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SOLUTIONS & PROBLEMS
Solution Fact Sheets
Reallocate Existing Spending
Federal Solutions
4 Federal Solutions Explained
State Solutions
City & County Solutions
Fed/State Solutions
Loca
Problems
People with serious mental illness account for a disproportionate share of suicides, homelessness, violence, and incarceration.
- 18% of population over 18 (43 million) has ‘any’ mental illness.
- 4% of population over 18 (10 million) have ‘serious’ mental illness (SMI). This site focuses on serious mental illness.
- 2 million mentally ill go untreated
- One-third of homeless are mentally ill (200,000)
- 16% of incarcerated (300,000) have mental illness
- 1,000 homicides a year are committed by mentally ill
- 10-17% of seriously mentally ill kill themselves
- $15 billion is spent incarcerating mentally ill
- Random acts of violence by minority are tarring the majority.
- Spend smarter: Spend on mental “illness” not mental “health”. (Video of untreated schizophrenia)
- Use Assisted Outpatient Treatment (court ordered outpatient treatment) for those with a history of violence dangerousness or multiple rehospitalizations due to noncompliance.
- Reform involuntary commitment laws so they prevent violence, rather than require it.
- Reform Medicaid law to preserve psychiatric hospitals (eliminate the IMD Exclusion)
- Reform HIPAA so parents of mentally ill can help loved ones.
Are people with mental illness more violent?
If you are talking about the 40-50% of Americans who may have a “diagnosable mental disorder” during their lifetime (18% annually), then ‘no’, the mentally ill are not more violent than others.
If you are talking about the 4% of Americans with the most serious mental illnesses that affect daily functioning–primarily schizophrenia and treatment-resistant bipolar disorder, then ‘no’, the mentally ill are not more violent than others.
If you are talking about the subset of the 4% group who go off treatment that has previously prevented them from being psychotic, hospitalized, or violent, then ‘yes’ the mentally ill are more violent than others. This higher than normal rate of violence increases even more when these groups abuse substances. When people ask, “Are the mentally ill more violent“, they are usually asking about this group, the most seriously mentally ill who are not in treatment.
What can make people with serious mental illness become violent?
Violence is almost always associated with going off treatment and becoming delusional or psychotic. There are many reasons people with serious mental illness go off treatment. Some reasons are not unique to mental illness while others are.
The ability to regulate behavior is compromised because the brain is the organ affected.
Anosognosia: Up to 50% of people with schizophrenia and many with bipolar lack insight: they are so sick they don’t know they are sick (anosognosia).
Costs/Side Effects: Some refuse treatment because of costs, side effects, lack of support, etc.
Civil Liberties: A misunderstanding of civil liberties, the nature of mental illness, combined with misinformation leads us to protect the right of the psychotic to ‘die with their rights on’ rather than mandating violence preventing treatments that can restore free will.
Reaction to hallucinations and delusions. When people with serious mental illness act out, they are often doing so as a logical reaction to their delusions, hallucinations, and paranoia. If you think someone is the Devil and trying to kill you, you will try to hurt them first.
Misplaced Funding: Most money spent goes to improving mental ‘health’ not treating mental “illness”. People with serious mental illness are usually sent to the end of the line, rather than the front. The ability to get services is inversely related to need, therefore people with serious mental illness find it difficult to get services. Mental health providers often discriminate against highly symptomatic people with serious mental illnesses.
Discussion
Almost everyone has issues with involuntary commitment and involuntary treatment. This site rather than saying “it’s a difficult issue” and dropping it, attempts to study the science and law to come up with policies that balance the right of patients to have freedom, their right to receive treatment, the public’s right to safety, and sound fiscal policy. And while not advocating mass institutionalization, we recognize that the dearth of hospital beds has caused mass incarceration.
Please Read Uncivil Liberties
Consequences of Status Quo
Violence and mental illness
Red Flag/ERPO Laws & mental illness
Increased violence by mentally ill
Mental illness tragedies in PA
Mental illness tragedies in MA
Mental illness tragedies in OH
Mental illness tragedies in NY
Mental illness tragedies in MD
Mental illness tragedies in WV
National plan to reduce violence
Homicide of mental health workers
63% of mass shootings by mentally ill
Mass murder often mental illness related
Mental illness violence predictors
Stigma and violent mentally ill
Homicide rate tied to commitment laws
Other Consequences
Consequences of untreated serious mental illness
2 million untreated mentally ill
1000 Homicides by mentally ill
Increased criminal justice costs
Mental health systems overwhelmed
Poorer prognosis for mentally ill
Suicide
Medical Basis
Serious mental illnesses are biological
Misdiagnosis of mental illness
Mental illness changes brain structure
Effect of antipsychotics (study)
Requiring danger delays treatment
Outpatient treatment cuts incarceration & costs (study)
Schizophrenia:
Schizophrenia Treatment Guidelines
Bipolar Disorder
Noncompliance, Lack of Insight& Anosognosia
Myths, Opposition, and Impediments to Reform
Old AOT research in circulation
Involuntary Treatment doesn’t drive patient From care
Mental Illness Awareness Week hurts
Schizophrenia advocacy vs. mental health advocacy
Coping Tips
Coping with mental illness in family
Tips & Tricks to help mentally ill family member
How to get someone admitted to hospital
Electroconvulsive therapy/shock treatment
How families can force mental health system to treat a loved one
Estate planning & special needs trusts
Consumer Perspectives
Donny Buchanan (put on AOT after shooting)
Mary Gibson Leek (high functioning bully others)
Anna Lisa Johansan (daughter of Letterman stalker)
Jon Stanley (deteriorated and recovered)
J. Nelson Kull (consumers thoughts on AOT)
Family Perspectives
Use Assisted Outpatient Treatment
AOT Supporters
SAMHSA endorses AOT
International Assoc of Chiefs of Police Endorse AOT (PDF)
AOT Data and Facts
What is Assisted Outpatient Treatment
Summary: national AOT research
How DC can increase use of AOT
# elgible for AOT by state and projected savings
AOT Reduces violence (studies)
NY Kendra’s Law constitutional
AOT improves mental health system
AOT increases medication compliance
Reform Involuntary Commitment and Treatment Laws
Civil Rights analysis: Uncivil Commitment
Involuntary commitment (legal)
Involuntary commitment (medical)
13 involuntary commitment reforms
How to change involuntary treatment laws
Involuntary treatment standards
Proposal for nationwide commitment standards
Model civil commitment standard
Preserve psychiatric hospitals & Modify Medicaid
Medicaid causes deinstitutionalization (very good)
Olmstead causes deinstitutionalization – oped
Olmstead causes deinstitutionalization – case history
95,000 psychiatric beds needed
Longer psychiatric hospital stays needed
Institutes for Mental Disease Exclusion – detailed overview
Trade Assoc. Paper: Ending IMD Exclusion (10/17)
Do we still need hospitals-study
Deinstitutionalization failed (WSJ)
Where are deinstitutionalized-survey?
Deinstitutionalization continues
Washington Hearings: Psychiatric Bed Shortage
Video: Congressional hearings on hospital bed shortage
Chief Biasotti written testimony
Chief Biasotti video testimony
Sheriff Dart written testimony
Judge Liefman written testimony
Prioritize mental “illness” instead of mental “health”
Mental health advocates mislead Congress – oped
Where we spend vs. should spend
Mental health vs. mental illness – speech
Mental “health” kills mentally “ill”
SAMHSA won’t prioritize seriously ill
Reform Not Guilty By Reason of Insanity and Not Fit for Trial
Multi-State Studies
Report Ranks 50 State Mental Health Spending
State solutions to mental illness problems
Inpatient/Outpatient commitment standards by state
National mental health expenditures
10X as many mentally ill incarcerated as hospitalized
Who can petition for nvoluntary commitment by state
Psychiatric hospital bed shortage by state
State by state use of jails vs. hospitals
States lacking “need for treatment” standard
Severe mental illness: management and impact on homeland security
Legal and Court Issues
Does Olmstead requires states use AOT?
Model Assisted Outpatient Treatment Law
Antipsychotics and legal implications
Consider past history in commitment proceedings
HIPAA (Patient Confidentiality)
Congress to overturn HIPAA Regs (2017)
Supreme and other Court Decisions
Mental Illness & Supreme Court Decisions
O’Connor v. Donaldson (survive safely)
Wyatt v. Stickney (right to treatment)
Zinermon v Burch (informed consent)
Clark v. Arizona amicus (NGRI)
Jurasek v. Utah (forced medication)
Lessard v. Schmidt (due process & dangerous)
Richard Roe (substitute judgement)
Riese v. St. Mary’s (involuntary medication)
Criminal Justice
How to reduce the mental illness to jail pipeline
International Assoc of Chiefs of Police Endorse AOT (PDF)
3/2018: Secret Service: 64% Mass Shooters Mentally Ill
NYS Chefs of Police endorse AOT
National Sheriffs Assoc endorse AOT.
Florida Sheriffs endorse Baker Act
Interagency Board on AOT & civil commitment standards
Mental illness strains law enforcement – national survey
10X as many mentally ill incarcerated as hospitalized
Officer involved shootings – study
115 Officers killed by mentally ill
Homicide rate tied to commitment laws
Mental Illness and law enforcement
Community policing tactics and mental illness
Chief Biasotti written testimony:
Chief Biasotti video testimony
Sheriff Dart written Testimony
Judge Liefman Written Testimony
Mentally ill more likely jailed than treated
Untreated mental illness increases crimal justice costs
Consequences to law enforcement
Mental illness treatment in jail
Media Articles
Editorials and Opeds
Rational Commitment Laws (DJ Jaffe/Rael Isaac)
Involuntary Treatment Saves Lives (Jaffe)
Huffington Post on Mental Illness
Mental Illness and Violence(DJ Jaffe/Sally Satel)
Medicaid Prevents Mental Health Care (Jaffe/Zdanowicz)
Russel Weston & Civil Liberties (Beth Barber)
Unfit to stand trial (Torrey/Zdanowicz)
Beds Deter Dangerousness (Lieberman)
Not everyone recovers (Mary Zdanowicz)
From Asylum to cell (Sally Satel)
Available in all formats at Amazon and Barnes and Noble
New York Kendra’s Law (AOT)
SEE KENDRA’S LAW HOME PAGE FOR MORE INFO
Text of Bill to Improve Kendra’s Law
Mental Health Directors Oppose
Kendra’s Law Nondiscriminatory
Kendra’s Law Improves Mental Health System
Kendra’s Law Increases Medication compliance
Kendra’s Law Reduces hospital admissions
Benefits of AOT last long-term
Kendra’s Law Regional variations
Kendra’s Law increased Service capacity
2005 Kendra’s Law Study
Research in support of improvements
Constitutional challenges to Kendra’s Law
Opposition: From We the People
Kendra’s Law: National Law Journal
Editorial Support
New York Times supports Kendra’s Law
Albany Times Union supports AOT
Buffalo News supports Kendra’s Law
Gannett Newspaper supports Kendra’s Law
Oped Support
NY Post on Remembering Kendra Webdale
Sheldon Silver on Kendra’s Law
Pat Webdale on daughter Kendra
Michael Biasotti: Police Chief
Albany Times Union Mary Barber
Organizational Support
List of Mental Health and other supporters