Pete Earley

(1-5-22) Lisa Dailey, Executive Director of The Treatment Advocacy Center, answered the same four questions that I posed to Dr. Delphin-Rittmon, Assistant Secretary for Mental Health and Substance Abuse, and other mental health leaders at the start of the new year. Thank you Director Dailey for your responses.

Question One: What was Treatment Advocacy Center’s biggest accomplishment during 2021?

The second year of the pandemic presented a new and unprecedented challenge to our commitment to represent those with the most severe mental illness in every relevant conversation.

In a normal year, we know what this encompasses. In 2021, research began to demonstrate something very concerning: our specific population, and particularly those with schizophrenia, are at a much higher risk of death or severe illness due to COVID than any other population apart from the elderly. It wasn’t a modest effect. The data was absolutely clear that failure to prioritize vaccination for those with SMI in our public health response meant that many of our loved ones with SMI would literally die. We knew it wouldn’t be enough for people to simply be eligible for the vaccine; those most at risk did not know that they were at greater risk.

We were not seeing any efforts to acknowledge and address the unique hurdles to vaccination faced by those with severe mental illness.

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(1-3-22) Dr. Miriam E. Delphin-Rittmon, Assistant Secretary for Mental Health and Substance Use and head of SAMHSA, was kind enough to answer four questions for me as we enter the New Year, including a question that asked what drew her into the mental health profession. The same four questions were asked to leaders of several national mental health organizations and their responses will be posted in the coming days. Thank you Dr. Delphin-Rittmon for sharing your responses.

Question One: What was SAMHSA biggest accomplishment during 2021?

First, Pete, allow me to say thank you for the opportunity to share my thoughts in your blog about the work being done by SAMHSA. As you know, our country has been grappling with a behavioral health epidemic long before the COVID-19 pandemic added to the urgency of Americans’ needs. Consequently, I would say, SAMHSA’s biggest accomplishment has been in our work to scale up our policies, responses and resources to better meet those needs.

Through the Biden-Harris Administration, we have added more than $5.5 billion through our Substance Abuse Prevention and Treatment and Community Mental Health Services block grant programs. Part of the Mental Health Block Grant spending has entailed investing $825 million in 231 Community Mental Health Centers throughout the country. We also awarded 100 grants totaling $250 million to increase access to Certified Community Behavioral Health Clinics (CCBHCs) throughout the nation.

The CCBHC expansion grant program increases access to and improves the quality of community mental and substance use disorder treatment services. CCBHCs provide person- and family-centered integrated services, including 24/7 crisis intervention services for individuals with serious mental illness or substance use disorders, including opioid use disorders; children and adolescents with serious emotional disturbances; and individuals with co-occurring mental and substance use disorders.

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(12-28-21) My blog last week, Conservatives’ Criticism Of Housing First Is Wrongheaded. Yes, Hugh Hewitt, That’s You, drew this response, arguing that my “defense of Housing First seems more like a reaction to criticism from Hewitt than a nuanced understanding of Housing First’s inability to address the needs – including appropriate housing and treatment – for the serious mentally ill population.” (Meanwhile, thank you to whoever sent me a Christmas angel anonymous!) 

Dear Pete,

As fellow family members, advocates, and analysts, we were surprised to read your article attacking criticism of Housing First and your characterization of people who are concerned with Housing First.

At the same time, we see your article as an opportunity to bring clarity to an issue often charged with political and ideological divisiveness. Our Coalition, Hope Street Coalition, was created to address alternatives to street suffering and the drivers of homelessness, particularly untreated serious mental illnesses and addiction.

We recognize that the current system most often leaves this population unhoused, creating further harm for this vulnerable population and the community.

Even before the article begins an image depicts a black figure directing a man’s head away from a homeless man lying on the sidewalk, suggesting that those who disagree with Housing First are willfully ignorant and un-compassionate. We argue, however, that the exact opposite is true. We are concerned and even opposed to the unilateral, one-sized-fits-all of Housing First approach because we have not averted our gaze but have examined it squarely – particularly from the perspective of the unhoused seriously mentally ill and addicted.

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(12-24-21) Thank you Margaret Konopacki for sending me this email about your son and his enduring Christmas gift.

Dear Pete,

On New Year’s Eve December 24, 2016, my only child, David Martin, stood before our family Christmas tree with his guitar and announced that he had a very special gift for me, his mom.

He had a familiar twinkle in his eyes when he began singing “Maggie’s Song,” which he’d written about me. (Watch video below.)

Little did I know at that moment, this would be the last Christmas gift I would ever receive from my son. He ended his life on September 24, 2017 after just turning 30.

I believe he took his life due to the hopelessness that he felt. David was intelligent, kind, and gifted. But his mental illness convinced him that he was a failure who had let everybody down. I believe it was our mental health system that was a failure and let him down.

His death changed me. I refused to give up. To help others and keep my son’s memory alive, I created a non-profit called the Birdsong Foundation. It offers grants to Canadian musicians with mental illnesses and showcases their work. Our first album includes work by eleven Canadians and will be released in May 2022 along with a Canadian tour.

This Christmas I will think of of my son and listen to him sing “ Maggie’s Song.” I believe it is a tribute to all mothers and to motherhood. It shows the devotion and love of an adult child and his mother – perhaps the last person who still believed in him and who did not give up on him.

Along with my therapy dog named River – to remind me to “go with the flow” – I will ask myself what can I do to prevent other sons and daughters from dying, and I will tell David’s story.

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(12-21-21) I’ve always argued that using “dangerousness” alone or as the primary legal standard for involuntary civil commitment is foolish. I do not believe anyone can accurately predict dangerousness. This doesn’t mean I oppose all criteria intended to protect individuals from being abused and unnecessarily hospitalized. I have written before about how other countries lean more on “need for treatment standards” rather than solely sticking with dangerousness. (click here to read about Australia and here about Europe.)

In 2010, Drs. Megan Testa and Sara G. West published a well-researched paper that chronicles the abuses that led to the dangerousness criteria and the unintended consequences that criteria has created.

“Although the shift toward strict dangerousness criteria for civil commitment was based on the honorable intentions of protecting the rights of individuals with mental illnesses and ensuring that they received effective treatment delivered in the least socially disruptive settings, serious unintended negative consequences have occurred…Current civil commitment criteria force relatives to watch their loved ones go through progressive stages of psychiatric decompensation before they can get them any help at all.”

Strict adherence to dangerousness has increased homelessness and incarceration of individuals with serious mental illnesses, they conclude.

Sadly, most major mental health organizations shy away from discussing civil commitment, except for the Treatment Advocacy Center. One of its board members, Evelyn Burton, published an editorial this month in The Baltimore Sun arguing that Maryland’s civil commitment laws need to be reformed. I suspect she is speaking for many others who are watching a loved one grow sicker and sicker without any way to intervene.

Treatment Before Tragedy; Reform Maryland Involuntary Commitment Law

Guest commentary for The Baltimore Sun written by Evelyn Burton

Involuntary psychiatric hospital treatment can help prevent homelessness and incarceration and is a potential lifesaver for those in the midst of a psychiatric crisis and people around them — people like Sara Alacote, Ismael Quintanilla and Sagar Ghimire, who were killed in Baltimore County in May by a neighbor with severe, untreated paranoid delusions. It is a safety net for those whose mental illness makes them unable to recognize their need for hospital treatment and can lead to successful community living.

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(12-17-21) I’m a strong advocate for Housing First programs with wrap around treatment services that help Americans who are chronically homeless, especially those with addictions and/or mental illnesses.

Housing First recognizes that putting a roof over someone’s head is the first step to recovery. Common sense tells us that if you are psychotic and/or addicted it is much more difficult to overcome those problems if you are sleeping on the streets.

Unfortunately, Housing First is under attack by a cabal of conservatives. Most recently, radio talk show host Hugh Hewitt launched an unwarranted diatribe against Housing First in The Washington Post. While arguing against passage of President Biden’s Build Back Better program now before the Senate, Hewitt warned that Biden’s bill would squander $170 billion earmarked for development of affordable housing if approved as passed by the House.

“Billions of dollars must not be captured by the radical advocates of Housing First, an innocuous, even just-sounding slogan concealing a counterproductive radical agenda hostile to the idea of placing any conditions on aid for the homeless,” Hewitt proclaimed.

Until I read that comment, I didn’t realize that I and hundreds of other parents and social workers who support Housing First are considered “radical advocates.”Click to continue…