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Mental Health Courts January 17, 2013

Posted by Crazy Mermaid in Committment Hearing, Uncategorized.
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Mental health courts link offenders who would ordinarily be prison-bound to long-term community-based treatment. They rely on mental health assessments, individualized treatment plans, and ongoing judicial monitoring to address both the mental health needs of offenders and public safety concerns of communities. 

Mental health courts share characteristics with Crisis Intervention Training (CIT), jail diversion programs, specialized probation and parole caseloads, and a host of other collaborative initiatives intended to address the significant over-representation of people with mental illness in the criminal justice system.

In the early 1980s, Judge Evan Dee Goodman helped establish a court exclusively to deal with mental health matters at Wishard Memorial Hospital in Indianapolis. This court was a dual purpose court. It to handled the probate court needs of people needing to be on a civil commitment for psychiatric treatment and it established a docket to deal with cases of the mentally ill offender who had been arrested on minor charges. This was necessary as the mentally ill were frequently arrested and had charges pending when the treatment providers sought a civil commitment to send their patient for long term psychiatric treatment. Judge Goodman’s court at Wishard Hospital could serve both purposes. The probate part of the mental health court would handle the civil commitment. The criminal docket of the mental health court could handle the arrest charges. The criminal charges could be put on diversion, or hold, allowing the patient’s release from jail custody. The civil commitment would then become effective and the patient could be sent to a state hospital for treatment. Judge Goodman would schedule periodic hearings to learn of the patient’s progress. If warranted, the criminal charges were dismissed, but the patient still had obligations to the civil commitment.

In addition to arranging inpatient treatment, Judge Goodman often put defendants on diversion, or on an outpatient commitment, and ordered them into outpatient treatment. Judge Goodman would have periodic hearings to determine the patient’s compliance with the treatment plan. Patients who did not follow the treatment plan faced sanctions, a modification of the plan, or if they were on diversion their original charge could be set for trial.

Judge Goodman’s concept and the original mental health court were dissolved in the early 1990s.

In the mid-1990s, many of the professional mental health workers who had worked with Judge Goodman sought to re-establish a mental health court in Indianapolis. Representatives of the county’s mental health service providers and other stake holders began meeting weekly. After a couple years of lobbying local authorities the in Marion County, Indiana, the mental health court began as a formal program in 1996. Many consider this to be the nation’s first mental-health court in this second wave of mental health court initiatives. Since the PAIR Program did not operate with any new funds, there was not much scholarly research and therefore the accomplishments of Judge Goodman and the PAIR Program are frequently overlooked. The current PAIR Program is a comprehensive pretrial, post-booking diversion system for mentally ill offenders. A program launched in Broward County, Florida was the first court, to be recognized and published as a specialized mental-health court. Overseen by Judge Ginger Lerner-Wren, the Broward County Mental Health Court was launched in 1997, partially in response to a series of suicides of people with mental illness in the county jail.

Shortly after the establishment of the Broward County Mental Health Court, other mental health courts began to open in jurisdictions around the U.S., launched by practitioners who believed that standard punishments were ineffective when applied to the mentally ill.  In Alaska, for example, the state’s first mental health court (established in Anchorage in 1998) was spearheaded by Judge Stephanie Rhoades, who felt probation alone was inadequate. “I started seeing a lot of people in criminal misdemeanors who were cycling through the system and who simply did not understand their probation conditions or what they were doing in jail. I saw police arresting people in order to get them help. I felt there had to be a better solution,” she explained in an interview. Mental health courts were also inspired by the movement to develop other problem-solving courts, such as drug courts, domestic violence courts, community courts and parole reentry courts. The overarching motivation behind the development of these courts was rising caseloads and increasing frustration — both among the public and among system players — with the standard approach to case processing and case outcomes in state courts. In February 2001, the first juvenile mental-health court opened in Santa Clara, California.

Since 2000, the number of mental health courts has expanded rapidly. There are an estimated 150 courts in the U.S. I was “processed” through my involuntary commitment through King County’s (Washington State) court, one of the first in the nation. Snohomish County (my county in Washington State) just opened theirs in October 2012.

(From Wikipedia)


Chenille: Reality Check Service Dog December 16, 2012

Posted by Crazy Mermaid in Delusions, Hallucinations, mental illness, Uncategorized.
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RandyI met the cutest service animal the other day at a mental illness support group. She’s a friendly, bouncy Chihuahua named Chenille.  I never thought about using a service animal for help with mental illness symptoms, but that’s exactly what she is.   She is a reality checker for her master.

As with many people suffering from mental illness, her master’s symptoms include hallucinating. He sees people and things that aren’t there and hears things that aren’t there. Her job is to help him determine what is real and what isn’t.

For example, if there’s someone suddenly sitting in a chair in his living room that he’s never seen before, if she barks he knows it’s a real person.  If she doesn’t react, then he’s seeing someone who isn’t really there.   The same goes with noises.  Dogs are sound-sensitive, and if there’s a lot of racket or unexplained noise, the dog will react to it.  If someone calls his name from another room (and he thinks he’s alone in the house), and she doesn’t react, he knows he is hearing things that aren’t there.

What a relief it is to be able to tell reality from fantasy by using the unbiased opinion of a dog.

People not suffering from mental illness take for granted their ability to tell reality from fantasy every waking moment. They can’t appreciate what a gift it is not to have to questions whether what they see or hear is real.  If the average person sees someone new sitting in their living room, he doesn’t even have to wonder whether that person is really there. But for people with certain forms of a mental illness, they can’t depend on their eyes to know whether that person is real. It is challenging to live in a world where your mind plays tricks on you.  You need help detecting reality. Who better than a dog to do that for you?

Imagine hearing a loud noise coming from the bedroom. Or hearing someone call your name from the room next door that you thought was empty.  There’s no one else with you in the house. Or is there? What would it be like not knowing the answer to that question on a regular basis?  A dog can be a lifesaver.

People who use the “reality challenged” phrase in jest might want to reconsider whether that term is appropriate, given the fact that certain people are living the embodiment of the true meaning of that phrase.  In order to leave a semblance of a normal life, they need a way to tell whether their perceived reality is real.

During the height of my psychotic break with reality, I met someone at a Starbucks for coffee who was probably not real. He was a green-skinned merman who I thought was my long-lost son from 500 years ago. Long story. But the point is that person was as real to me as anyone I have ever met.  I sat across a table and had coffee with him for several hours. Now at this juncture of my life, I realize I was probably one of those people you see who are sitting there in a restaurant talking to someone who isn’t there.  Imagine going through this every single day of your life.  You need an outside, unbiased source to tell you whether that green-skinned merman sitting across from you having coffee is real.  For my part, it never dawned on me that it could be anything but real. But what if it wasn’t?

This use of a service animal is a clever and fascinating way to help people manage the symptoms of certain mental illnesses.  This is the first time I have ever heard of this use. I wonder if more people could be helped by these service animals.

Virtual Hallucination Machine: NAMI Mental Illness Awareness Week October 8, 2012

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October 7th to 13th is Mental Illness Awareness Week (MIAW).  In celebration of this, some of the local National Alliance on Mental Illness (NAMI) chapters will have a virtual hallucination machine available for the general public to try out. What is a virtual hallucination machine?

Created by Janssen Pharmaceuticals, a Belgium pharmaceutical company, its purpose is to give mental health providers, police, and the public an idea of what it is like to have a psychotic break with reality. The virtual hallucination machine is designed to mimic the sensations that someone with schizophrenia or who is in the middle of a psychotic break with reality experiences.

Consisting of goggles and earphones, the participant is set in various situations, with the goal of accomplishing a certain task such as getting a prescription filled at a pharmacy.

Once the goggles and earphones are on, voices begin to hiss, whisper, and sometimes yell at the participant.  There is no way (short of removing the goggles and earphones) to get the images to stop. As the experience continues, the participant becomes more paranoid as he “realizes” that the pharmacist is trying to poison him or have him committed or the pizza delivery man is delivering a poisoned pizza or any other obviously errant perceptions of reality suddenly become very real.

“Things flash out of nowhere. Small voices saying, ‘Go get your medication.’ The bus driver is talking to you normally and all of a sudden he starts calling you ‘Your Highness.’ Then he becomes part of the hallucination,” says one participant. “It’s a whole busload of children, then it changes to a busload of adults. There’s a nurse involved. You see normal things and then all of a sudden someone pulls up next to you and says, ‘Get off the bus.’ ” You are in the role of the individual on the bus, seeing what is in the mind of someone who is like that.”

Participants get to experience the very real perception of that situation from the psychotic point of view, and come away with an appreciation for the high degree of Hell the psychotic person experiences during that psychotic break with reality.  Unlike the participant, the psychotic individual is unable to simply remove the earphones and goggles and walk away.  The psychotic individual is stuck in that awful place for as long as it takes to get him out of there.

Said one participant: “It was a very tiring and painful experience. I don’t know what you can do if you cannot turn it off,” he said after taking off the goggles and earphones on the Virtual Hallucination Machine. “It’s the emotion it brings up in you from within. The voices are rude and insistent, demeaning and demoralizing.”

“The neurons are firing images in random order. Like being awake but dreaming. Like a lot of jumbled thoughts,” said another participant. “Like being trapped in a nightmare but you are awake.”

For more on this subject, check out the following:

Virtual Hallucination Fact Sheet NAMI http://namifingerlakes.org/Documents/Virtual%20Hallucinations%20Fact%20Sheet%20CRC%20FINAL%206%202%202006.pdf

Cruel Voices http://namifingerlakes.org/Audio_Files/Cruel%20Voices%20-%20Schizophrenic%20Auditory%20Hallucinations.mp3

Straddling the Line of Insanity (trying out a virtual hallucination machine) http://www.denverpost.com/news/ci_4076750

Legislators, the Media and the Public experience Schizophrenia http://www.nycvoices.org/article_737.php

Mindstorm: simulating psychosis; A new virtual reality experience depicts hallucinations in 3-D.(A Virtual Hallucination: Mindst http://www.entrepreneur.com/tradejournals/article/171253778.html

Here We Go Again: Reducing Mental Hospital Beds August 19, 2012

Posted by Crazy Mermaid in Delusions, Mental Hospital, mental illness, Schizophrenia, Uncategorized.
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Here we go again: more psychiatric hospital beds are disappearing in Washington State.  How do I know?  Not from anything in the news.  It’s because I got a phone call from a 75 year old woman whose 54 year old schizophrenic son is being released from Western State Hospital.  She called because she was desperate to find housing and help for her son before he is released, which will be soon.  She explained that she is an old lady and can barely care for herself, much less her son, who has been at Western for many years.

At Western, he has case managers and people who make sure he takes his medication as well as  living support.  He never learned how to shop or care for himself because his symptoms were so severe that they required him to be permanently hospitalized.  I’m guessing that  even with proper medication, he isn’t symptom-free or he would have been released years ago.  Even with proper medication, delusions and hearing voices is fairly common in hard-to-treat cases like his. Once out of that protective environment of the hospital, she is concerned that when he stops taking his medication, his symptoms will increase and he will become unmanageable. She is looking for housing for him that will also provide help in adjusting to life on the outside.  And she doesn’t have much time.

This situation is tragic.  They’re taking a man who has spent most of his life in an institution getting the help and support he needs in order to function, and throwing him outside to fend for himself.  Had there been any adjustment support for him, she wouldn’t be so desperate.  Programs like those he needs are overfull.  He won’t be able to get into those programs for years because they’re at or over capacity right now.  And with the State releasing more people like this man, more people will fall through the cracks.  The State hasn’t funded stop-gap programs for people like him.  There simply isn’t anywhere he can go.  Who knows what will ultimately happen to this man?

Although I understand the need to balance the State budget, balancing it on the backs of the more vulnerable population is unconscionable.

Contrary to popular opinion, 99.9 percent of people housed in institutions like this aren’t dangerous when released.  So we shouldn’t be afraid of him. In fact, statistically they are the ones who are more likely to be assaulted  and victimized  because they’re not equipped to survive outside their institution.  Turning a man out who has been taken care of most of his life will not make his quality of life improve.  In fact, the type of living situation that he was in had allowed him to have his “home base” at the hospital, able to freely come and go at will.  The point of the hospitalization was to keep him taking his medication allowing him to live with and manage his schizophrenic symptoms.  If he is left to his own devices at this late stage of his life, he will likely discontinue taking his medication, which will mean the symptoms of his illness, barely contained anyway, will return in a big way. I’m not saying he will be a danger to others.  I’m just saying that hearing voices and other negative symptoms will likely return in a big way without proper medication and supervision.  Clearly, his case must be particularly difficult because had he had an “easy” case, he would have been released years ago. He’s there because that’s where he needs to be.

His institutionalization is very different from involuntary commitment, so his release shouldn’t scare anyone from the standpoint of him being a threat.  Far from it.  He is allowed to come and go at will, but his base is always at Western State Hospital.  He goes on outings and to visit his parents, but he never stays there for any length of time.  He always has to return to Western so they can give him the care he needs.  He hasn’t gone grocery shopping or done the dishes or any number of things we are all used to doing in order to survive.  If left to his own devices without any education in performing these relatively easy tasks, he will risk his well-being to the point of being dangerous.  Just turning him loose out into the world will be a hardship.  His 75 year old mother won’t be much help, and because of his symptoms he can’t live with her- especially once he’s off his medication.

They say the mark of a civilization isn’t how they treat their rich.  It’s how they treat their poor and vulnerable population.  And from the way this gentleman is about to be treated, it’s clear that we’re not exactly the best civilization in the world.


Therapy and Weight August 16, 2012

Posted by Crazy Mermaid in Mental Illness and Bankruptcy, Uncategorized.
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I never would have voluntarily entered counseling in a million years.

However, my release from the mental hospital was conditioned by a contract I had to sign before the hospital would release me. The Least Restrictive Treatment (LRT) contract between the State of Washington and me required me to attend weekly therapy sessions with a Licensed Mental Health Counselor. Michelle, my caseworker at the mental hospital, selected my therapist, Beth, and made arrangements for my first therapy visit to occur three hours after my release from the hospital.

Walking through the door of my new counseling office, I was very wary of the arrangement. Still psychotic, I didn’t believe that I belonged in therapy. Therapy was for screwed up people, and I clearly wasn’t one of those. I was perfectly well. But rather than return to the mental hospital, I resigned myself to going through the motions of therapy.

It turns out that my therapy has had and continues to have surprising benefits. Who knew that my lifelong battle with my weight and food started at a very early age, and is the root of my personal battle of the bulge?

My battle with food is getting more interesting the more therapy I have. The therapy allows me to put my food battle in perspective, something that has eluded me for the past 50 years of my life. It never dawned on me before I started counseling that I could put a pattern to my personal battle of the bulge.

Talking with my therapist continues to be valuable.  With the increasing trust in my therapist comes knowledge. The little girl in me is starting to understand that everyone has food calorie limits that aren’t dictated by others. Regardless of whether I felt starved as a little girl, there were always caloric ceilings to adhere to or I gained weight. The laws of physics apply to everyone, including the little girl in me. As adults, we’re free to live on our own, with rules and regulations acquired independently.  But certain things never go away. No matter what the circumstances, there is a limit to the number of calories we can ingest each day before gaining weight. In my case,  1950 calories a day is what  my body needs in order to perform at the optimum level. Any less and I lose weight, and any more and I gain weight.

Recently my therapist has been guiding me through some exceptionally difficult therapy. With that difficult therapy has come an ever-expanding girth.   In the three months of exploration of certain things in my life, my stomach has expanded about 3 inches because of the enormous number of calories I have been taking in. One of my ‘go-to” comfort foods is dark chocolate. During my intense therapy sessions, I have been allowing the little girl in me to eat as much and whatever she wanted, understanding that it was part of the therapy process. Chocolate chips are my comfort food, and I need to have unlimited access to them in order to get better.  I understood on an intellectual level that my body had daily calorie limits.  But the little girl inside me has been fighting those caloric limits as if they were imposed by people rather than the laws of physics.

I’m finally reaching a landmark in my therapy, where I am beginning to internalize the fact that caloric limitations area caused by the laws of physics. They aren’t administered by others. With concept comes a new approach to food. I’m not saying I’m skinny or even that I’ve started to lose weight. I’m simply coming to terms with the laws of physics. That, after 50 years, is a major accomplishment.

May Is Mental Health Month May 7, 2012

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May has been designated as Mental Health Month for over fifty years. It is a time to reflect on our own mental well-being as well as raise awareness for the mentally ill in our community. Learning about some of the most commonly diagnosed mental health conditions is a great way to increase understanding and decrease the stigma of mental illness.

In the United States, it is estimated that 1 in 4 adults have a diagnosable, treatable mental health condition at some point in their lives. Mental health disorders are also the leading cause of disability in the United States today. Many experts feel that the United States is facing a mental health crisis due to the increase stressors in our culture. Screening and treatment for mental health conditions should be a vital part of health prevention.

Many people never receive the treatment they need due to stigma, cost, or lack of health insurance. People may also not be aware of where they can go for treatment or mental health education. Fortunately, through the Affordable Healthcare Act, there are more resources and programs becoming available to people of all socioeconomic backgrounds.

A great place to start is with a primary care physician who will give you a depression screen and discuss any symptoms or concerns you have with your mental health. Through many clinics in Minneapolis, health care professionals can refer you to a helpful program or psychiatrist who can better help you manage your condition.

Mental Health America: www.nmha.org

(Reprinted from http://www.examiner.com/article/may-is-mental-health-month-7 Andrea Wodel)

The Search for a Paranoid Schizophrenic Brother March 21, 2012

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In this weekend’s Seattle Times Pacific Northwest magazine, there is an article about a woman who spent years looking for her brother, a paranoid schizophrenic (http://seattletimes.nwsource.com/html/pacificnw/2017692663_pacificpmissing18.htmlic ) In the article, she talks about the years of pain and suffering she and her family underwent as their family member suffered through his illness.   When she finally tracked him down, he had been dead for years.

Unlike “normal”  illnesses, paranoid schizophrenics have a symptom that makes it almost impossible to treat without the intervention of mental health professionals.  That symptom is called Anosognosia  (I  wrote an entire blog about this symptom).  It means that because the person suffering from the illness has no insight into their condition, they won’t accept treatment for it.  They don’t seek help or accept help because they genuinely don’t believe they’re ill.   This unique symptom is why I have labeled this condition the worst disease in the world.  All of the pain and suffering this family endured is the result of this symptom- to say nothing about the suffering paranoia has on the afflicted person.

In my duties as the phone message taker for my local NAMI affiliate, I come across at least two phone messages a week from loved ones looking for answers to this specific dilemma.  They can’t get help because their full-grown loved one doesn’t recognize they are ill. Any talk about getting them help results in deep distrust and escapism. It is frustrating to have to tell those callers that unless their loved one has been declared “a danger to himself or others” by a designed mental health professional, there is nothing that they can do about their illness-struck family member. It is heartbreaking to hear those stories week after week.

It all comes down to the fact that our laws don’t recognize anosogonia as a symptom that should be an exception to the current law. In the case of that symptom, the law  requiring the person having to demonstrate that they are a danger to themselves or others by a third party before they can receive help should be abolished.  If this law were changed to allow for intervention before the person ended up in prison, the world would be a better place.  The jail and prison populations would be substantially less, and we would be able to stop wasting money on these incarcerated mentally ill people who failed to seek treatment.

Instead of making this exception to the law, the jails and prisons are full of people who didn’t receive the mental health care that would have turned them into productive members of society.  The cost of their incarceration is enormous, averaging $40,000 per year. This doesn’t include the lost taxes and spending that would have been generated had the person been a productive member of society instead of a drain on society.  What I don’t understand is why nobody else perceives this problem the way that I do.  It seems so cut and dried.

If the law could be changed just for people suffering from paranoid schizophrenia to acknowledge the anosogonia symptom, thus allowing people to get help, it would do the world a lot of good.

Had this symptom been acknowledged in that sister’s attempt to get her brother help, the story might have ended without her brother’s death.  It’s too bad things didn’t turn out.  Maybe in the future things will be different.  It could have saved a life and make the quality of life better for that younger sister and her family

Anxiety December 2, 2011

Posted by Crazy Mermaid in Uncategorized.

The primary purpose of hospitalization is to administer powerful drugs in a controlled environment.  As the drugs begin to take effect, anxiety builds.  Most of the drugs, including antipsychotics and mood stabilizers, have anxiety as a side effect.   The resulting synergy from each medication’s anxiety side effect produces an incredible surge of anxiety, unlike anything most of us have every known. So the secondary reason for hospitalization is to learn to control the anxiety.

Learning to control that anxiety, as it builds up higher and higher with each passing day as the medications take effect, is how patients spend their time. At the mental hospital, we take classes on it, we do exercises on it, we learn various coping methods for it.  And in the end, we even take medication for it.  But the medication is never enough, and we are limited in the amount that we can take. So we have to learn how to handle the anxiety ourselves, to the best of our ability.

Although some people live with anxiety their whole lives, in general anxiety is not on most people’s radar. They have absolutely no concept about what anxiety is and how debilitating it can be. It’s difficult to put into words what anxiety feels like, but I’ll try:  Stand up straight, legs slightly apart. Now, tighten every muscle in your body. Ball up your fists. Clench your jaw. Next, try sitting down. Can you do it? Probably not for long. Imagine feeling like this all of the time, 24/7. You can’t relax, no matter how hard you try.

If you sit down, the muscles in your legs are still tight. The muscles in your entire body remain tight.  You can bend your limbs  in the right direction, but those muscles don’t relax- ever. Your whole body, though not rigid, can’t relax. You clench your teeth. It’s exhausting.  When the anxiety gets unbearable, you feel like you’re crawling right out of your skin.

One of the most common outlets for handling anxiety in a mental hospital is to pace the halls.  Those of us with severe cases would walk up and down the halls, over and over again, trying to work out some of that anxiety.  We couldn’t stop walking for very long, because the anxiety would come back in full force if we stopped walking.  And so we continued to walk the hallways, over and over again.  We walked miles every day, one foot in front of the other, up and down those carpeted hallways.

Everything that we did there was structured to teach us how to cope with that anxiety. Group therapy sessions discussed and sometimes actually showed us how to handle stress and anxiety. There were physical steps we could take with our bodies- everything from squeezing the flap of skin between our thumb and index finger to massaging our finger of choice to controlled breathing. Then there were steps we could take that weren’t direct acts upon our bodies. We could blow bubbles, color in coloring books or on blank white sheets of paper, watercolor, or do jigsaw puzzles. There was also aromatherapy. Lavendar was the favorite. But walking the halls was the single most valuable outlet for handling anxiety.

Unfortunately, the building’s psych ward wasn’t built with our anxiety side effect in mind.  The hallways were about 10 feet wide and about 50 feet long. So only a few of us could fit comfortably at a time.  Sometimes it got a little crowded with all the people pacing.  But when you’re that anxiety-riddled, pacing is your only option and crowded hallways are the least of your worries.

I seriously considered taking up smoking at the hospital because I heard from some of the other patients that it would help me with my anxiety. My mental hospital was the only one in the State to allow smoking, even going so far as to supply the tobacco and rolling paper for the homeless people who had no money to buy cigarettes.

Anyway, once I became convinced that smoking would help my anxiety, I actively tried to take up smoking, but my nurse/guard did everything she could to discourage me.  In the end, because she made it almost impossible for me to start smoking, I didn’t take it up.  I’m eternally grateful to her.

Before my breakdown, I went to sleep the minute my head hit the pillow. But with all the medication I was taking, sleep just wouldn’t come. The anxiety was just too powerful. Sleeping pills were discouraged long-term because they’re so addictive. So access to them was very restricted.

When I was released from the hospital in the care of my psychiatrist, he started right in trying to treat my anxiety so that I could sleep.  He pointed out that lack of sleep would put me back in a manic stage and I would have to return to the hospital.  Understandably, I became extremely anxious about trying to get enough sleep. So anxious that it affected my ability to sleep. I would lay awake until 2 am, knowing that if I didn’t get to sleep I would get manic. The anxiety was so bad that I would lay in bed trying to get to sleep, my teeth clenched so tightly that my jaws hurt. So we (my psychiatrist and I) worked on finding a way to get me to sleep and keep me asleep.

Over a period spanning many months, “we” went through many different drugs looking for one that worked.  I would buy one (expensive) drug, take it for a few weeks and abandon it when it didn’t work. Then I would buy another (expensive) drug and take it for a few weeks, abandoning it because it didn’t work. On and on it went, racking up hundreds of dollars for drugs that didn’t work. Finally, we found Seroquel. It’s an anti-psychotic that also acts as an anti-anxiety drug for me, and I can take up to 400 mg of it if I have to.  Although I take just 200 mg of it at night, just knowing that I can take up to 400 mg makes getting to sleep much easier.

Fortunately for me, I didn’t become addicted to sleeping pills or start smoking.  I’m learning other ways to handle my anxiety.

Mental Health Court September 10, 2011

Posted by Crazy Mermaid in Healthcare, Mental Hospital, mental illness, Mental Illness and Medication, Uncategorized.

According to the news program Frontline, as of January 2010, one out of every 100 people in the United States is incarcerated . Of that population, nearly 25% of these 3 million people have a diagnosed mental illness, and 16% of the prison population has a severe mental illness. At a cost of 7% of the operating budget of the United States, the figure for incarceration of the mentally ill totals $910,000,000. It’s no wonder that prisons are the largest mental health institutions in the nation.

The latest weapons to help reduce the population of mentally ill in prisons are Mental Health Courts.  Designed as an alternative to incarceration of the mentally ill,  the cost of these courts is substantially less than the $62 per day that prisoners cost the taxpayer, saving taxpayers tens or hundreds of millions of dollars.

Designed for violators who have committed a crime as a direct result of their mental illness, the program doesn’t allow anyone who has committed a felony to participate. The purpose of the program is to get those targeted mentally ill individuals help by giving them intense judicially supervised treatment including help with their mental illness that has up until that time eluded them in the judicial system.

In the Mental Health Court program, the prisoner, or client as he is known in the program, is given a choice of attending Mental Health Court or serving time in prison or jail. This program is entirely voluntary. If the client chooses Mental Health Court,he must participate in the entire program for the two year duration. A large part of this participation is receiving the needed mental health services as well as supervision by members of the mental health team, including the judge, prosecutor, public defender, and court mental health specialist. This team of people encourages the client to stay on track with the program.

As a result of attending Mental Health Court, the client, now medicated and a productive member of society, will graduate from the program in an official ceremony, receiving a certificate of graduation in front of friends and family. He then becomes a productive member of society rather than a burden on the already over-crowded prison population.

If the client drops out of the program or is terminated for any reason, he is sentenced for the crime. The penalty is no greater than if the client had not participated in the program, and the judge will normally take into consideration the fact that the client did make the effort to try Mental Health Court.

The goals of the Mental Health Court are to increase access to mental health resources, encourage a focus on recovery, prevent revolving door to the jail, give an opportunity to contribute to society, and spend less time in jail or prison.

As anyone with a mental illness can tell you, staying on the program and taking the needed medication goes a long way towards keeping the client out of the revolving door of jail. By the end of the two year period, the client is generally stabilized and capable of making the realization that he needs medication in order to function well in society. Hopefully, this realization will be enough to keep him medicated and out of the prison system, thus increasing his quality of life and decreasing the cost to American taxpayers.

The cost of housing mentally ill in jails is an expense we can all do without, as long as we are as a nation kept safe. We can use all the help we can get in these uncertain financial times.

Mental Health Advance Directive August 30, 2011

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While I was at the NAMI Washington Conference a few weeks ago, I ran into an attorney who represents people with mental illnesses who have committed crimes (mostly misdemeanors). During the course of our conversation, she asked me if I had a Mental Health Advance Directive. I told her I had never heard of it, and decided that if I hadn’t heard of it, chances are you haven’t either.

A Mental Health Advance Directive (MHAD) is a written (legal) document that describes your directions and preferences for treatment and care during times when you are having difficulty communicating and making decisions. It can inform others about what treatment you want or don’t want, and it can identify a person called an ‘agent’ who you trust to make decisions and act on your behalf.

There are advantages to having a mental health advance directive, including the following:

• You have more control over what happens to you during periods of crisis;

• Providers and others will know what you want, even if you can’t express yourself well;

• Your directive can help your case manager and others who are involved in your mental health treatment;

• The law requires providers to respect what you write in a mental health advance directive to the fullest extent possible;

Anything that might be involved in your treatment can be a part of a mental health advance directive, including, for example, the following:

• Consent for, our refusal of, particular medications or inpatient admission;

• Who can visit you if you are in the hospital;

• Who you appoint to make decisions and take actions for you (your agent);

• Anything else you want or don’t want in your future care.

What is an agent? Should you have one?

An agent is someone you appoint to represent yourself in the event you become incapacitated and unable to represent yourself. If you want an agent, the agent has to be the following:

• At least 18 years old;

• Who knows you and knows what you want when you are doing well;

• Who can inform treatment providers about your preferences and can advocate for you;

(Note: By law, your agent can’t be your doctor, your case manager, or your residential provider unless that person is also your spouse, an adult child, or a sibling.)

Who should get a copy of your mental health advance directive?

If you name an agent, that person must be given a copy. After that, it is up to you who you give a copy to. Think about giving one to your current mental health provider, your lawyer, and trusted family members. Bring a copy if you are being admitted to a mental health facility. Any treatment provider who gets a copy is required by law to make it a part of your medical record.

Will everything in my mental health advance directive be followed? In certain instances, it may not be followed. Those instances include:

• Your instructions are against hospital policy or are unavailable;

• Following your directive would violate state or federal law;

• Your instructions would endanger yourself or others;

• You are hospitalized under the Involuntary Treatment Act, or are in jail.

I urge you to consider putting this document in place if you have a mental illness. You can find the form at: http://www1.dshs.wa.gov/mentalhealth. (Note: this is for Washington State, but other states and countries have their own).

Material taken from the following source: Washington State Department of Social and Health Services