Dorothea Dix, Mental Health Pioneer June 8, 2013Posted by Crazy Mermaid in Book Reviews, Dorothea Dix.
Tags: Dorothea Dix
1 comment so far
As I was doing research on the history of mental illness, I kept coming up with obscure references to a woman named Dorothea Dix. She seemed to have a lot to do with treatment of mental illness, but it was difficult to find out much about her. She wasn’t in many of the history books I was reading at the time about mental illness. Who was this woman? Why hadn’t I ever heard of her?
Dorothea Dix was a teacher who began a second career as an advocate for mentally ill at the age of 39, which was spinster-hood back in the mid 1800’s. She had volunteered to teach Sunday school to a bunch of women inmates at East Cambridge Jail in Massachusetts. What she found there changed her life forever.
She couldn’t believe the horrible conditions the inmates were kept in. There was no distinction made between criminals, mentally retarded, and mentally ill prisoners. All were kept together in filthy conditions. She asked why the prisoners were kept in such horrible conditions and was told that the insane don’t feel heat or cold (Viney & Zorich 1982). From that point forward she dedicated her life to improving the lot of the mentally ill.
Earlier in her life, she had befriended two men who became powerful politicians. One was the Governor of Massachusetts. She made extensive and copious notes about the abominable conditions in the jails and reported her findings to the Massachusetts legislature, begging for more money to improve their lot. She got the funding, and after the mental hospitals in Massachusetts were expanded and cleaned up, Dorothea went to the other States and began her method all over again. She was successful in cleaning up the conditions of the mentally ill in the United States, and then went to Europe and did the same thing. All in all, her contribution to improving the treatment of the mentally ill was enormous.
The reason we can’t find much about her in the history books was because she avoided the spotlight, refusing to take public credit for her work. Despite the extensive funding she managed to secure for hospitals, she refused to have any named after her. She refused to have her name on most of her publications. She was embarrassed if anyone tried to express gratitude for her work and its effect on their lives. And the medical community hasn’t recognized her in general because they think she doesn’t deserve acclaim because she didn’t contribute to our understanding of the nature of mental disorders. Regardless of history’s treatment of her, we owe her a great debt.
In April of this year, a new book by Jane Kirkpatric came out about this amazing woman. Available through Amazon, the site address is as follows: http://www.amazon.com/One-Glorious-Ambition-Compassionate-ebook/dp/B009MYATDI/ref=sr_1_1?s=books&ie=UTF8&qid=1370709851&sr=1-1&keywords=one+glorious+ambition+the+compassionate+crusade+of+dorothea+dix#reader_B009MYATDI. I hope you enjoy it as much as I did.
The DSM-5 May 21, 2013Posted by Crazy Mermaid in DSM 5, mental illness.
Tags: DSM 5, mental illness
On May 18, 2013, the American Psychiatric Association released its latest version of the Diagnostic and Statistical Manual of Mental Disorders, called DSM-5. This manual provides a common language and standard criteria for the classification of mental disorders. It is relied upon by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers.
It is news, then, when the National Institute of Mental Health’s (NIMH) director, Dr. Thomas Insel, said they will no longer be using the recently updated manual. In his latest blog entry, Dr. Insel diagnosed the problem with the new manual as follows: “The weakness is its lack of validity”.
Dr. Insel had the following to say about the new manual:
“Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:
- A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
- Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
- Each level of analysis needs to be understood across a dimension of function,
- Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.
It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.
That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system. The best reason to develop RDoC is to seek better outcomes.
RDoC, for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning. Many NIMH researchers, already stressed by budget cuts and tough competition for research funding, will not welcome this change. Some will see RDoC as an academic exercise divorced from clinical practice. But patients and families should welcome this change as a first step towards “precision medicine,” the movement that has transformed cancer diagnosis and treatment. RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders.”
With the power of the Federal Government behind him, Dr. Insel’s brave step of disregarding the DSM-5 has the capability to transform the entire mental health field.
Financial Destruction May 10, 2013Posted by Crazy Mermaid in Mental Illness and Bankruptcy, Mopney and Mental Ilness.
Tags: Financial Destruction and Mental Illness, Mental Illness and Bankrupcy
1 comment so far
Back in February 2008, I began my descent into total and complete madness. As my mania and delusions increased, my husband knew that I- a frugal person by nature- was out of control. He had no idea what was going on, but with no history of drug use or mental illness, he had no reason to consider them as explanations for my increasingly bizarre and outrageous purchases.
Even if he had known that I was in the throes of a psychotic break with reality, the truth is that there wasn’t a thing he could do about it. The bottom line was that although he was legally responsible for my debts (Washington is a community property state), he had no power to stop me from bankrupting us. Signatory on all of our accounts, I had every legal right to spend our money as I saw fit. No matter that I had lost contact with reality.
To his credit, my husband performed a small miracle. Despite the fact that there’s no 3 day grace period for car purchases, he managed to convince the dealership to allow him to return the $55,000 Lexus Convertible that I bought in the throes of my psychotic break with reality – paid for with a “hot” check- within hours of it hitting our driveway. In the meantime, continuing my out-of-control buying spree, clothing, shoes, jewelry, and lots of plants and yard ornaments all went on the plastic.
Within months of the start of my spending orgy, having blown through tens of thousands of dollars, I was involuntarily committed to a mental hospital, giving my husband some breathing room to do damage control. During my spending spree, I brought home armful after armful of merchandise, packing the bags upstairs to my bedroom and setting them down on the floor. Once I was involuntarily committed to the mental hospital, he enlisted the help of my mother and sister to return all of the merchandise.
Damage control underway, my husband turned his attention to the bigger picture. My purse in his possession, he tore up all my credit cards. He flagged our credit to prevent me from opening another account without his knowledge. And, reaching beyond his legal limit, he –without my permission or knowledge- closed all of our credit and bank accounts, opening new ones that I had no access to or even knowledge of.
Coming out of my psychotic break, I was ashamed and embarrassed at my conduct, even though my husband took pains to explain that the financial train wreck was, like my tremendous medical bills, another cost of my mental illness. He refused to consider my actions an act of moral bankruptcy.
I could do nothing to atone for my sins except put in place as much protection (from myself) as possible in case I again became psychotic. In the end, I realized that it came down to eliminating my access to all of our accounts. I have no credit cards. I don’t know what our bank account numbers are or what our bank balance is. In fact, I know nothing about our finances. My husband dispenses cash to me- me, a professional woman who made $100K a year. And that’s the way it has to be.
Clifford Beers and the Mental Health Bell April 24, 2013Posted by Crazy Mermaid in Uncategorized.
1 comment so far
In 1900, Clifford Beers, a Yale graduate and young businessman, suffered an acute breakdown brought on by the illness and death of his brother. Shortly after a suicide attempt, Beers was hospitalized in a private Connecticut mental institution. At the mercy of untrained, incompetent attendants, he was subject to degrading treatment and mental and physical abuses.
Beers spent the next few years hospitalized in various institutions, the worst being a state hospital in Middletown, Connecticut. The deplorable treatment he received in these institutions sparked a fearless determination to reform care for individuals with mental illnesses in the United States and abroad.
In 1908, Beers changed mental health care forever with the publication of A Mind That Found Itself, an autobiography chronicling his struggle with mental illness and the shameful state of mental health care in America. The book had an immediate impact, spreading his vision of a massive mental health reform movement across land and oceans.
“I must fight in the open.” Clifford Beers, in 1909, used those words to respond to critics who suggested he start his consumer movement anonymously. During his stays in public and private mental institutions, Beers witnessed and was subjected to horrible abuse. From these experiences, Beers set into motion a reform movement that took shape as Mental Health America.
During the early days of mental health treatment, asylums often restrained people who had mental illnesses with iron chains and shackles around their ankles and wrists. With better understanding and treatments, this cruel practice eventually stopped.
In the early 1950s, Mental Health America issued a call to asylums across the country for their discarded chains and shackles. On April 13, 1956, at the McShane Bell Foundry in Baltimore, Md., Mental Health America melted down these inhumane bindings and recast them into a sign of hope: the Mental Health Bell.
Cast from shackles which bound them, this bell shall ring out hope for the mentally ill and victory over mental illness.
—Inscription on Mental Health Bell
Now the symbol of Mental Health America, the 300 pound Bell serves as a powerful reminder that the invisible chains of misunderstanding and discrimination continue to bind people with mental illnesses. Today, the Mental Health Bell rings out hope for improving mental health and achieving victory over mental illness.
(Note: A Mind that Found Itself is a free Kindle book on Amazon).
The Case for Insanity April 10, 2013Posted by Crazy Mermaid in Uncategorized.
add a comment
The case for insanity is compelling.
I had ESP. BIll and Melinda Gates, Oprah Winfrey, the Dalai Lama, and numerous others all thought I was a genius. They fawned over my every idea and were at my beck and call.
God gave me my very own store. Science Art and More in Seattle contained some merchandise for everyone but most of it was for my eyes only. Scientific concepts that I had formerly believed were known to the general public were actually only presented to me. Bill Gates offered me a million dollars for a coffee cup in that store with scientific formulas written on it that would solve world hunger.
Bill and Melinda Gates offered me a job at The Bill and Melinda Gates Foundation. They promised me world travel and millions of dollars, along with a new car and new wardrobe as a signing bonus.
I counted a time-traveler with special abilities as one of my friends. He went back in time and cleared out parking spaces for me in a crowded mall parking lot. He formulated makeup, designed clothing and made jewelry especially for me and arranged for them to be placed inside a nearby Fred Meyer store for me to find.
I had a shopping buddy- a woman who shopped for outfits with me. She had exquisite taste and I had an unlimited supply of money.
I owned millions of dollars worth of jewelry, including a 3 carat yellow diamond in a platinum setting, and a priceless abalone bracelet that had once been owned by my (Mermaid) grandmother.
Trees bared their souls to me. I conversed with my (deep-voiced) rat terrier and my friend’s impossibly self-centered cat. I talked with a nasty blood pressure machine in a hospital who craved electricity like people crave food.
Last but not least, I was a genuine mermaid whose real name was Pangaea. Fish talked to me. I felt the webbing between my toes, which were my fins. I had a beautiful tail whose weight showed up on my scale (accounting for why I weigh more than I look like I weigh).
I was beautiful. Wealthy. Brilliant.
What’s not to like about mental illness?
NAMI Connections Support Group March 28, 2013Posted by Crazy Mermaid in Uncategorized.
I am facilitating my first NAMI Connections support group this coming Thursday, and I’m excited.
NAMI Connections is a signature program of NAMI (National Alliance on Mental Illness) in which people with a mental illness meet at regularly scheduled intervals. People come to the group for camaraderie and support from people sharing similar situations. It’s one thing to talk to your friends and relatives about issues concerning your mental illness. It’s quite a different story when you talk with someone in the group who has been through the same situation that is challenging you.
My issue that I talk with at support groups is my inability to hold a regular job, especially doing what I love, which is project management for major construction projects. I can no longer do that job for several reasons, including the slippage of my I.Q. (due either to the medication I take or simply the damage done by my mental illness) and my inability to successfully manage stress, which that job is full of.
When I talk about how much I miss my old job with my therapist, I call it my “pity party”, which she loathes. She tries to help me through my episodes of self-pity, but she can’t really relate. We’ve talked about this numerous times. I just couldn’t come to terms with never being able to do the job I love again, despite the fact that my job put me in the mental hospital.
When I tried to talk with my family about this, they couldn’t relate either. They’re all gainfully employed and don’t seek to gain identity and self-worth through their occupation. They don’t wake up at 5 a.m. every morning (without an alarm clock) panting to go to work.
Coming to a NAMI Connections support group and meeting a guy who was a Senior Project Manager for Microsoft before he had his nervous breakdown (also called a psychotic break) helped me immensely. He could relate to my identity crisis because he’d been through a similar situation. When I talked about self-identifying with a profession, he understood perfectly. Since he was coping well with this, it inspired me. When I asked him what he was doing to successfully combat the frustration of not being able to work at his chosen profession, he had some suggestions that he could share from personal experience.
Although he didn’t have a “magic bullet” for me, simply seeing his success gives me hope.
The great thing about a support group for mental illness is that the facilitator doesn’t have to have all the answers. It’s simply a way for people suffering from their medication side effects or symptoms of their illness to find companionship and understanding from their peers. That’s why it’s called a “peer support group”.
I hope the people who come to my support group get as much out of the experience as I do.
Mental Illness: Worst Disease in the World? March 14, 2013Posted by Crazy Mermaid in mental illness.
Tags: Involuntary Committment, mental illness
add a comment
As the worst possible disease, mental illness isn’t even on most people’s radar. But consider, for a moment, the facts.
Unlike cancer, mental illness has a lousy public relations campaign. It doesn’t have a public personality attached to it- at least nobody positive. There’s no Lou Gherig or Lance Armstrong or Stephen Hawking to bring a sense of empathy to the masses. Unlike breast cancer, hundreds of millions of dollars aren’t spent on events to publicize mental illness- events like the Susan G. Komen Walk for the Cure – where the color pink has come to symbolize breast cancer in everything from headbands to hand mixers. Unlike Lance Armstrong’s Livestrong cancer campaign, where yellow bracelets signify triumph over cancer, there is no little plastic bracelet color for mental illness awareness. In fact, because of its enormous stigma, you would be hard-pressed to find victims and family members willing to take the spotlight for mental illness.
Everyone recognizes that the term “cancer” is a blanket term for a multitude of illnesses all sharing the same basic characteristic: improper cell division. Unlike cancer, the general public doesn’t perceive mental illness as a blanket name for illnesses caused by brain chemistry imbalance. Both are breakdowns of normal bodily functions, yet cancer doesn’t have the reputation of being a character flaw or a sign of moral bankruptcy that mental illness does.
Patients with cancer are not embarrassed to tell their friends and family their diagnosis. They aren’t afraid of being thought less of as a person for that diagnosis, that somehow they fell short. But with mental illness, the stigma is so great that the fear of rejection and isolation is a legitimate concern. You just don’t tell anyone.
Because their loved one’s illness isn’t associated with moral bankruptcy and character flaws, friends and relatives of cancer victims don’t have the same incentives to keep anyone from knowing their loved one has cancer. Protecting themselves from the unspoken charge of moral bankruptcy by association isn’t a top concern of the families of cancer patients, so they get emotional support from those around them.
Other diseases, like cancer or ALS or a stroke, don’t cause its victims to commit heinous crimes. You don’t see a breast cancer victim as the lead-in story on the nightly news because she murdered a bunch of school children. You don’t hear about a stroke victim trying to assassinate the President. A lung cancer victim doesn’t jump off a bridge to get away from the horrible voices in his head. And yet the connection between these types of actions and mental illness, if the news media even bothers to make one, is voyeuristic rather than sympathetic.
No legitimate insurance company would dare decline to authorize or pay for mainstream treatment of a cancer victim, but up until a very recent change in the law, insurance companies had little or no such coverage for mainstream treatment of mental illness, reasoning that it wasn’t, after all, a real physical illness. When they do cover it, it’s under a separate policy from “physical” health, called “Behavioral Mental Health”. We don’t see major insurance companies splitting off cancer from a list of diseases, calling it “Cell Divisional Health”, severely restricting its access, and farming out its administration to an entirely separate company.
When it comes time for hospitalization, there isn’t a question of whether a cancer victim or stroke victim even needs to go to a hospital. If they’re seriously ill, a cancer patient doesn’t have to be at death’s door before he’s admitted to the hospital. But a mentally ill victim has to either be about to hurt or kill himself or others (as determined by a third party) or needs to have tried (and failed) to kill himself before a mental hospital will consider admitting him.
If they’re hemorrhaging, but not near death, a cancer patient isn’t turned away for lack of space. Cancer patients don’t have to wait until there’s room for them at a hospital. Unlike hospital space for the mentally ill, hospital space for cancer victims hasn’t decreased over the past 20 years.
Alzheimer’s patients aren’t routinely discharged from hospitals onto the streets, left to fend for themselves. Cancer patients aren’t routinely discharged before they are stabilized. And yet the mentally ill are routinely discharged out onto the streets before they’re ready all of the time.
The cancer patient doesn’t have to give up his civil rights in order to be treated. He can leave the hospital whenever he wants. But in order for a mentally ill patient to be treated, he has to give up his civil rights. Mental patients are locked in, physically unable to leave the hospital until someone else- the attending psychiatrist- says they can go- however long that takes.
Once in a hospital, a cancer patient has the option to discontinue medication at any time. Mentally ill patients who have been involuntarily committed, on the other hand, must leave their civil rights at the door when they enter a mental hospital. Whether they want to or not, they are forced to continue medication while they are hospitalized.
Comparing the physical pain of the cancer or the effects of cancer treatment with the effects of mental illness is in some ways like comparing apples to oranges. Whereas the cancer victim fights for her life, the severely depressed victim fights to die. Is the physical pain of cancer worse than the emotional pain of continually hearing horrible voices in your head nonstop? Is radiation sickness worse than lithium side effects? Is prostate cancer preferable to schizophrenia?
I’m not trying in any way to minimize the pain and suffering that these diseases engender. My point is that each of these diseases -all of them- including mental illness-engenders tremendous pain and suffering. None of them- including mental illness- is any less severe than any other.
For too long, mental illness has been a quiet disease. Quietly terrible, but still quiet. This is a disease- or a family of diseases- on par with cancer and ALS and strokes, and yet there is a huge vacuum out there. Nobody even thinks about mental illness as a true physical disease. It’s not even on the radar. This needs to change. We need to raise people’s consciousness about mental illness, and give it the parity it deserves. We’ll know we’ve done our job when “mental illness” takes its rightful place on the list of Terrible Diseases in the public consciousness.
Airport Security and Mental Illness February 28, 2013Posted by Crazy Mermaid in Uncategorized.
add a comment
I was recently invited on a “girls weekend” to Arizona, which is about a three hour flight from my house. My husband bought my airline ticket a few months ago, and I was excited about the trip. Before I left, he printed my boarding pass and handed it to me. My brother-in-law drove my sister-in-law and me to the airport and dropped us off. My sister-in-law and I were on the same flight, and together we made it through security, to our gate and to our destination without incident.
On the way back home, my hostess dropped me off at the airport. I was alone and hadn’t printed a boarding pass. I hadn’t traveled alone on an airplane since before I was hospitalized (almost five years ago), and back then you didn’t print the boarding pass from a computer (at least I didn’t). I managed to figure out how to print the boarding pass at the kiosk and was on my way to the security check point, luggage in tow. Suddenly, the voice returned.
Voice: They’re going to find something in your luggage. You’re going to be arrested and jailed.
The voice came from outside my head, as if there was a person standing next to me in line.
I fought back.
Me: I know there’s nothing contraband in my luggage. I packed my own bag and know exactly what’s in it.
Voice: They’re going to find something. Just wait and see.
Me: No they won’t.
Voice: Yes they will.
I had been expecting to walk through a scanner, and I was worried about that. Unfortunately, my fate was worse. I realized as I stood in line and watched the people in front of me that Security wasn’t allowing people to walk through the scanner. They were making people put their hands on their head and spread their legs apart as they “wanded” them. The voice intensified.
Voice (louder and more insistent): They’re going to find something on you.
Me: I don’t have anything to hide.
By this time I was shaking and had broken out in a sweat. I began to worry that security would suspect something was wrong by the way I was behaving.
I knew logically there was nothing in my bags or on my person, and I knew the voice was just figments of my imagination, but that didn’t make it go away. It intensified as they “wanded” me. The conversation went on like this until I picked up the luggage from the conveyor belt and slipped my shoes back on, which was probably about 15 minutes.
With mental illness, you never know when the symptoms are going to rear their ugly heads. I know I will never travel alone on an airplane again.
Obsessive Compulsive Disorder (OCD) February 15, 2013Posted by Crazy Mermaid in Anxiety, Mental Hospital.
1 comment so far
Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry; by repetitive behaviors aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions. Symptoms of the disorder include excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The acts of those who have OCD may appear paranoid and potentially psychotic. However, OCD sufferers generally recognize their obsessions and compulsions as irrational, and may become further distressed by this realization.
Obsessive–compulsive disorder affects children and adolescents as well as adults. Roughly one third to one half of adults with OCD report a childhood onset of the disorder, suggesting the continuum of anxiety disorders across the life span. The phrase obsessive–compulsive has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is excessively meticulous, perfectionistic, absorbed, or otherwise fixated.
Despite the irrational behaviour, OCD is sometimes associated with above-average intelligence. Its sufferers commonly share personality traits such as high attention to detail, avoidance of risk, careful planning, exaggerated sense of responsibility and a tendency to take time in making decisions.
OCD occurs in two to five percent of the population, and is the fourth most common psychiatric diagnosis. The majority of OCD patients who have not experienced symptom relief may have not received adequate trials of appropriate medication and/or behavioral therapy. The remainder typically do not respond because of poor treatment compliance, unrecognized cognitive impairment, co-occuring psychiatric illness or poor understanding of treatment. Adequate treatment for OCD often requires that medication trials be longer than those for other psychiatric illnesses. Additionally, behavioral interventions are time- and labor-intensive, frequently requiring close supervision and support.
Located in Belmont, MA, the OCD Institute at McLean Hospital is a national and regional center dedicated to the advancement of clinical care, teaching and research of obsessive compulsive disorders. The program provides partial hospital and intensive residential care for individuals age 16 and older who suffer from severe or treatment resistant OCD. It offers an innovative combination of somatic, behavioral and milieu treatments not found in other programs. It takes Medicare and Medicaid among other insurance plans, and comes highly recommended by a friend who completed the 8 week program in September 2012.
(Reprinted from Wikipedia and The McLean Institute)
Mental Health and Competency Restoration in Washington January 29, 2013Posted by Crazy Mermaid in Involuntary Committment, Mental Hospital.
Tags: Involuntary Committment, Mental Hospitals
Imagine having a mental health crisis and finding yourself in a county jail, with little or no mental health treatment, isolated with no direct human contact, in a cell with no toilet or furniture for 23-24 hours a day, wearing only a smock, as days become weeks, then months, all while the symptoms of your mental illness get worse.
According to a report, released today by Disability Rights Washington (DRW), this is a recurring problem in local jails across Washington State. Over the last few years, people with mental illness, intellectual disabilities, and traumatic brain injuries have had to wait for several weeks or even months to get an evaluation to see whether or not they are competent to stand trial. If they are found incompetent to stand trial, they often wait additional weeks or months to get services at the state hospital where there is mental health treatment designed to restore competency to stand trial. While they wait in jail, they are held with little or no mental or behavioral health treatment, often under severe punitive conditions for disability-related behavior. This includes being held in isolation, where their mental health often deteriorates.
Individuals may be held for low-level infractions, like trespassing or vagrancy, often because mental health services were unavailable. “It is unacceptable that people end up in jail facing criminal charges simply because they cannot obtain the mental health services they need in the community. We are turning these individuals into prisoners when they should be patients,” said Emily Cooper, attorney with DRW.
“Jail is the worst possible place for people struggling with serious mental illness. As a society, we need to stop the pattern of unnecessary incarceration of people with mental illness,” said Gordon Bopp, President of the Washington Chapter of the National Alliance on Mental Illness (NAMI). “They are not criminals. Nobody chooses to have a mental illness, and therefore nobody should be jailed for having one. Instead, they should be offered treatment,” Bopp said.
Along with sheriffs, mental health providers, judges, prosecutors, defense attorneys, and disability advocates, DRW has worked on this issue through multiple legislative sessions. Last year, the Legislature adopted an aspirational, seven-day performance target for the completion of competency evaluations and state hospital admission for restoration services. The Joint Legislative Audit Review Committee confirmed in a report issued last month that the state hospitals are failing to meet this target, and the time people spend in jail awaiting evaluation and treatment is growing.
“The longer a person with a mental health crisis spends in jail, the more devastating and long-lasting the consequence,” said David Lord, DRW Director of Public Policy. “Eliminating the excessive time these individuals spend in deplorable jail conditions must be one of the highest priorities of the legislature,” Lord said.
From January 25, 2013 report from Disability Rights Washington “Lost and Forgotten: Conditions of Confinement While Waiting for Competency Evaluation and Restoration”