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(3-27-20) Local, state and federal officials need to begin thinking outside the box if they intend to help homeless Americans, especially those with serious mental illnesses.

The trillion dollar recovery package proposed by Congress includes direct payments to those who qualify.  (Click here to learn how much you will receive.)

But many homeless Americans don’t have permanent addresses, direct deposit or bank accounts, especially homeless young people and those with serious mental illnesses.

I serve on the Corporation for Supportive Housing board of directors with Matthew Morton,  a Research Fellow at Chapin Hall at the University of Chicago, and an expert on youth homelessness. He’s written about options officials can take to get cash into the hands of homeless Americans. Some four million young people are without housing.

“You face extraordinary difficulties,” he writes about the young, “that most young people don’t and may not ever have to. Chances are, you first fell into homelessness through a path of trauma and family adversity. Now you have to manage the stress of not knowing where you will sleep or where your next meal will come from. You face the very real risk of being abused, exploited or trafficked. You endure repeatedly dehumanizing experiences that undermine your sense of self-worth. These hardships disrupt your ability to thrive during one of life’s most critical developmental windows. Now, add COVID-19.”

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(3-24-20)

What should a psychiatrist do when a patient, who has had symptoms of a serious mental illness but is currently stable, refuses further treatment?

Dr. David Kantor, a Canadian psychiatrist, sent me an email addressing this question. He explained there is a process in Ontario that permits doctors to override the patient’s choice before that patient regresses.

Please share your thoughts on my Facebook page about his email.

Evaluating An Individual’s Ability To Give Consent

By Dr. David Kantor, MD FRCP

Successful treatment of people with severe mental illness (SMI) such as schizophrenia, is inarguably a problem everywhere in the world. The primary reason for this is the fact that many of these patients (estimate by various literature accounts as between 40%-90%) lack insight into their illness. That is, they do not appreciate the fact that they suffer from the illness and/or that adequate treatment is necessary.

Different geographic jurisdictions worldwide have different mental health laws. A major aspect of how these laws differ is the degree to which the particular jurisdiction allows for involuntary treatment in this patient populations.

I am a psychiatric specialist in the province of Ontario, Canda. In Ontario, all medical treatment is dictated by the patient’s willingness or unwillingness to undergo the advised treatment – i.e consent to treatment.

However, Ontario laws demand that a patient’s capability to consent to treatment be assessed when there is reason to believe the patient may not be capable.

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(3-21-20) The chairman of the Fairfax Board of Supervisors announced today that the county where I live suffered its first death because of the coronavirus. The individual’s name was not given.

The Washington Post reported late today that a psychiatrist at the county mental health intake center had resigned after claiming he and other mental health workers there were not being adequately protected.

I had asked our local mental health officials and Sheriff Stacey A. Kincaid this weekend about safety steps being taken at the Merrifield Center For Community Mental Health and Fairfax County Adult Detention Center. I posted the sheriff’s safeguards this morning, but hadn’t heard from mental health officials.

I’m reprinting an edited version of the Post account about Psychiatrist Jason Williams sudden resignation.  Obviously this news is upsetting to me personally because two of my adult children work locally with persons with mental illnesses, one as a peer support specialist and the other as a mental health clinician for an area  housing nonprofit.

In the midst of this uncertainty, I received a promising email  from long-time local mental health advocate Joanna Walker with the National Alliance on Mental Illness Northern Virginia chapter that includes Fairfax County.

“I’m pleased to report that NAMI Northern Virginia will be using HIPAA Compliant Zoom Conferencing for our support groups. This morning I co-facilitated the first online  meeting of our Arlington Connection Recovery Support Group. This group was advertised to former group members only because it was a test of the software, however future family and peer support groups will be available to the public, with links on NAMI-NorthernVirginia.org. I really like the ability to see participants on video, and our meeting was very successful.”

What are your communities doing to insure safe procedures at mental health intake centers? Are your communities using video conferencing for support groups? Please share helpful mental health articles and information on my Facebook page.

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(3-21-20) In a telephone call yesterday, Fairfax County Sheriff Stacey A. Kincaid said she’d taken several steps to protect staff and inmates at the county’s Adult Detention Center from the COVID-19 threat. The jail can hold as many as 1,260 prisoners. It’s estimated that 20 percent have a known mental illness.

No local inmates have been found to have the virus.  Some jurisdictions, mostly in California, are releasing inmates being held for minor, non-violent offenses or reducing bail, but that has not happened in Fairfax. Sheriff Kincaid explained that the decision to free inmates would be made by the judges who ordered them detained, not her department.

I’d asked the sheriff about precautions after learning that inmates in federal prisons had to buy soap to wash their hands and after posting complaints by a prisoner in the nation’s “Super Max” penitentiary in Florence, Co., citing unsanitary living conditions.

Inmates at the Fairfax jail are being told to wash their hands repeatedly during the day, are not charged for soap, and cleaning at the jail has been increased, as has inmate screening.

While all visits to the jail have been curtailed to protect staff and visitors, inmates are being offered twice-a-week, 15 minute phone calls without being charged.

In an email,  the Sheriff’s Department Public Information Officer Andrea Ceisler elaborated on what actions the Sheriff has implemented.

“If an inmate were to be a presumptive case,” Ceisler wrote, “we would hold them in isolation for up to 14 days with ongoing Health Department consultation. For testing, we would send a respiratory specimen to the Health Department.

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VICE reported finding  “horrible physical conditions—from pests to raw sewage” in a 2019 story spotlighting conditions inside  the federal detention center in Manhattan.  (ACLU photo.)

(3-16-20) Like cruise ships and nursing homes, jails and prisons are prime breeding grounds for deadly outbreaks of the coronavirus. So, I was shocked this week when the Treatment Advocacy Center’s CEO John Snook relayed a message to me about how the federal Bureau of Prisons is reportedly charging inmates for soap.

The Bureau of Justice Statistics (BJS) estimated that 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons and 479,900 in local jails. That was in 2006 and, since then, the numbers have been growing. It is generally accepted that 383,000 prisoners across the country have a serious mental illness.

Shortly after the Covid-19 virus began making headlines, I received a letter from a prisoner being held in the BOP’s Administrative Maximum Facility (the ADMAX), the most secure unit in our nation located in Florence, Colorado.

Every three months, he explained, prisoners are moved into new isolation cells for security reasons. He was moved abruptly without explanation recently, being sent to a different cell on a Thursday. He immediately asked for cleaning supplies but was refused. Minimal cleaning supplies are dispensed on Wednesdays at the ADMAX, he wrote, so he had to wait even though his cell was filthy.

“When I entered, I turned to assess the damage and sweat needed to scrub my new cell without detergent, nor much needed disinfectant. I alway look at the toilet/sink comb when entering a random cell since it’s usually the nastiest thing in need of cleaning. Then the shower, where some guys masturbate, blow their nose, spit, piss, etc., and rarely clean, so the shiny stainless steel is buried in months and years of fossilized slime. Dog pound kennels are hygienically more human than our ADX cells. Not that animals deserve less. It’s just bewildering how some Americans demand better treatment for another species, than they do for our own.

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