(5-30-19)

Dear Pete,

As I read your blog piece on Assisted Outpatient Treatment, I asked myself, what are we committing people living with serious mental illness to?

And why wouldn’t we start with practices that promote engagement, and offer people help that they find meaningful?

I am a clinical social worker who worked in a specialty clinic for people with psychotic disorders for 17 years. I’ve been involved with clinical training and education of mental health professionals for 24 years, in academic psychiatry and social work.

In my clinical practice, I provided psychosocial assessment, individual and group psychotherapy, clinical case management, and family support and psycho-education.

Throughout my career, I’ve always promoted the use of evidence-based practices that focus on engagement and recovery for people living with severe mental illness. These include family psycho-education, which I call the forgotten evidence-based practice. It is not the same as the National Alliance on Mental Illness’s Family to Family program.

It’s engagement of the whole family in treatment, at a level the person with the illness is comfortable with. It is emotional support, education, and skills training.

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(5-27-19)  Ranya Abdelsayed spent a year in Afghanistan targeting senior al-Qaeda and Taliban fighters at one of the Central Intelligence Agency’s most important bases. Less than 48 hours before she was to return home, the 34 year-old fatally shot herself in the head.

The CIA maintains a Memorial Wall in the lobby of its Langley headquarters to recognize those who “gave their lives in the service of their country,” but a recent spat reveals a lingering prejudice and stigma about mental illnesses.

The Washington Post, which broke this story,  quoted a longtime CIA historian, who retired in 2016, objecting to her name being approved and a star representing her being added to the wall:

Abdelsayed’s inclusion violates the agency’s own criteria — and her star “must absolutely come off the wall.”

The famed memorial, he said, is reserved for deaths that are “of an inspirational or heroic character” or are the result of enemy actions or hazardous conditions…“There’s been an erosion of understanding in CIA leadership for at least two decades about what the wall is for and who is it that we’re commemorating…Now we have a suicide star on the wall. That’s not what the wall is for. Suicide is a great tragedy, of course. But the purpose of the wall is not to show compassion to the family. It’s to show who in our community is worthy of this ­honor.”

Yep, you read that right: “Show who in our community is worthy of this honor.”

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Deputies chased an unarmed Ethan, who had schizophrenia, into this camp where he was fatally shot. (Photo by Young Kwak/INLANDER)

(5-12-19) Justine Murray told me after she’d learned her son, Ethan, had been fatally shot that she would use his death to advocate for better police training and mental health care services.

I posted a powerful video of her earlier this month that was recorded shortly after she was informed that her 25 year-old son had been killed by a Spokane County Sheriff’s deputy. The officer was responding to calls about a young man running around without a shirt on and ‘acting strange.'” He pursued Ethan into a homeless camp. Ethan had schizophrenia and was not armed with any weapon when he was shot multiple times.

In a detailed article published by the Inlander, she recounts Ethan’s struggles. Anyone who reads it will learn about how parents struggle when a child gets ill.  “There’s other moms, other people that need help,” she told the publication. “I don’t think there will ever be closure because there just isn’t. So I’m just turning it into advocating.”

Bravo Justine! Keep Ethan’s memory alive.

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(5-20-19) A new publication by the Substance and Mental Health Services Administration (SAMHSA) about involuntary commitment reveals how dramatically Dr. Elinore McCance-Katz is changing the federal government’s view of Assisted Outpatient Treatment.

Prior to Dr. McCance-Katz’s 2017 appointment to the newly created position of undersecretary for mental health and substance abuse, AOT was not a federal priority. AOT proponents, such as Dr. E. Fuller Torrey and D.J. Jaffe, accused SAMHSA of funding anti-AOT organizations.

Now SAMSHA is promoting AOT in a report released last month entitled Civil Commitment and the Mental Health Care Continuum: Historical Trends and Principles for Law and Practice .

AOT requires someone, who meets criteria, to undergo court-supervised, mandatory treatment in a community setting. Its opponents frequently call it “forced medication” although AOT can require other treatment services besides or in addition to medication. Its supporters argue it is necessary to rescue individuals with serious mental illnesses who “lack insight” and do not understand they are ill.

Mental Health Weekly, a subscription service that reports about litigation, legislation and corporate policy affecting mental health, interviewed Dr. McCance-Katz about the new report. It quotes her stating that the purpose of the new SAMHSA report “is to start to talk about the needs of the population with serious mental illness [SMI] and how we can best meet those needs.”

“What we’re trying to do is discuss circumstances and conditions under which individuals might need commitment and how that process might be undertaken.”

The SAMHSA report looks back more than 40 years to the closure of state hospitals and the failure of states and the federal government to fully support community based care. It reports there are insufficient hospital beds for Americans with mental illnesses. It suggests AOT laws can be a successful alternative to a lack of beds and postulates that AOT laws can force states to better fund better community services. The rational: if someone is ordered by a judge to undergo treatment, then community treatment must be provided.

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(5-16-19) The blog I posted on Mother’s Day announcing Thomas Silverstein’s death in Colorado from heart complications, sparked a flurry of personal emails from retired and current federal Bureau of Prison employees whose opinions I respect.

Many of whom I had interviewed in 1987-89 when I was doing research inside the U.S. Penitentiary in Leavenworth for my book, The Hot House: Life Inside Leavenworth Prison.

Several complained that I had written an overly sympathetic and incomplete portrait of Silverstein who had spent 36 years in isolation, believed to be the longest of any federal prisoner. They argued that I failed to document how dangerous he was and why isolationing him was necessary.

In retrospect, I agree there were incidents in Silverstein’s life that I should have posted to be fair. I omitted them, not because of any ill intent, but because I was focusing in my blog about his three decades and more of isolation and our 32 years of correspondence about his life behind bars.

While the murder of Correctional Officer Merle Clutts was the impetus for putting Silverstein under “no human contact” status, I failed to explain that he had already been convicted of brutally murdering three fellow prisoners, although his first conviction was later overturned.

An official involved in isolating Silverstein said the BOP couldn’t risk releasing him into the general prison population or even into solitary confinement in a special housing unit where other prisoners were kept because of his demonstrated history of killing.

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(5-14-19) I’m not interested in endorsing any presidential candidate nor getting involved in a conversation about partisan politics.

My focus is on seeking better mental health care for all Americans.

Last Friday, I happened to see Morning Joe on MSNBC when Democratic hopeful Sen. Amy Klobuchar (Minn.)  was a guest.

She told the hosts and viewers that improving our mental health care system and addressing the opioid crisis were her top priorities. She explained how deinstitutionalization and a lack of proper funding for community care had lead to homelessness and the inappropriate incarceration of persons with serious mental illnesses. (Click here to view her segment.) 

Ohio governor John Kasich mentioned the need for better mental health care during the 2016 campaign, as did Hillary Clinton, but Sen. Klobuchar is the first presidential candidate this time around, who I have heard, making it a priority.

During her televised appearance, Sen. Klobuchar spoke openly about mental health issues in her own family.

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