The conditions that I found on the ninth floor of the Miami Dade Detention Center were shocking, but does Virginia treat its prisoners with mental illnesses any better? How about your state?

     If you’ve read CRAZY: A Father’s Search Through America’s Mental Health Madness, you know that inmates in Miami’s C wing were housed under what jail officials admitted were “medieval” conditions. Stripped naked, as many as five or six men were held in two man cells that were bone chilling cold because of a design flaw. Often the water didn’t work, so thirsty prisoners drank from toilets. The day I accompanied the jail’s part-time psychiatrist on his rounds, he spoke to each prisoner an average of 12.5 seconds.

So how do jails in my own state compare?

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FROM MY FILES FRIDAY: The senseless  murders at the Navy Yard reminded me of another horrific shooting that deeply touched my family’s life. Seven years ago, Master Police Officer Michael Garbarino and Detective Vicky Armel were fatally shot by Michael Kennedy, a young man with untreated mental illness. They were the first Fairfax County Police officers kiilled in the line of duty in the department’s 67-year history. Here’s a slightly edited reprint of an article that I wrote for The Washington Post. 

Thank You, Detective
Vicky Armel Took Up for My Son When the System Wouldn’t

By Pete Earley
Friday, May 12, 2006 

Fairfax County Police Detective Vicky O. Armel, who was murdered Monday during a shooting rampage by a troubled teenager, had helped people with severe mental illnesses. I know because she helped my son.

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     I was in Dallas giving a speech when news broke that Aaron Alexis had heard voices and appeared to have a mental illness. I was asked about the Navy Yard shooter during interviews with the local NPR affiliate at KERA radio and with the Dallas Morning News. While I always point out that persons with mental illnesses are more likely to be victims of violence rather than committing it, I took a different approach in both interviews.
     I said we need to acknowledge that some individuals are dangerous but what keeps most of them from acting out is that they get meaningful treatment. I hoped to tie the need for treatment to these horrific and reoccurring tragedies.
    Fortunately, NPR’s Krys Boyd and the Dallas News’ Christina Rosales didn’t sensationalize my remarks as they easily could have.

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A GUEST BLOG: A Hopeful Color For Mental Health Awareness

By Shannon Jacuzzi 

I lost my younger sister to suicide in 2004.  It was a shock.  She was 36.

I wanted to do something.

Stacey

Stacey’s illness presented postpartum and unexpectedly.  Her diagnosis: Bipolar Disorder I.

When my sister was a child, she was not diagnosed with a mental illness.  I remember her having some schoolwork difficulties and some going back and forth between parents who were divorced, but she had no diagnosis.  During her teenage and high school years, my sister was known for her outward beauty and socializing popularity.  Grades continued to be difficult through college, and sometimes she slept late.  However, it wasn’t until after she married and was postpartum with her second child that symptoms uncovered a brain-related condition.  Paranoia and frenzied activity began with a business idea.  She experienced her first hospitalization.

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FROM MY FILES FRIDAY: A year ago, I published this letter from a young woman dealing with her’s father’s mental illness and her own. I hope you find it as compelling as I did and still do.

Hi Pete Earley,

…I came across your book while looking for a source of comfort during my own family’s time of need. Two months ago, my dad was finally forced into treatment for his undiagnosed severe bipolar disorder and coexisting extreme alcoholism. My mother and I (I am an only child) have been trying unsuccessfully for years to get him help.

In order for him to finally be involuntary subjected to treatment, he had to have a major traumatic psychotic episode and had to contact Help 4 Addiction for his alcohol rehabilitation. He had a previous psychotic episode earlier this year that landed him in a mental health facility for one week. But the latest one proved even more traumatic to all of us.

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Dr. Tom Insel is stirring the pot again!

You might recall that the director of the National Institute of Mental Health upset many in psychiatry when he dismissed the DSM-5, the so-called Psychiatry Bible, in an April 29th blog  just weeks before the new edition was scheduled to be published. (In addition to his original blog, you might wish to read the New Yorker’s take on Insel’s words.)

Now Dr. Insel has published a blog that questions the long term value of anti-psychotics.  For those of us whose family members have been helped by medication, his comments are troubling.  Each time my son has stopped taking his medication, his symptoms have returned and he’s gotten into trouble. I’ve always known there may be adverse side effects. We have discussed them. The question that Dr. Insel didn’t answer is how are we to know beforehand when and if someone can reduce or stop taking their medication?

My friend, Dr. Dinah Miller, one of the author’s of the popular blog, Shrink Rap, raised this question when she reacted to Dr. Insel’s blog.

So perhaps you’ve heard that people with certain mental disorders need to stay on their medications forever.  Certainly, some do — they stop their medicines and each time they try that experiment they end up sick — in the hospital, in jail, on the street, or simply festering in the basement.  But some people stop their medicines and they don’t get sick, so clearly, not everyone with a given diagnosis must stay on medicines for life, but we don’t have a way of knowing who needs them and who doesn’t.  We know risks for populations (maybe, to read Dr. Insel’s blog, we don’t know them as well as we thought), yet we know nothing about a given individual until a doc stops the meds or the patient goes off them on their own.  We also know that the medicines have risks.  How much risk?  Who knows.  Here, one figure sticks: of those who remain on an older generation antipsychotic (Haldol, thorazine, prolixin) for 25 years, 68% will get tardive dyskinesia.  And that figure doesn’t say anything about dose.

Because medication is such a controversial issue, I’m not going to interpret what Dr. Insel wrote. Instead, you should read it for yourself.

Anti-psychotics: Taking the Long View

By Thomas Insel on August 28, 2013