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(7-8-16) Dear Pete,  In your recent blog post, “Violence and Mental Illness: An Uncomfortable Subject But A Grim Reality For Some Families,” there are frequent references to “warning signs.” Please tell us what all the warning signs are. –K. Y.

I passed this email request to  my friend and fellow advocate Doris Fuller, Chief of Research and Public Affairs at the Treatment Advocacy Center, who wrote poignantly and eloquently in the Washington Post about her own daughter’s illness and eventual suicide. Here is her thoughtful reply. 

Red Flags for Family Violence

Risk factors

Most people with serious mental illness are not violent. However, a small percentage not being treated may be violent toward family members or others. According to Surviving Schizophrenia: A Family Manual, the three most important predictors of violence are:

• Past history or threats of violence, against family members or others;
• Concurrent alcohol or drug abuse; and
• Failure to take prescribed antipsychotic medications.

Additional risk factors that have been found to be significant are:

• Being 20 to 35 years old
• Delusions of being persecuted, watched or attacked (“paranoia”)
• “Command hallucinations” that order the person to engage in a specific behavior (e.g., hearing a “voice” that orders the person to commit a violent act to end world hunger)

As the number of risk factors present increases, risk increases.

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(7-6-16)  Mental health activist Leah Harris has written and is performing a one woman show about family trauma based, in part, on her childhood experiences with her mother who had schizophrenia. Performances begin July 9th and run until July 23rd in the Washington D.C. area. Congratulations Leah!

The playwright with her mother and grandmother, 1977.

Why I’m Doing a One Woman Show about Inherited Family Trauma

By Leah Harris

I was raised by Jewish grandparents who grew up during the Great Depression. (I guess this makes me an honorary Baby Boomer, even though I’m technically Generation X.) My grandmother loved to tell me stories told to her by her father, my great-grandfather Max Schumacher, who emigrated from Poland to the US in   1914, and died before I was born.

“Your great-grandfather was sitting on the stoop with this little girl, and a Cossack rides by on his horse and pop! shoots the little girl in the head, killing her. He never forgot that day. Soon afterwards, he came to America. If he hadn’t, he most likely would have been killed in the Holocaust.”

“Grandma, what if the Cossack had shot great-grandpa Max instead of the little girl?”

“Well,” she’d say, “none of us would be here.” It made my head hurt to think about it too much.

As a child, I would sometimes get annoyed at my grandmother, because she told the same exact stories over and over again. I could recite them by heart. But today, I am grateful for my her storytelling. Our family stories are firmly implanted in my consciousness. They have formed the seeds for my creative work delving into the nature of trauma and memory.

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(7-5-16  A second prisoner with mental illness dies after being held on a minor charge in the Hampton Roads Regional Jail, which already is being sued for negligence in another troubling death. When two investigative reporters learn about this second incident, state officials stonewall, hiding behind HIPAA which they claim prevents them from releasing any information. Meanwhile, the Office of the State Inspector General and the disAbility Law Center of Virginia, which have the authority to investigate inmates deaths, stay mute.

Thankfully, Richmond Times Dispatch Reporters K. Burnell Evans and Sarah Kleiner, who have been doggedly investigating Virginia’s mental health care system, set out to learn the identity and background of this anonymous prisoner. 

Had it not been for them, it is doubtful that anyone would have bothered to learn any information about the deceased.  Their story reveals how easily it is for individuals with mental illnesses to be marginalized in Virginia. It also raises additional questions about the leadership in state agencies that are responsible for caring for Virginians with mental illnesses. 

State fails to notify family after woman dies at Central State Hospital

BY K. BURNELL EVANS AND SARAH KLEINER

Richmond Times-Dispatch July 2, 1916

DINWIDDIE, Valerie Anderson was buried as she died — quietly and alone, in the care of Central State Hospital workers.

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(7-4-16) This is the second analysis of Rep. Tim Murphy’s mental health reform legislation that could be voted on as soon as tomorrow in the House.) 

AN OPEN LETTER TO ADVOCATES ABOUT THE MURPHY/JOHNSON  BILL

BY DEBBIE PLOTNICK, MENTAL HEALTH AMERICA

Dear Fellow Advocates:

It’s time to step back and take some credit. Acknowledge that your efforts have made a significant difference, even though no one has gotten everything they’ve wanted. But your efforts have had very positive results. Then gather your strength to not only beat back more of what you don’t want, and what you find hurtful, but also to fight for more of what you know is true and right, and for what you do want.

Look closely at where things are presently, not only where you wish they were, and just how far they have yet to go. Stop and really assess, don’t get stuck on where things were. Look at pending legislation in terms of existing law and regulation, and then think about what has the potential for good, as well as for bad. But most importantly, and hardest of all, is look beyond personalities and propaganda. Follow your own good counsel to present. Be in the here and now as you fight for what you passionately believe should come to pass (no pun intended).

What follows is detailed and nuanced. I respectfully ask you to please read it and then critically weigh what you think, and consider how you’d like to proceed. Maybe something will change, maybe everything will change, and maybe nothing will change. But it is my sincere hope that by reading this you’ll have a better understanding of where things are now, how they got there, and the important role advocacy has played, and can still accomplish.

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(7-1-16) The House is expected to vote on Rep. Tim Murphy’s Helping Families In Mental Health Crisis Act early next week. I’m publishing two blogs about the bill, which is being called the first major reform in decades of our mental health system. D. J. Jaffe initially strongly supported the bill but had doubts after it was revised — although he still backs it. On Monday, we will hear from an advocate who initially opposed the bill but later endorsed it after it was redrafted.) 

Helping Families In Mental Health Crisis Act

An Analysis by D. J. Jaffe, director of Mental Illness Policy Org.

I have been asked whether people should support the Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646)  which will shortly come to a vote in the House. At this point, the decision is not, “how does this bill compare to previous versions of the bill?” It is clearly very much weaker. The question is: what is the net impact on “adults” with “serious” mental illness, the population we advocate for? Positive or negative?

I do come down on the side of supporting.

Others may disagree with our conclusion because they are focused on different populations. Mental Illness Policy Org is focused on the 4% who have the most serious mental illnesses, primarily schizophrenia and treatment-resistant bipolar. Most community programs refuse to serve these ‘high-needs’ patients. The seriously ill are the ones most likely to become victimized, incarcerated and homeless. Put another way: throwing money at mental health does little for the seriously ill. Schizophrenia and bipolar cannot be predicted or prevented. The treatments adults with them need, for example hospital care, is much different from children with mild ADHD or adults with “lived-experience” need. So that is the lens we look through to analyze the bill.

Rep. Murphy, who originally authored the bill, is a hero who never gave up advocating for the most seriously ill. But late in the process, Energy and Commerce Committee chair Fred Upton, allowed Ranking Member Frank Pallone to insert numerous provisions–some merely wasteful, others problematic– at the behest of the mental health industry and to remove numerous provisions that would require them to serve adults with serious mental illness. But there are still provisions that are very helpful to the seriously ill.

Rep. Murphy’s bill will be voted on by the entire house after July 4^th recess. No news on when or if the Senate will consider The Mental Health Reform Act (S. 2680), a semi-companion bill.

Following are provisions still in the bill that could affect adults with serious mental illness grouped into four subjective categories which you may agree or disagree with.

1. Definitely good provisions
2. Potentially beneficial provisions that really can’t be judged
3. Useless provisions
4. Potentially harmful provisions

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