Pete Earley

(9-21-16) This is the second in a three part series that I am writing about my recent trip to India to speak about mental health reform.

Mental health services in India are scarce and living conditions for many of those who are ill often border on being barbaric. This is especially true for women and children who find themselves homeless and abandoned on the streets or confined in facilities where restraints are commonly used and physical and sexual abuses are all too common.

During my short visit to Chennai for the three day summit, I wasn’t able to do much except visit a handful of local facilities and listen to personal stories that I later augmented with articles and news reports. Everyone readily admitted to me that India faces incredible challenges. Much of the problem is because of scale. India has a population of 1.3 billion, has more than two thousand different ethnic groups, and has two nationally recognized languages. Some 58% of its residents earn less than $3 per day, putting them under worldwide poverty guidelines.

As is true in other nations, serious mental illnesses – such as schizophrenia and bipolar disorder – are thought to be prevalent in seven percent of the population. In India that translates to multi-millions, yet there are only an estimated 40,000 mental health beds nationally in government and private hospitals. The widespread poverty in India causes high numbers of other mental disorders such as anxiety and depression. In the past decade, suicides have jumped 22 percent. It’s estimated that only one in four Indians have access to any sort of psychiatric care, and that is strictly among the middle and wealthy class.  In India, insurance companies do not pay for psychiatric care.

For the poor, there are little or no services and stories of abuse and neglect routinely surface. In 2001, a fire at a mental facility killed 26 persons who were burned alive chained to their beds. More recently, a children’s hospital came under public criticism when it was revealed that guards were knocking out the youngsters’ teeth so that they could better perform oral sex on the staff. Between 2010 and 2013, as many as 84 patients died in a single state-run mental hospital in one Indian state. All were thought to have curable illnesses but they died because of abuse, communicable diseases contracted in the mental hospital, poor sanitation, malnutrition, and lack of treatment.

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(9-19-16) This is the first of three blogs about my recent trip to India where I toured mental health facilities.)

“Individuals with mental issues are incapable of making their own decisions.”

“I disagree. They are not condemned to impaired thoughts 24/7 and their voice needs to be respected.”

It’s an argument that could be heard in any American city. But I was hearing it in Chennai, India during a three day conference on Justice and the Rights of Homeless Persons with Mental Health Issues.

I’d been invited to give the conference keynote and, unknowingly, my talk thrusted me into a spirited debate in India about patient rights.

Vandana Gopikumar, a co-founder of The Banyan, one of the largest mental health service organizations in India, had read my book, and invited me to speak. (More about this amazing advocate and The Banyan in upcoming blogs.) Of course, I spoke about my son, Kevin, and his recovery. Mid-way through my talk, I mentioned what I see as an ongoing feud in mental health circles in the United States.

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(9-15-16) Yesterday I reprinted a letter from a father about how Crisis Intervention Team trained officers had treated an individual in the midst of a crisis with respect despite the verbal abuse that he was yelling at them.  I am writing today about a completely different experience for individuals in New York City who are deemed “emotionally disturbed.”

Individuals with mental illnesses are being restrained in a mesh bag commonly called “the burrito.”

News about the restraining device surfaced earlier this year after a bystander posted a cell phone video of it on Youtube. (See video at end of blog.) The video shows a man lying on the ground with his ankles and legs bound with orange tape with both hands secured behind his back. He is surrounded by New York City Police officers who, after searching him, lift him onto a white body bag and bright blue lettering that they then zip around him, completely enclosing his body and head with only his feet extending from the end. After he is restrained mummy style, he is transported.

The full body restraint bag is being marketed under the name EDP Bag, an acronym for Emotionally Disturbed Person bag, and was created specifically for the NYPD, although it now is being marketed to other departments for $899 by a company called DeSantis Gunhide.

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(9-14-16) Here is a refreshing reminder why Crisis Intervention Team training for the police should be required in every jurisdiction.

When the police get it right
By M. Moss, first published in The Washington Post. 

“F— you pigs!”

This was last month. My son was on his side on the ground, in handcuffs, a police officer pinning down his legs, another officer holding down his upper body.

“F— you piiiiiigs!”

When it looked as though he might be scraping his face on the asphalt of the Washington & Old Dominion Trail bike path, the officers moved him, while holding him down, so his face was on the grass.

“Buddy, if you calm down, we’ll let you sit up.”

“F— you piiiigs!”

The joggers and bikers on the trail moved past, looking concerned but not stopping to turn the scene into a spectacle.

My son has a neurological disability. He didn’t ask for it, and learning to live with it has not been an easy task. He is also a big man — 6-foot-2, 180 pounds and fit. When he drinks, which is rare, he is unpredictable, aggressive and — though I hate the expression — a danger to himself and others.

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(9-13-16) A gadfly is a person who interferes with the status quo by posing novel, potently upsetting questions, usually directed at authorities. Mental health gadfly D. J. Jaffe, who along with Dr. E. Fuller Torrey frequently stirs up controversy in mental health circles, claims that Democratic presidential hopeful Hillary Clinton’s mental health plan, which I cited in an August blog, isn’t as good as the mental health legislation that could be voted on in the Senate this week. Meanwhile, Clinton’s rival — Republican Donald Trump — has not offered any ideas about fixing our mental health care system.

In addition to attacking Clinton’s plan, Jaffe and John Snook, executive director of the Treatment Advocacy Center (which was founded by Dr. Torrey), have criticized   greater federal funding of Mental Health First Aid, an eight hour course that helps ordinary citizens recognize mental illnesses. Some communities are using Mental Health First Aid rather than the 40 hour Crisis Intervention Team training for law enforcement.

Hillary Clinton’s mental health plan doesn’t compare to the bipartisan plan already on the table

by DJ Jaffe

Donald Trump has not introduced a mental health plan, so we can’t evaluate it. But Hillary Clinton did introduce a mental health plan. Unfortunately it is not  as good as the bipartisan Helping Families in Mental Health Crisis Act (H. R. 2646), which passed the House by a vote of 422-2, and should be taken up by the Senate this week. It is not even as good a bill as combining Senator Alexander’s Mental Health Reform Act (S2680) with Senator Cornyn’s Mental Health and Safe Communities Act (S2002) would be. 

The Clinton plan largely focuses on improving mental wellness in everyone, rather than helping the most seriously mentally ill. There are forty-three million Americans who have a mental health issue, but only ten million, have “serious mental illnesses” including schizophrenia and bipolar disorder. 140,000 of the seriously ill are homeless, 365,000 are incarcerated, and 95,000 who need hospitalization can’t get it. That is the problem we have to focus on.

 More money may not be the immediate answer. The federal government already increased mental health spending to $147 billion but at the same time, it made the ability to get care inversely related to the severity of the illness. The easiest to treat go to the head of the line for services and the seriously ill go to jails, shelters and morgues.  The Substance Abuse and Mental Health Administration (SAMHSA), encourages spending to go to irrelevant and useless programs and some that are actually harmful. H.R. 2646 puts a doctor at the helm of SAMHSA to try to stop that. The Clinton plan ignores the issue.  

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(9-12-16) Distraught, a Fairfax County resident threatening suicide seeks help.  Nearly four hours later – after being told no bed has yet been found – the resident is asked if he/she still feels suicidal. When the resident replies “no,” the resident is told that he/she could elect to go home or continue to wait until a bed can be found.

The resident leaves.

The family is frustrated. It wanted the resident to get help, not be sent home untreated. The resident (whose privacy I am respecting) had finally hit rock bottom and reached a point where he/she appeared willing to seek and accept help.

But that opportunity was lost.

After the tragic death of Virginia state Sen. Creigh Deeds’ son, Gus, who was sent home untreated because no local bed was available, the state created a bed registry that could be used to locate where beds were available. Since its creation, I have been assured that Virginia has sufficient beds. In fact, I was recently told that there are nights when there are empty beds.

But as this Fairfax example shows, people in need of treatment are still not being readily admitted. Based on emails and telephone calls that I have received, this seems especially true if an individual arrives at a mental health facility or hospital voluntarily seeking help and not because of a detention order issued by a magistrate that requires the local community service board to find a hospital bed.

Having patients wait for hours is one way to discourage them from being hospitalized. It also is a way to avoid admitting someone by declaring that a patient sitting in a waiting room no longer poses a risk and, therefore, doesn’t need to be admitted.

Because there is no data readily available that would show how many residents simply give up and leave after waiting for hours, it is impossible to identify who these patients are. But I suspect that many of them are much like the resident whose case I have cited above and verified. They are poor and seriously mentally ill, which makes treating them difficult. Some are intoxicated or high, compounding the problem. They are potentially troublesome patients who, more than likely, will end up costing a hospital money and/or depleting scarce county and state services. Many of them are “high utilizers,” which means they are in-and-out of emergency rooms and crisis centers several times a year.

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