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April 27, 2007
Topics in this update include:
Update on Jonathan’s Law Earlier this week, the Assembly joined the Senate in passage of Jonathan’s Law. It was sent to the Governor’s desk on Tuesday night. Governor Spitzer has ten days to veto or sign the bill. Jonathan’s Law will provide greater access to records of an investigation to families for both children and adult programs in developmental disabilities and mental health. The intent of sharing information with stakeholders should be an essential objective of an investigatory process. At the same time, we want to insure that this is done in a manner that does not create obstacles to incident reports and quality assurance reviews. The end game should be a more structured and more comprehensive response for families in desperate need of finding information but it should also be response that does not interfere with an incident report or quality assurance review. We have been meeting with the administration and with the legislature to discuss what we think is a very appropriate response to an enhanced role in the investigatory process for families and recipients at the same time as not creating obstacles to an investigation. We are strongly advocating for the successful twenty year model in Philadelphia of Family and Recipient Based Satisfaction Teams. Listed below is an overview of the role of these teams. The teams are comprised completely of families and recipients. They have the authority to go into any mental health facility and interview recipients of services. They then provide a report to the provider agency on the needs, strengths and problems based on interviews with recipients of services. They then report their findings on a bi-monthly basis to the leadership of the city of Philadelphia Mental Health Agency. In a situation in which there is an incident, they are mandated by the city authority (Philadelphia Mental Health agency) to review the incident. These teams go through a thorough training process so they are familiar with the protocols and confidentiality standards currently in place in law. An incident and quality assurance review by these teams are a win-win for everyone. For families and recipients of services, they have a mechanism in place to have greater involvement in an investigatory process. For other investigative bodies involved in an incident review (such as state entities), they are assured that there would be limited interference in the investigation until such time as sharing of information would not create any barriers to an independent review. Overview of the Consumer Satisfaction Team, Inc. (CST) of Philadelphia Model
Update on Virginia Tech In this week’s Washington Post, the Keynote Speaker for our May 3rd Spring Reception, Best-Selling Author Pete Earley wrote a very compelling piece about why the Panel appointed by Virginia Governor Timothy Kaine to investigate the massacre at Virginia Tech should have a member who is someone with a psychiatric disability. Last week, I wrote a brief piece about the stigma associated with this tragedy by equating all people with mental illness with violent acts. Mr. Earley does a wonderful job of articulating that the real voices of mental illness are people like Patty Duke, Mike Wallace, Kay Redfield Jamison, Patrick Kennedy and many other successful people. The one in five Americans who have a mental illness struggle every day to get better—these folks should be lauded and encouraged for their resiliency and courage in moving forward in their lives instead of being stigmatized with the taint of the small percentage of people who commit acts of violence. Here is the article:
Pete Earley is the father of an adult son who has a mental illness. His book "Crazy: A Father's Search Through America's Mental Health Madness" was a finalist for the 2007 Pulitzer Prize in nonfiction.
Upcoming Events MHANYS’
May 3rd Speaking of Pete Earley, we are only six days away from our MHANYS Reception and silent auction. The event is taking place in a very attractive venue (The State Room in downtown Albany) with lots of food and lots of gift baskets that will be auctioned off. Each of these baskets will have a theme associated with them including the Yankees, sports, gardening, The Theater, gourmet food, pet supplies, A night out on the town, kids, The Racetrack and so much more. Among the items included are Yankee Tickets, Clubhouse at Saratoga Racetrack Tickets, Theater Tickets, Free Time Warner Cable Service for several months, lots of local restaurant certificates, beautiful art work and the list goes on and on. You’ll have to come see it to believe the vast array of items that will be available. We are appreciative of the many people who have already signed up. However, we still have plenty of room and would hope that you will be able to attend what promises to be a wonderful event for a great cause. For more information, please call us at (518) 434-0439 or you can register on line at www.mhanys.org. **************** BUILDING
CONNECTIONS PROJECT A
collaborative project between May 17 & 18, 2007 The Kingston Holiday Inn Kingston, New York 8:30 a.m.- 5:30 p.m. Please visit www.mhanys.org/events.htm, for information on this event and more. ** Date for registration has been extended to May 11th **
**************** The
Geriatric Mental Health Alliance of New York’s GERIATRIC
MENTAL HEALTH: THURSDAY, MAY 31, 2007 9:00am — 4:00pm New York Hotel Pennsylvania New York City, New York For
more information, visit Mental Health Information Center One of the best resources we have at MHANYS is our Mental Health Information Center. From 9—5, on Monday—Friday, we respond to questions related to mental health concerns. Though we do not provide any direct clinical advice or a specific referral, we tap into the experience of our staff and their areas of expertise to respond to people’s requests. Melissa Ramirez, the Project Coordinator for the Mental Heath Information Center, is accessible and very knowledgeable about resources available in the community. For more information call (800) 766-6177 x216 or (518) 434-0439 x216. Also, we constantly update our webpage for the most recent information in mental health, you can log onto www.mhanys.org. Correction
IN THE NEWS: Colleges
Walk Delicate Line in Assessing Students' Mental Health DALLAS - College students struggle with becoming adults, handling relationships and independence. They might get depressed, even write an essay laced with violence or profanity. So when do routine troubles become severe enough that college officials need to do something? That's often hard to tell, some college counselors and administrators say, reflecting on the mentally ill Virginia Tech student who fatally shot 32 people, then himself. "What happened at Virginia Tech is an extreme example that makes for great conversation. But the truth is, if we treated every undergraduate who was depressed as about to exhibit a manic episode, we'd have to confront virtually every student in campuses across the country," said Dean Bresciani, vice president for student affairs at Texas A&M University. Colleges say they can and do look for warning signs, but they simply can't predict whether a student will erupt into violence. They're also bound by laws that restrict access to mental health records and can make it difficult to get a disturbed person necessary treatment. Monday's rampage at Virginia Tech raises questions about what campuses should do when students exhibit disturbing or threatening behavior. Some professors and counselors say it's a painful call to review their practices. "I can't say that we could have prevented a Virginia Tech, but you can identify people who are ticking bombs, and you can keep a watch on them and you don't have to wait for them to commit crimes," said Murray Leaf, an anthropology professor at the University of Texas at Dallas. This week, UTD's faculty senate voted to add rules on how professors should handle disruptive students. The decision is unrelated to what happened in Virginia - rather, it was a reaction to a few cases in which students have been hostile, Leaf said. The new rules, which campus administration must approve, say a professor can request that a threatening student be barred from class or campus until the dean of students can resolve the matter. The rules also define disruptive behavior to include stalking, being abusive and other things. Leaf said there have been a few cases in recent years of students bullying faculty members, threatening lawsuits or using menacing language. "My sense is there may be one or two on campus at any time, but not to the level of Virginia Tech." College officials across Texas say they don't keep exact numbers on students with serious behavioral problems, but it's rare. Most students who seek counseling are dealing with typical challenges: general anxiety or depression brought on by homesickness, the stress of schoolwork, or troubles with a roommate or significant other. Some students have more serious issues, such as severe depression, an eating disorder or bipolar disorder. COUNSELING ON THE RISE "There's no question that across the nation, we've had higher numbers of students coming in for counseling. And we also have higher numbers of more serious mental health issues," said Jane Bost, associate director of UT's counseling and mental health center. She attributes the trend to several factors: newer medications that help students who otherwise wouldn't be able to attend school and function well. There's more academic pressure than 15 or 20 years ago. And there's less stigma attached to seeking help. The potential for violence has prompted college officials to craft policies on handling troubled or disruptive students. For instance, UT's policy states: "Every supervisor, administrator, and university official is responsible for responding promptly and thoroughly to allegations of campus violence and reporting such behavior." That applies to violence by students and staff alike. UTD's policy says students in danger of harming themselves or others should be encouraged to go to the hospital, and the college should contact the proper medical or legal authorities. There are also instructions on how to pursue hospitalizing a student who refuses to go voluntarily. The shooter at Virginia Tech, Cho Seung-Hui, was briefly hospitalized in 2005. A court had found that Cho, who was accused of stalking two female classmates, was "an imminent danger to self or others." But he was let go and referred to outpatient treatment. In Texas, people can be hospitalized against their will if they pose an immediate, serious threat to themselves or others. "It is a high burden, and it should be," said Barry Sorrels, a criminal defense lawyer in Dallas. "It's not a rubber stamp. It has to be backed up by evidence." And as Cho's case shows, someone can still be hospitalized and released, and then later commit violent acts. "Nobody can predict the future, and any time you're talking about state of mind and mental capacity there's always shades of gray," Sorrels said. Those shades of gray can surface in class assignments. Cho, an English major, wrote two plays that dealt with murder and pedophilia. They were so disturbing that a professor and other students took notice. `HARD TO JUDGE' But just because students write about violence doesn't mean they'll commit it. "Sometimes it's really hard to judge. Some kids are writing grotesque materials just to shock you," said Robert Nelsen, an associate provost who teaches fiction writing at UTD. And he said creative writing professors see violent or obscene writing "more often than you think you would see it." Nelsen recalled one male student who wrote about women in an inappropriate sexual manner. In cases like that, he said he advises them to get counseling and tries to monitor them. In other cases, when students seem depressed in their writing, Dr. Nelsen says he's walked them over to the counseling center. Beth Newman, an English professor at Southern Methodist University, said she's encountered "worrisome" students, but no one who was aggressive and hostile. She said faculty members know whom to call if they think a student is depressed. "I often do that, and a lot of other people do as well," she said. Privacy laws restrict how much a mental health provider can tell others about a patient. But Leaf at UTD says he believe colleges could do more to keep professors, deans and counselors connected. "I think the Virginia Tech disaster embodies the problem, but it's certainly not the only thing that does," he said. "You have to act like a small town. You have to know each other." Bost said colleges need to be careful in the aftermath of the Virginia Tech shooting. "We don't want to swing to being overreactive," she said. "There are people with mental health issues that we don't want to further stigmatize." New York State would more closely scrutinize its use of solitary confinement for mentally ill prison inmates under the proposed terms of a legal agreement scheduled for review by a federal judge on Friday. New York is one of several states that have faced lawsuits over the means used to punish mentally ill prisoners, and, under a settlement reached last week, it has agreed to consider changes in how it uses solitary confinement as a disciplinary measure with the mentally ill. Many advocates hail the agreement as a watershed in prison reform because of the effects long sentences in isolation have had on the most vulnerable prisoners, including suicide and self-mutilation. Some mentally ill inmates serve months to years in punitive segregation, locked up for 23 hours a day and sometimes restricted to a diet of cabbage and a pasty flour loaf three times daily for up to 30 days for misbehaving. Disability Advocates Inc. and the Legal Aid Society of New York sued the state over the practices five years ago, and the resulting agreement goes before Judge Gerard E. Lynch of the Southern District of New York on Friday for final review. If the agreement is approved, as expected, the state will not be barred from the use of solitary confinement, or punitive segregation, to discipline mentally ill prisoners, but it would have to provide far more assessment and services for mentally ill inmates in solitary. In addition, the state would be required to review the reasons for and the length of proposed segregation sentences. Many mental health advocates believe that the New York settlement will create pressure on other states to review their policies of confining mentally ill prisoners. Others, including state lawmakers and advocates, said the agreement was only a small step toward stopping inhumane treatment of these prisoners. Many of those advocates were particularly disheartened last fall when Gov. George E. Pataki vetoed a bill that would have banned the use of solitary confinement for the mentally ill in New York. “We see the settlement as a step in the right direction because it provides additional resources and services for treating the mentally ill in prison,” said Robert Gangi, executive director of the Correctional Association of New York, an advocacy group that is now lobbying the new administration in Albany to stop sending mentally ill prisoners into isolation. “But it falls far short of the policy changes that are needed to ensure humane and appropriate treatment for all the mentally ill people in prison.” In New York, with one of the largest prison populations in the country, mental illness has been diagnosed in about 8,400 of the 63,000 inmates, according to the State Office of Mental Health. The number of inmates has decreased significantly in the last few years, but Mr. Gangi said the number of mentally ill prisoners was rising, possibly because the condition is being more accurately diagnosed. Under the agreement, mentally ill prisoners sent to solitary confinement would be entitled to leave their cells for therapy and treatment for two to four hours daily. Their placement in solitary confinement would have to be preceded by extensive reviews, all prisoners entering the system would be screened for mental illness, and the state would be required to provide some mentally ill prisoners with alternative residential housing. State officials said that because of both the agreement and their own budgetary priorities, they had set aside an additional $9 million in the 2007-8 fiscal year for programs within existing prisons and new or renovated facilities to accommodate mentally ill inmates, a total of $57.5 million dedicated to mentally ill inmates. The agreement also stipulates that New York prisons, which local and national advocates say are unique in using restricted diets to punish prisoners already in segregation, cannot use the cabbage-and-loaf punishment for more than seven days with mentally ill prisoners without “exceptional circumstances.” Lawyers who brought the suit and national prisoner rights advocates said the New York settlement was unique in covering all mentally ill prisoners, from the time they enter the system until they leave, whereas some states have merely stopped sending prisoners with major mental illnesses to prisons with especially harsh conditions. “The proof of the pudding is in the eating,” said David C. Fathi, senior staff counsel with the American Civil Liberties Union’s national prison project, who has handled several cases around the country regarding the treatment of mentally ill inmates. “We will have to see how this is implemented. But on paper, it is very significant, a victory and a step forward.” He added, “Now we can point to New York and say, if New York can do it, why can’t you do it?” Prison
Horrors for the Mentally Ill The State of New York took a step toward basic human decency when it agreed to settle a lawsuit brought on behalf of mentally ill prisoners, who often endure horrific neglect and mistreatment. The settlement, which must be approved by the courts, provides for a range of welcome changes, including better care and monitoring for the severely ill people being held in solitary confinement or disciplinary lockdown, typically for 23 hours a day. It still falls far short of what’s needed and is not a substitute for the sweeping reforms vetoed by former Gov. George Pataki last year. The Legislature should pass that bill again and Gov. Eliot Spitzer should promptly sign it. Maltreatment of mentally ill prisoners is a national shame. People who suffer from delusions and hallucinations are far more likely than non-disabled prisoners to break rules. When they are confined in their cells, their symptoms worsen. All too often they harm themselves. A 2003 study found that nearly a quarter of the inmates in lockdown were mentally ill. Of those, nearly 45 percent reported that they had tried suicide and nearly a third reported self-mutilation. The settlement provides slightly better treatment and better suicide prevention in lockdown. But the basic problem is that severely ill inmates should not be held in lockdown at all. The mental health bill would ban disciplinary confinement for the seriously mentally ill. It would also require the prison system to expand treatment programs and give mental health professionals more influence in deciding treatment options. The measure would more than pay for itself by reducing danger and disorder behind bars, shortening prison stays for the mentally ill and increasing the likelihood that they would manage to stay out once they are released. NEW YORK - Patients treated with drugs for bipolar disorder benefit greatly from the addition of intensive psychotherapy, according to findings published in the Archives of General Psychiatry. "Bipolar disorder is an extremely debilitating illness, in large part because of the difficulty in treating bipolar depressive disorders," Dr. David J. Miklowitz, of the University of Colorado, Boulder, and colleagues write. Clinical trials support the effectiveness of adding psychotherapy to drug treatment for preventing the recurrence of depressive and manic episodes. However, the effectiveness of various strategies has been unclear. To investigate, the researchers compared the time to recovery and the likelihood of remaining well for 12 months after four disorder-specific psychotherapies. The 293 outpatients with bipolar I or II disorder also received drug treatment. About half of the patients were assigned to one of three types of intensive psychotherapy (family-focused treatment, cognitive behavioral therapy, or interpersonal and social rhythm therapy) and the other half were assigned to collaborative care, which was a brief psychoeducational intervention. Intensive psychotherapy consisted of up to 30 sessions for 9 months, and collaborative care included 3 sessions over 6 weeks. About 66 percent of patients in all of the groups completed therapy. More patients in the intensive psychotherapy group recovered compared with patients in the collaborative care group, Miklowitz and colleagues report. The recovery rate at 12 months for patients in the intensive psychotherapy group was 64.4 percent; in the collaborative care group, it was 51.5 percent. The average time to recovery was 113 days for patients who received intensive psychotherapy and 146 days for those who received collaborative care, the authors add. The odds of a patient being clinically well during any study month were 58 percent greater with intensive psychotherapy than with collaborative care. The investigators found no significant differences in the outcome of patients in the three intensive psychotherapy groups. The researchers suggest that the cost-effectiveness of different models of psychotherapy for bipolar disorder should now be compared. |
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