Humanizing Mental Illness

SPECIAL NOTE:   This article was written and submitted by Mike Weaver, NC CANSO board member and Executive Director of Mental Health Association of the Tar River Region.

After Christmas, and after picking up a friend at his house near Hartford, Connecticut, we were bogged down in Holiday traffic. We decided to get off onto highway 6 which parallels 84 and goes through Newtown. We saw the many shrines to those tragically killed there and could feel the pain in that beautiful New England village. Not many escaped the tragedy. I thought about the many mothers and fathers, sisters and brothers and extended family members who would feel that day forever. I also thought about Adam Lanza and what he needed that day in order not to kill his mother, students and teachers and himself.

I also listened to talk show hosts and listeners as they espoused their views on gun laws, mental illness, commitment and other related topics. One talk show host clearly said, “the problem is not guns, it’s the mentally ill we need to deal with.” I have been diagnosed with bipolar disorder since 1986 and after each shooting that involves a diagnosed person, the rhetoric ramps up. This time it is stronger and meaner toward those of us living with mental illness.
“The premise that we can predict or prevent violent acts is unsupported. Even in the case of severe mental illnesses, there is no special knowledge or ability to predict future behavior. The fact is people with mental health conditions are no more likely to be violent than is the general population.” (Dr. Wayne Lindstrom, MHA) “The truth is that nobody is able to predict behavior on the individual level. Psychologists and psychiatrists may be able to predict relative risks for groups, but that breaks down when we start looking at an individual person.”(Norman Hoffman, Phd.)

Actually, those with mental illness are eleven times more likely to be the recipient of violence than to commit violence. So, the next suggestion by many is that we need to commit more individuals with mental illness into locked wards and to force people into treatment. We can no longer go around locking up people because they act strangely, talk to themselves or have a mental illness. This is also financially impossible in our current environment. States have tried this. (Illinois lowered its standards to allow the commitment of virtually every person with schizophrenia and bipolar disorder.) There are not enough beds and do we want to return to the world of those with mentally illnesses peering out of state institution windows for a lifetime?

Rather than committing large groups of people and forcing people into treatment, it would be more humane and cost effective to dedicate adequate resources toward prevention, early intervention and recovery oriented services which have positive outcomes. We need to treat people as people and not as diagnoses. It is not about normalizing mental illness any more than normalizing cancer. We need to humanize it so that those living with a mental illness and their family members don’t become the scapegoats for every shooting in America.

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Creation of ‘The Dangerous List’ is Scapegoating

SPECIAL NOTE:  This article is written and submitted by Bonnie Jo Schell, Chairperson of the Board of Directors for NC CANSO.

President Obama’s Plan to protect US children and communities from random and planned violence includes one alarming proposal. The President wants all loopholes closed from state and national lists that could keep guns out of dangerous hands—the hands of those diagnosed to be mentally ill. NY quickly passed legislation to force professionals to notify an agent of the state if they reasonably judged the patient as likely to harm herself or others, compromising patient-doctor confidentiality.

Keeping lists of people either receiving treatment or committed for danger to self or others or likelihood to functionally deteriorate is scapegoating the one out of every five Americans likely to need mental health treatment at some point in their lives. The List demonizes the “Other” as The Problem, in the same way that the rhetoric in the last election demonized 47% of our citizens receiving government benefits as being responsible for the high debt ceiling of the US. At least none of the mass murderers since Columbine were members of the 47%.

In scapegoating a person or relatively powerless group is made to bear the blame, is punished and stigmatized for wrongs that were not of his doing. The term comes from a goat let loose in the wilderness on Yom Kippur after the high priest symbolically laid the sins of the people of Israel on its head. (Lev 16:8-22.) In the U.S. we have scapegoated Communists and their sympathizers, Japanese-Americans, Gays, Roman Catholics, the Irish, African-Americans, people from Mexico or South America, and since the 9/11 attacks, people of Middle Eastern ancestry. The Inquisition tortured and burned people making suggestions of religious and social reform; The Holocaust gassed people charged with being a drain on the German economy: The lists of expendables included Gypsies, the Physically and Mentally Disabled, Inebriates, Homosexuals, and Jews—all “useless eaters.”
The Dangerous List would contain many false positives since the only sure way to get services is to say you feel like killing yourself or someone else. Every homeless person in the dead of winter knows that.
The Dangerous List is a rush to “do something” that is overly simplified and not sound:

• Neither experts in criminal law nor psychiatrists can accurately predict the next violent offenders.
• Individuals with suicidal ideation will be careful to not mention it to a therapist or doctor for fear of being put on The List. Whose suicide rates have increased at an alarming rate? Teenagers and senior men, usually not in treatment. There are twice as many suicides among mental health patients as homicides.
• The chances that the list would contain more than 1% of the 5% of persons with mental illness who commit violent acts while using alcohol is slim.
• In these days of mass access to information “in the public domain,” lists of persons with mental illness are bound to be misused. Will Community Colleges and/or Universities check their applicants against The List? Will veterans with PTSD be turned down for further education? Will Homeland Security use The List at airports?
• Those considered to have the personality disorder of being a sociopath without any empathy for others may never be on The List unless a parent puts them on when they kill animals as a child, store up grudges, blaming others, and are socially rejected from groups they wish to belong to.

Back in 1963 when I was diagnosed with schizophrenia, the doctor told my parents to be sure I never received help in the public system or had my psychiatric sessions submitted to a group or private insurance company or I would never be allowed to teach school in Georgia. I learned to pass as “normal.” I was fearful on every job that it would somehow be discovered that I lied in answering the old question: Have you now or in the past been diagnosed or told you have a mental illness? That question, along with birthdate, is gone now since it was a violation of the American with Disabilities Act.

I thought times had changed. Mental Illness is now known to be a condition from which at least 60% recover completely. Hollywood and country music stars, athletes and politicians, have been open about having depression or bipolar and addiction disorders. They get treatment, are interviewed on mindful, deliberate changes in their lives they are making, and they go back to work.
Personally I don’t object to persons who have been judicially committed as a danger to self or others being prohibited from owning a gun, but that prohibition should have time limits and not be for a lifetime.
In the US we keep a registry of those with Tuberculosis because of its extreme contagion and destruction. We keep lists of convicted pedophiles, but not all of those who may have thought about sexually molesting minors and mentioned that to a therapist. Even though a small percentage of persons with diabetes go into a coma and cause automobile or truck accidents, we don’t require doctors to turn in the names of those with Type I or II Diabetes. People with epilepsy in most states can have a driver’s license if they have gone three years without a seizure. We do not have a master list of households to which peace officers have been called for domestic violence or restraining order violations; that information only is revealed in the newspapers after a murder.

The last time I was seriously and dangerously suicidal, I made a daily contract with my doctor to live another day and to write poetry and call a friend every day until I began to feel better. If I had revealed my suicidal thoughts and the doctor had immediately reported me to authorities, I would not have gone back. Compiling a master Dangerous Persons List gives the state a false sense of protection and safety. Furthermore, it removes dignity and respect from a group of people who have not committed a crime.
It would make more sense to reduce the availability of weapons of mass destruction.

Bonnie Jo Schell
January 21, 2013

2013: North Carolina Mental Health Services System will Begin New Year With Long-Sought Change!

Significant mandates arose from an agreement between the U.S. Department of Justice and the State of North Carolina in the latter part of 2012.   This New Year will include a new emphasis on personal agency and choice for individuals using public mental health services in North Carolina!  As a result, our Local Management Entities/Managed Care Organizations (LME/MCOs) are to be ensuring a level of engagement and an emphasis on best service outcomes that we have not seen in our state!  Four state-wide trainings for MCO staff have begun after dozens of people put their heads together to create the training process against at timeline!  Below are some of the training topics.

Diversion of people from inappropriate settings

While the initial target of the DOJ settlement has been the 7,000 or so individuals living in congregate facility settings, the mandates are very far-reaching.  It means focusing more on the potential of people to set goals, grow, and recover rather than assuming dead-end living because people’s deficits are too great to warrant the services they could otherwise have benefited from.

North Carolina, therefore, will be “closing the door” on our overabundance of facilities by carefully screening people for whether they truly need to be in a facility.  Novel idea?  Not so, it has been considered before.  Our state just did not have the political will to implement the actions necessary to ensure people lived more humanely and at least had a choice about where they were placed beyond hospitalizations.  But because of The Department of Justice motivating us, now we do have the will, and this will help our state come forward as a people who desire a humane culture.  So a broader approach to screening people out of facility settings has recently been developed and will be fully operational shortly.

In-reach and Transition Coordination

The next set of functions to be developed per the Settlement and is  the systematic but personal engagement of people living in facilities, finding those who want to live in the community, and making the  arrangements to help that happen for the person’s success.  Our state has decided to use peer specialists for this role because of the natural nature of a relationship between two people who have shared past experiences.  NC CANSO says “BRAVO” to this decision!  The training manual for the MCOs articulates that they are to use peers for the In-reach effort, and if they have no available peers in their areas immediately, they must have them employed for this important effort within twelve months!

The transition staff, who will be trained in options counseling, which includes understanding local housing availability, benefits counseling, and service linkage to the right level of services will be the next important function within the service team.

This team will work closely with the MCO housing specialist so that the transition staff will have housing availability when assisting a person to transition.  This effort will require close coordination and pacing housing and service efforts with the person’s desire to move on out of the facility.

The Department of Health And Human Services Housing Director has been able to determine housing solutions through various programs with rental assistance and other incentives and will also be doing outreach to communities to develop even more housing alternatives.

Person-Centered Services and More Peer Support

Meanwhile, as the transition pieces are developed and trained according to a timeline established by the DOJ, staff in the Best Practices section at the Division of Mental Health, Developmental Disabilities, and Substance abuse services are working with stakeholder groups that include consumers, providers, other agency people to ensure that North Carolina finally has a top-notch serviced definition for ACT (Assertive Community Treatment) teams, for Supported Employment, and for Supported housing/tenancy supports.  Furthermore, the creation of roles for certified peer specialists to enhance the service efforts and results in people’s lives has been another ongoing effort.  The development of these services has required a bit of research, including outcomes studies, and the services will be monitored for fidelity with established and respected tools.

THIS makes people who use services know they are valued—the fact that there will be this level of accountability for service quality now!

NC CANSO wishes to thank Disability Rights North Carolina for its effort in focusing the sights of the Department of Justice on our long-existing problem.  Our members have participated or are participating in many parts of these exciting changes.   We hope our voices make a positive difference for our peers and those who strive to support us in the public system!  Happy, busy New Year!