Pete Earley

Image by Clker-Free-Vector-Images from Pixabay

FROM MY FILES FRIDAY: Since the publication of my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, I have been fortunate enough to speak in Brazil, Iceland, Portugal, India, Poland, and Canada. Whenever I visit a foreign country, I ask how individuals with mental illness are treated. What community services are available? How do these countries handle the fine line between protecting civil rights and getting those who are seriously ill the help they might need? I posted a variation of this blog in March 2014. What experiences have you had in foreign countries? Please let me know in the comment section on my Facebook page.

Do Europeans look at mental illnesses differently from us?

I was in Warsaw, Poland, last week delivering a speech to an international group whose members appeared shocked when they heard my personal story about how my son and I were turned away from a hospital emergency room when he was psychotic. The audience continued to be surprised when I added that there were 365,000 persons in the U.S. with severe mental illnesses in U.S. jails and prisons, making jails the largest public mental facilities in America. Jaws dropped when I said a recent study found that the odds of someone getting a hospital bed vs a jail bed were three-to-one in favor of jail.

I’m always curious about how other nations balance civil rights and involuntary commitment. Poland adopted the World Health Organizations’ standards:

Involuntary admission is permitted only if both the following criteria are met: – there is evidence of mental disorder of specified severity as defined by internationally accepted standards; – there is a likelihood of self-harm or harm to others and/or of a deterioration in the patient’s condition if treatment is not given.

Given that most U.S. states use similar standards, I wondered why my European audience found my personal story and U.S. incarceration rates so surprising. Why haven’t their jails becoming dumping grounds?

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(3-14-21) In a recent blog questioning whether states need to build new psychiatric hospitals, I mentioned CooperRiis and Gould Farm  as examples of long-term residential facilities that offer compassionate care.  Virgil Stucker, the nation’s leading authority on healing communities, responded with this guest blog. 

Consider the Concept of a Mental Health Recovery College

By Virgil Stucker

Pete, thank you for your thoughtful blog about the chasm in the care continuum between inpatient hospital acute care and community-based care. As you can imagine, I share your concerns.

Society’s long-term care and treatment options for individuals with complex and persistent mental illnesses have too often been the streets, jail or the homes of aging parents.  About 8.4 million mentally ill adults, with an average age of 45, appear to be living in various states of chronicity with varying levels of parental support and modest Social Security Administration funding.

Some of these individuals may benefit from a local PACT (assertive community treatment) programs, which are designed to keep them out of a hospital and to provide access to some level of case and medication management. Some may be in a group home; some of these homes are good, but many are like small warehouses that are more isolating than state hospitals used to be. Many could have benefited had they had the opportunity to experience a robust mental health recovery program, the best of which offer multi-stage treatment options and actually help their residents obtain training, employment and independent living. Click to continue…

Photo by Tulsa World newspaper

FROM MY FILES FRIDAY:  I was in my early 20s, the first time I visited a prison and saw how inmates with mental illnesses were being treated. I wrote an expose for The Tulsa (Okla.) Tribune, that sadly has since closed. In this blog first posted in May 2010, I recalled the reaction my expose received with the response that came after I wrote a story about an abandoned cat. The contrast is a reminder of how important it is for us to demand compassion for those who are ill. 

Prisons, Cats, and an Oilman: Where Is Our Compassion For Others?

I have never forgotten my first trip into the white knuckle hell of the Oklahoma State Penitentiary (Big Mac) in McAlester, Oklahoma, and how it changed my life. More than a decade later, I would write The Hot House: Life Inside Leavenworth Prison, which recounts a year that I spent off-and-on inside a federal maximum security penitentiary describing everyday events. I have visited dozens or jails and prisons since then and am always shocked when I see how little has changed in many of these facilities when it comes to housing the mentally ill, the fastest growing segment of our prison populations.

During the mid-1970s, psychotic inmates in McAlester were shot with heavy doses of Thorazine that turned them into drooling zombies who rarely left their bunks. Many slept 23 hours per day in a drugged out trance.

I was so outraged I wrote an expose for the Tribune that I hoped would prompt reforms. It was greeted by silence. There was no community uproar, no letters to the editors, not a single reaction from an elected official.

Shortly after my series was published, a cat crawled through a hole into a warm spot seeking shelter. What the cat didn’t realize was that it had taken refuge inside a hollow portion of a state landmark called The Golden Driller.

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(3-8-21) Virginia legislators recently passed legislation that will allow defendants to introduce evidence about their mental state at the time of an alleged crime. One of the key advocates who pushed for passage was Anna Mendez,  president of Mental Health America in Virginia and the organization, Partner in Mental Health.   Does your state allow defendants to disclose a mental illness during a trial?

Increasing  Access to Justice for People with Mental Illness – The Most Significant Change to Virginia Criminal Procedure in Recent History

By Anna Mendez

On Saturday, February 27, 2021, the General Assembly passed legislation (see bill below) that will allow defendants with mental illness (as well as intellectual or developmental disabilities) to introduce evidence in court pertaining to their diagnosis and how it may have impacted their mental state at the time of the alleged offense.

This legislation also requires judges to consider mental illness, intellectual disability, and developmental disability during bail and sentencing and requires training for court-appointed lawyers to help them understand the unique responsibility of representing defendants with such conditions. It nullifies a Virginia Supreme Court ruling from 1985 that banned the introduction of such evidence during a trial.

The harm caused by 1985 court ruling is incalculable. For 36 years, the accused were denied a necessary tool to defend themselves.

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A modern asylum: the Worcester Recovery Center and Hospital

Dear Pete,

Why not bring back a state hospital system where clients have a safe place to live, can progress, work, and receive compensation? Involve patients rights groups, and THROW AWAY the “our pill can cure everyone” lie bought by Congress and even the Surgeon General. Big Pharma sure sold us the Brooklyn Bridge and we have paid way too much for it. Our loved ones still are paying for it.

“There used to be state hospitals. some better than others. I can only cite the old Napa State Hospital in California. It used to be where individuals could stabilize in locked units (for their safety and other’s). As they became more stable, they moved to less restrictive units where they could gain employment or move into the community. As they continued on their recovery path, they could get housing in the community. At one point, the hospital had a working farm where individuals could work, including a dairy, garden, etc. This community had their own coin laundry, canteen, salon, a lake you could walk to and sit by, tennis courts….and a general post office, all on grounds.

“I worked there, long after it ceased to be a working and partially self-sustaining entity. By then the ‘patients’ had nothing to look forward to, nothing to increase their self-esteem, nothing but the same daily routine every day. If they did improve and work, they had to be paid minimum wage but many were not reliable, not fire-able, in short, everyone lost.”

Sincerely, Vickie Williams, wife, mother, daughter, Psychiatric Tech, BSN/RN retired.

Why does talk about bringing back state hospitals make me nervous?

I suggested in my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, that we needed to reconsider shuttering state hospitals.

I am in favor of repealing the IMD Exclusion that prevents most psychiatric facilities from getting Medicaid if they have more than 16 beds. We are in the midst of a national psychiatric bed shortage. As was pointed out last week in a Manhattan Institute analysis, it’s obvious that many individuals with serious mental illnesses, such as schizophrenia, are not getting treatment in community settings because they need longer term care. Plus, a lack of long-term beds contributes to jails and prisons housing individuals whose only real crime is that they got sick.

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Photo by Elina Krima from Pexels

(2-26-21) A conservative think tank has joined a growing national chorus calling for an end of a federal rule that discourages states from building psychiatric hospitals and providing long-term, in-patient care for the seriously mentally ill.

The Manhattan Institute argues in a new report released this week that the Medicaid’s IMD Exclusion rule has outlived its usefulness and should be repealed.

President Trump’s President’s Commission on Law Enforcement and Administration of Justice and the Interdepartmental Serious Mental Illness Coordinating Committee created by the Obama Administration also have called for dropping the rule.

What is the IMD Exclusion and why should you care?

It’s a rule that has been around since 1965 that discourages states from building and supporting large psychiatric hospitals and pushes them instead to provide community based treatment. The so-called “16 bed rule” accomplishes this by denying states Medicaid reimbursement for adults between the ages of 22-to-64 if they are treated in psychiatric hospitals and other facilities which have more than 16 beds. States must pay 100 percent of the cost of care for the seriously ill in most long-term psychiatric hospitals, compared to 50 percent for those treated in the community.

The new report’s authors, Stephen Eide and Carolyn D. Gorman, provide a thoughtful argument in favor of dumping the rule.

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