVICE

By Betsy Greer

A newly created group is asking Arlington county officials to make the sale or swap of 5.5 acres of prime Arlington county property to the Virginia Hospital Center (VHC) conditional on that hospital improving its emergency room and psychiatric ward services for individuals with mental illnesses.

“Too many Arlington residents have been turned away from VHC due to a shortage of beds or because they don’t treat minors,” said Naomi Verdugo, one of the organizers of the Arlington Mental Health Alliance. “This requires them to travel all over the state for psychiatric hospitalization, far from their families who should be part of their treatment. Arlington residents deserve better from their community hospital.”

For the advocates, it is a fight between them and Goliath, an independent, not-for-profit hospital operated like a well-heeled corporation, which in 2014 had more than $600 million invested in securities, excess revenue of more than $60 million over expenses. It is coming at the time VHC is requesting state approval for licensure for 100 new medical and surgical beds, but NONE for patients with mental illness.

VHC’s own 2014 Community Health Needs Assessment, gained from a survey of community stakeholders, listed mental health conditions and depression as the two most important health concerns, ahead of adult obesity, diabetes and substance and alcohol use!  

‘There are a number of reasons why it is important for the Virginia Hospital Center to respond positively to the requests made by us and the Arlington Community Services Board (CSB), which provides mental health services in our county,” said Anne M. Hermann, chair of the Arlington CSB. “This is a community hospital and the beds they have are not nearly enough to cover the need. This shortage is demonstrated by the frequency with which Arlingtonians experiencing a mental health emergency are turned away from VHC and sent elsewhere in the Commonwealth, sometimes quite some distance.”

A primary CSB request is that VHC commit to a minimum of 15 additional single-occupancy adult psychiatric rooms and commit to opening additional psychiatric beds to meet demand when a compelling need is demonstrated. VHC uses only 35 of its currently 40 licensed behavioral health beds, 17 for substance abuse treatment. The remaining 18 beds reserved for those needing stabilization for a mental illness crisis are in double rooms which restricts use unless a new patient is of the same sex and deemed stable enough to share a space. (Ironically, VHC markets itself as the only area hospital offering private rooms.)

Judy Deane, a CSB member and another long-time Arlington advocate, echoes Hermann’s point. “Every year, [VHC} turns away several hundred people who are suffering a psychiatric emergency and tells them to go elsewhere because of the severe shortage of psychiatric beds.

“Since VHC is acquiring County land that used to be used for mental health treatment, it seems only right that, as part of the deal, VHC add enough psychiatric beds to serve the community’s needs, “ she said.

Outdated mental health units!

The CSB wants VHC to update its psychiatric treatment unit for those with mental illness, currently placed in one of its original buildings that offers minimal natural light. Describing this request as an “urgent issue” that should occur in any VHC renovation plans, the CSB says that the psychiatric unit should be configured “in line with best practices with regard to design, natural light and staffing to create” a more therapeutic and pleasant environment for recovery.

A third request is for VHC to staff its Emergency Department with a full-time mental health clinician and designate a separate suite of rooms attached to the Emergency Room, to allow patients who manifest primarily psychiatric symptoms to be assessed, treated and provided respite separate from other Emergency room patients — and, where possible, diverted from psychiatric hospitalization.

Lastly, the CSB asks, and the Alliance strongly urges the VHC to establish an inpatient psychiatric unit to treat children and adolescents with serious mental illness.

These requests are grounded in the heart-wrenching stories of patients and their families.   At a November forum, the CSB heard the experiences of Arlington families who used or attempted to use VHC facilities. Their testimonies movingly speak directly to the CSB and Alliance positions. The CSB and the Alliance know there are many more such stories in the community.

The human cost: putting patient into a taxi and sending her home debilitated

One Arlington mother spoke of the experience of her adult daughter, taken to VHC because of suicidal threats and the consumption of an unknown combination of prescription medications.

“VHC did not have adequate bed space and released her via taxi in a debilitated state,” not even checking to see if anyone was home, she said. “VHC has inadequate facilities for both emergency and non-emergency psychiatric services. Arlington County should leverage their position to provide better facilities (e.g., a separate psych ER, greater capacity and flexibility for minor and adult psych patients, a psych unit with natural light, space for county social services personnel to facilitate follow-up care) for some of the most vulnerable citizens.“

Comments highlighted long Emergency Department waits for loved ones suffering a mental illness crisis and being sent to other hospitals – as far away as Petersburg, VA – because VHC did not have an open psychiatric bed.   For another Arlington family, this meant a two-hour drive from their home. “Consequently we were not able to visit our son much.” To the Alliance, it is clear the devastating effect that this had on the family who, when the son in crisis needed his family most, could not be with him enough. Psychiatric beds in Northern Virginia would help.

The insufficient number of psychiatric beds at VHC is a major driver for the CSB, which under state law has the responsibility of handling temporary detention orders (TDOs), those orders when an individual, needing care, will not voluntarily accept hospitalization and seeks a commitment hearing. The CSB has eight hours to find a psychiatric bed, using a state psychiatric hospital as a last resort. This was one statutory change that followed the case of the son of State Sen. Creigh Deeds, who was released because no hospital bed could be found for him. He attacked his father before committing suicide.

Hospital turned away 57% of individuals needing mental health care 

The CSB has the data showing that in the first half of the current 2017 fiscal year, of 229 CSB cases, the hospital turned away 57 percent – or 130 individuals. That required placing 72 at other private hospitals with the added expense of police transportation to these out-of-county facilities (which in fiscal year 2016 came to more than $50,000 of County dollars). Fifty-eight ended up at the Northern Virginia Mental Health Institute in Fairfax as the hospital of last resort.

In its explanation of the issue, the CSB concludes the lack of [VHC] hospital capacity has a significant, negative impact on people with mental illness and their families.

Another family’s story concerned its 21-year-old son who has had seven TDOs. “More often than not, my son was released to come home after four or five hours and told there were no beds available. The beds that were found for him were sometimes as far away as Poplar Springs Hospital in Petersburg, VA. That was too far for us to visit and too far for us to make it to his [commitment] hearing.”

The testimonies also highlighted the experiences of Arlington families in the need of psychiatric beds at a medical facility for children and adolescents with mental illness. Children and adolescents frequently have other medical conditions in addition to mental illness and with such co-morbid diagnoses, a psychiatric-only facility like Dominion Hospital in Falls Church won’t work.

One mother related that she was able to walk from her home to VHC to give birth to her child, but when another child at eight years old needed psychiatric care he ended up at Johns Hopkins Hospital in Baltimore, a daily four-hour round-trip drive for her to be with him. One evening in bad weather, it took the father four hazardous hours to drive from Baltimore to Arlington to visit their very ill, lonely and frightened little boy.

Another family said their son had been hospitalized three different times to stabilize and treat him for psychotic behaviors, and not once was this at VHC. “The telling part of this story is we live three blocks from the hospital.” This family said it strongly believed Arlington County must make increased psychiatric capacity at VHC a part of the sale or swap of land to the hospital.

Hospital pays no federal, state or corporate income taxes

The Alliance notes that as a not-for-profit hospital, VHC pays no federal, state or corporate income tax – nor does it pay Arlington County property tax. As a not-for-profit hospital, VHC is required to provide community benefits, such as uncompensated care (not the same as bad debt), serving Medicaid patients and services in specialties that make little or no money for the hospital – such as psychiatric care. For all of the above not-for-profit benefits, VHC states it gives back “$30.7 million in community benefits.”

Arlington has to consider whether this is an equal benefit exchange with the community.

The Alliance is following the VHC process closely. It argues that as a condition of any land transaction, VHC needs to add psychiatric beds and enhance its psychiatric services. Before it completes its land sale or swap, VHC wants to obtain a state-mandated Certificate of Public Need for the additional 100 licensed beds — again, none of which are for psychiatric patients – which the hospital wants.

Alliance members plan to testify to all these points at an April 3 hearing before the Health Systems Agency of Northern Virginia and to continue to engage their County Board members. The Alliance knows there are others in Arlington – and the region – who have similar VHC mental health experiences, and invites others to join its effort.

  Naomi Verdugo is the contact at verdugo.naomi@gmail.com.

The post Virginia Hospital Says No Beds For Psych Patients But Wants A 100 New Profit Earning Beds For High Priced Surgeries- Cha-Ching! appeared first on Pete Earley.

(4-3-17) The biggest danger to improving mental health care in America today is not:

*Efforts to repeal and reform the Affordable Care Act or reduce Medicaid.

*Too many persons with mental illnesses being inappropriately incarcerated in jails and prisons.

*A lack of affordable housing, jobs, transportation, or access to crisis care beds and medications.

*A lack of peer support, clubhouses, Crisis Intervention Team trained officers, mental health courts or re-entry programs.

The biggest danger facing mental health care today is the opioid crisis.

Here’s a shocking figure for you to consider:

According to the Centers for Disease Control and Prevention, every day in our country 91 people die because of overdoses. Ninety-one deaths! That is a higher number than Americans who die each day in car accidents and shootings.

Now let me be clear. I am not diminishing this crisis. Let me repeat that. The opioid crisis is a national tragedy and scandal that must be addressed.

So what do opioid deaths have to do with mental health care?

In many states, including Virginia, mental health and substance abuse services are folded into one agency, often along with intellectual disabilities. (Addictions and mental illnesses are seen as a natural fit, because an estimated 40% of persons with serious mental illnesses also have co-occurring addiction issues.) My worry, based on history, is that tax dollars for mental health care are going to be the easiest and most likely to be cut as money is shifted into the opioid crisis.

There are obvious reasons for this. Parents of children with intellectual disabilities have been lobbying and fighting to protect their family members since birth. They are well organized and dogged. They also have a much more empathetic cause than individuals with serious mental illnesses who are homeless and perceived by many as being dangerous and deserving of institutionalization.

Need another reason why future mental health budgets will be in peril?

During the lame duck session of Congress in December, the 21st Century Cures Act was passed and it contained two very important mental health bills. But passing legislation and funding it, are two different things. Having approved two mental health bills, it could be easy for members of Congress to believe that they have solved the problems that plaque our mental health care system.

This is why it is vital that the new Assistant Secretary for Mental Health and Substance Abuse, a position created by Pennsylvania Republican Rep. Tim Murphy’s  Helping Families In Mental Health Crisis Act  be someone familiar enough with mental health to insure that Murphy’s hard-fought reforms are properly funded.

Since the Sandy Hook Elementary School shootings, Rep. Murphy, the only practicing psychologist in Congress, has made mental health reform a top priority. He has been relentless. In the Senate, he was aided by Texas Republican and majority whip, Sen. John Cornyn, and Senators Bill Cassidy (R-La.) and Chris Murphy (D-Conn.)

Obviously, we must do something to end opioid deaths and help those who are addicted. But in doing so, we must not forget the needs of the serious mentally ill who continue to roam our streets, homeless and all too often invisible to us.

Those who do not remember their past are condemned to repeat their mistakes.

From: State Budget Crisis 2011 NAMI : One in 17 people in America lives with a serious mental illnesses such as schizophrenia, major depression, or bipolar disorder. About one in 10 children live with a serious mental disorder. In recent years, the worst recession in the U.S. since the Great Depression has dramatically impacted an already inadequate public mental health system. From 2009 to 2011, massive cuts to non-Medicaid state mental health spending totaled nearly $1.6 billion dollars. And, deeper cuts are projected in 2011 and 2012. States have cut vital services for tens of thousands of youth and adults living with the most serious mental illness. These services include community and hospital based psychiatric care, housing and access to medications.

From an article I published in The American Prospect: Because of the murders at Virginia Polytechnic Institute and State University (Virginia Tech) on April 16, 2007, the state legislature was forced to address our state’s badly fractured and neglected system. The massacre of 32 students by Seung-Hui Cho, who then killed himself, led the governor and legislature to loosen the state’s involuntary commitment language and to approve $42 million in new revenues to be spent over the next two years, mostly to expand jail-diversion programs and hire 146 additional therapists and case workers. Gov. Timothy Kaine acknowledged that $42 million would not pay for a much-needed system overhaul, but he explained it was the best anyone could expect given a recession and corresponding drop in state revenues. At a press conference held to sign the legislation, the governor and major legislators slapped themselves on the back.

What the governor and legislature didn’t mention was that Virginia had cut $50 million from its mental-health services between 2002 and 2004 during a budget crunch, and when former Gov. Mark Warner left office in 2005, he had warned that it would take $460 million to bring Virginia’s anemic system up to par.

The post What’s The Biggest Threat To Mental Health Care? Ironically, It’s The Opioid Crisis. appeared first on Pete Earley.

(4-10-17) You are riding in a car on a major highway with a gentle rain splashing on the windshield while you speak into a car microphone to a case worker at Oregon State Hospital, where the movie One Flew Over the Cuckoo’s Nest, was filmed.

You say, “My brother is there and I am wanting to get in touch with his case worker.”

Your call is transferred and a case worker who doesn’t identify himself comes on the line.

You say, “My brother is in the hospital there and I was wondering if I can find out some information about him.”

He says, “Sorry, due to confidentiality laws I can’t tell you whether he is there or not.”

“I definitely know he is there because the police just told me that they took him to the hospital. I can at least provide information -“

The case worker cuts you off. “Yeah, I couldn’t do that without telling you whether he is here or not. But you could do that in a letter form. Of course, you can write a letter to anyone. You can write it to the doctor who is in charge of whoever the person is who might be here.”

Thus begins Sandra Luckow’s powerful documentary “That Way Madness Lies...”

This film is unique because Sandra is a professional film maker and her brother, Duanne, who is the lead character, began using video on his cell phone when he first became ill to film himself because he wanted evidence of how he was being persecuted.

The result is one of the most truthful and detailed portrayals (the documentary covers seven years of filming) of mental illness that I’ve ever seen.  

When we first meet Duanne, he owns a house and is a skillful restorer of rare automobiles, highly respected for his OCD-like insistence on perfection and dogged work ethic.

But as with so many artistic individuals who become seriously mental illness, Duanne begins to transform before our eyes.

During one delusional moment, he prepares a tent bedroom outside his house for Irina, a woman he met on the Internet and who he has been sending money to in Russia. He assures us that she simply missed her flight to join him but will be arriving shortly. She never does. Next, we listen to Duanne ranting about Pluto and the imagined wrongs of an insurance company while he stands at the ledge of Mulnomah Falls, peering over the railing at the ground some 611 feet below. But we are just starting to see the ravages.

We watch as his frustrated and befuddled parents and Sandra try to convince him that a Nigerian conman, whom he has been emailing and talking to on the phone for sixteen months, is not going to send him $10.5 million dollars. When his family refuses to give him an additional $6,000 for this African huckster, Duanne sells his nationally recognized restoration of a 1964 Turbo Charged Corvair. By the time, Sandra gets involved, Duanne has delivered $40,000 to the Internet scammer.

There are others who are eager in to pick his financial bones, but it’s not only Internet crooks who prey on him.

After Duanne is forced against his will into the Oregon State Hospital for an extended stay, he is sent a bill for $117,895.11 for mental health services that he did not seek and refused to accept.

Duanne eventually loses everything: his house, his business, his savings, and in the process, he becomes alienated from his parents and sister, all of whom have tried to prevent him from slipping further and further down the rabbit hole. In doing so, they have become the enemy and they pay for it heavily, eventually having to obtain restraining orders to protect themselves.

Alone, broke and continuing to believe there is nothing wrong with him, Duanne gets stuck in the revolving door of homelessness, hopelessness and jail.

As the documentary progresses, Sandra skillfully and subtly spins the narrative away from Duanne and onto herself, her family and our mental health system’s failure to help her brother. (Full disclosure, she arrives at my door after reading my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, only to leave just as unsatisfied as when she arrives.)

Like many of us, she turns her frustration and anger into advocacy by telling producers at  60 Minutes about she and her family are being threatened by Duanne but, as Sandra tells viewers, they are told that having “an AR 15 with hollow point bullets spattering (my) brains all over my apartment” does not constitute imminent danger. When she complains about his cruel and threatening remarks to Facebook, its administers turn a blind eye. 

I will not disclose the ending of the film but will say that – unlike the fairy tale ending that Hollywood requires – Duanne’s struggles continue and Sandra’s love proves insufficient to health a brain disorder just as devotion and love are no match for cancer or heart disease.

Sandra has spent nearly everything she has earned and saved to self-fund this documentary, picking up occasional sponsors and donations from friends. She received a third of the budget from Regina K. Scully of the Artemis Rising Foundation and Abigail E. Disney gave a substantial grant through her company Fork Films.  Despite her best efforts, she still needs more than a hundred thousand dollars to pay for post production and legal services. That lack of funding forced her to withdraw from one film festival where she hoped to attract funders.

Undeterred, Sandra told me that she has scheduled the premiere of “That Way Madness Lies…” for May 11 in Portland, Oregon where it all began.  

I hope Sandra gets the additional funding she needs because her documentary is a work of bravery in the tradition of Ida Tarbell, who took on Standard Oil, and Upton Sinclair’s meat packing expose: “The Jungle.”

Her film shows viewers the horror that serious untreated mental illness inflicts without sugar-coating and it reveals the shackles that prevent families from interceding, the inability of our current mental health system to help the severely and persistently ill, and the modern day charlatans who preach that paranoid schizophrenia is not real, that all medicines are poisons, and that Americans who roam our streets psychotic are electing to live in a world that daily torments them.

“That Way Madness Lies…” is a member of the International Documentary Association’s Fiscal Sponsorship Program. This allows donors to give to the film easily and securely. All donations are tax deductible to the fullest extent of the law. You can make a donation here. To learn more about the film go here.

The title of the film is from King Lear, Act 3 Scene 4.  “What I like about it,” Sandra told me, “is the ambiguity despite its seeming certainty.  What I hope the audience comes away with is a question of  ‘Which way does madness lie?’  In our mentally ill?  In our treatment of our mentally ill?  In the constraints imposed upon by ineffective policies?”

Those are all good questions. Please support and see this film.

The post ‘The Way Madness Lies’ – Most Honest Portrayal Of How Severe Mental Illness Ravages Families and Lives That I’ve Seen! appeared first on Pete Earley.

(4-16-17) For Christians, Easter is a time of miraculous resurrection. For others, it is a time to celebrate the coming of spring, birth and renewal. For all of us, it should be a time for compassion and caring for persons less fortunate, especially those with mental disorders and co-occurring problems.

Write Hal Lindsey said it best:

“Man can live about forty days without food, about three days without water, about eight minutes without air…but only for one second without hope.”

Have hope, help others, change lives.

Happy Easter and thank you for reading my blog for the past eight years.

The post Happy Easter From Me To You: Let’s Continue Working For A Better World appeared first on Pete Earley.

The post Outrageous! Joan Bishop recounts the tragic death of her psychotic sister in powerful documentary, raising troubling questions about our system appeared first on Pete Earley.

Congressman Tim Murphy and Dr. Michael Welner confer at hearing.

(4-19-17) This story in today’s Wall Street Journal by Michelle Hackman supports what I reported in a  blog last month about efforts by Republican Pennsylvania Representative Tim Murphy to get Health and Human Services Secretary Tom Price and the White House to appoint Dr. Michael Welner as the first Assistant Secretary for mental health. Whether this appointment will really happen, however, is still anyone’s guess given the oftentimes erratic temperament of the White House.

Trump’s Latest Pick for Mental-Health Post Has Helped Prosecutors Secure Convictions

Forensic psychiatrist Michael Welner has testified in high-profile cases; on television, he has called killers ‘alienated losers’

By Michelle Hackman  published in The Wall Street Journal. 

WASHINGTON—The Trump administration is struggling to fill a top mental-health post, a job created last year to coordinate the efforts of far-flung federal agencies.

The assistant secretary position in the Department of Health and Human Services was first offered to a Florida judge, but the offer was withdrawn due to his lack of a medical background, according to people familiar with the matter. A second candidate had broad support but pulled out.

Now a leading contender is Michael Welner, a forensic psychiatrist who has testified for the prosecution in numerous high-profile criminal cases, according to a half-dozen people familiar with the process including Dr. Welner himself. He faces opposition for some controversial positions.

He has made a career of testifying in court about the psychiatric state of people accused of crimes including murder and terrorism, often challenging other experts in arguing that defendants understood their actions.

Some advocates consider him a pioneer with a keen understanding of mental illness and violence. Dr. Welner’s candidacy is supported by the American Psychiatric Association, which noted that he “has worked in the private sector for over 25 years.”

But critics say his legal testimony often conflates mental illness with criminal intent.

Embarrassment to Profession 

“He is an embarrassment to our profession in that he spouts, as facts, opinions that are in no way based on scientific evidence,” said Xavier Amador, director of the Leap Institute, which trains mental-health and police professionals.

The mental-health position at HHS was created last year as part of a broader law called the 21st Century Cures Act. Rep. Tim Murphy (R., Pa.) pushed for it as a way to coordinate various agencies involved with mental health.

The position, along with other mental-health initiatives in the law, was in part a response to the 2012 shooting in Newtown, Conn., of 20 first-graders and six adults at an elementary school. Democrats called for more gun-control measures, while many Republicans focused on the shooter’s mental-health problems.

Whoever gets the role will gain a prominent perch in the Trump administration at a time when government officials are increasingly focused on the nationwide opiate crisis and on tamping down on violence perpetrated by people with severe mental illnesses.

HHS Secretary Tom Price first offered the job to Steven Leifman, a Florida judge who’s gained attention for efforts to divert people with severe mental illnesses from jail. That offer has been pulled back, people familiar with the matter said, adding that Mr. Murphy objected to Judge Leifman’s lack of medical experience.

Mr. Murphy’s office and Judge Leifman declined to comment.

John Wernert, who headed mental-health policy in Indiana when Vice President Mike Pence was governor, was also considered a strong contender, but withdrew without giving a public reason. Elinore McCance-Katz, chief medical officer of Rhode Island’s Department of Behavioral Health, is also being considered.

An Early Trump Supporter

But Dr. Welner, an early Donald Trump supporter who appeared on television during the campaign to vouch for the candidate’s mental health, has the edge, according to people familiar with the matter, in part because Mr. Murphy backs him.

“Dr. Murphy sought out Dr. Welner, one of the nation’s foremost authorities in crisis psychiatry, to lend his expertise throughout the oversight process during the multiyear investigation into our nation’s broken mental-health system, as well during the development of the groundbreaking Helping Families in Mental Health Crisis Act, signed into law last year,” said Carly Atchison, a spokeswoman for Rep. Murphy. “Dr. Welner has been and remains an unqualified supporter of President Donald Trump and his agenda to help families in psychiatric and addiction crisis.”

The congressman became interested in Dr. Welner’s work following the Newtown shooting, when the psychiatrist appeared on CNN and elsewhere to discuss the shooter’s motives. Mr. Murphy then enlisted Dr. Welner in helping to draft the mental-health legislation.

Among his peers, Dr. Welner is best known for his work on the “depravity standard,” which aims to create scientific tests to help juries determine which behaviors qualify as especially heinous. With an unbiased measure, the theory goes, courts could apply appropriate sentences without unconscious prejudice.

That approach has been criticized for disguising moral judgments as scientific analysis.

“The role of the forensic psychiatrist is to evaluate a person and say what factors—biological, psychological, social—contributed to the offenses they committed, and not to pass judgment on how bad the crime was,” said Reena Kapoor, associate director of the forensic psychiatry fellowship at Yale University.

Expertise Beyond Reproach

But others say Dr. Welner’s expertise is beyond reproach.

“Dr. Welner’s broad knowledge of mental health and substance abuse, his commitment to treating persons with [severe mental illnesses], and his passion for excellence make him an ideal candidate,” Lewis A. Opler, former chief medical officer for New York state’s Department of Mental Health, wrote in endorsing Dr. Welner.

Dr. Welner said in an interview last week that the post would provide a rare opportunity to make a broad impact. He said he interviewed with Dr. Price about the position in March.

“All my life I have been cleaning up messes from tragedies that have already happened,” he said. “The idea of devoting my energies to preventing messes from happening is why I went into medicine in the first place.”

Dr. Welner has conducted psychiatric analyses for several high-profile prosecutions. He helped convince a judge that Brian David Mitchell, the self-proclaimed prophet who kidnapped Elizabeth Smart, was competent to stand trial despite previous rulings to the contrary.

During the retrial of Andrea Yates, a Texas woman who was convicted of drowning her children in a bathtub, Dr. Welner argued Ms. Yates had planned her actions and was therefore legally sane. Ms. Yates was found not guilty by reason of insanity.

Dr. Welner said that his work in those cases was accurate and scientific and that, in other cases, his testimony “has enabled those with genuine illness to be given added consideration, hospitalization, and even release.”

Dr. Welner has made numerous television appearances, describing killers on air as “depraved,” “evil” and “alienated losers.”

On occasion his commentary has strayed from criminal matters. During the recent presidential campaign, Dr. Welner told CNN that Mr. Trump was “the embodiment of healthy narcissism.”

Write to Michelle Hackman at Michelle.Hackman@wsj.com

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