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Mental Illness Clients Deserve Respect and Understanding
The following article, authored by Jennifer Gross, Community Educator at Sound Community Services, appeared in the July 29, 2007 edition of The Day.
An article entitled “Justice Finds No Middle Ground for Mentally Ill Defendants” appeared in The Day on July 2, 2007. A more profound issue, perhaps, is the criminalization of mental illness, which is rooted in deinstitutionalization and the failure of our nation to provide community-based services for individuals with mental illness following the demise of public psychiatric hospitals.
At the threshold of the 21st century, a disturbing trend has become evident. As the number of hospitalized adults decreased during the second half of the 20th century, the number of prison inmates with serious mental illness was on the rise. In fact, the federal Bureau of Justice Statistics (BJS) reports that the number of inmates in jails and prisons with mental illness quadrupled in just six years—from 283,000 in 1998 to 1.25 million in 2006. This surge coincided with the closure of the last of the hospitals.
While the lofty goal of deinstitutionalization was community integration, in general the necessary resources were never provided. The result is clear. In the United States, half of inmates with mental health problems have been convicted of nonviolent offenses, primarily low-level drug and property offenses. Statistics reflected in the BJS report show that those most at risk for imprisonment are people who cannot get treatment—those who are poor, homeless, or experiencing addictions. In such circumstances, individuals are more likely to commit a crime. Prisons currently house three times more people with serious mental illness than do psychiatric hospitals. Mike Fitzpatrick, Executive Director of NAMI, says jails and prisons “have become the new mental hospitals.”
Despite the sometimes harsh conditions found in psychiatric hospitals, they provided the full complement of psychiatric, medical and residential services. In direct contrast to psychiatric hospitals, however, prisons are ill-equipped to provide the full range of services needed. Individuals with mental illness receive treatment that often consists of little more than medication, which may be poorly administered or monitored. Prisons cannot offer the long-term intensive supportive and therapeutic environment needed for recovery, and discharge planning for housing and employment is minimal.
Prison systems rarely provide correctional officers with mental health training. As a result, officers do not understand the behavioral symptoms of mental illness and will punish offenders with mental illness for symptoms like being noisy, refusing orders, self-mutilating or attempting suicide. This leads to a vicious cycle of isolation and ever-worsening symptoms.
In Connecticut, officers at only two state prisons—those housing the majority of inmates with mental illness, Garner and Northern—receive a mere eight hours of mental health training. A bill passed in the most recent state legislative session required the Department of Corrections to develop a four to eight hour per year mental health training program for all corrections staff working with inmates who have a mental illness, but this and other provisions of the bill were not funded.
The magnitude of the problem is evident upon examination of prison statistics in Connecticut, where the adult population of people with moderate to severe mental illness has increased from 2,200 in 2000 to 3,700 in 2005 or from 12% to 20%.
While the lack of resources and the resulting rise in the rate of incarceration have been a betrayal of the initial promise of deinstitutionalization, a few bright spots remain. Connecticut offers jail diversion programs in all 20 arraignment courts in the state, but only about 40 percent of people with serious mental illness can be diverted, in large part due to the lack of community housing and services. According to Thomas Kirk, Commissioner of the Connecticut Department of Mental Health and Addiction Services (DHMAS), “…people with psychiatric disabilities who commit minor crimes that are directly related to their illness…are better served if we divert them into treatment. As they improve with treatment it enhances the quality of community life for everyone and reduces demand on the correctional system.”
Crisis Intervention Teams (CIT) offer a pre-arrest jail diversion opportunity by providing 40 hours of specialized training in psychiatric and substance abuse disorders, including crisis de-escalation techniques, to police officers who volunteer. The New London and Norwich teams have been highly successful in their efforts to link people with treatment in lieu of arrest, but are constantly hampered by lack of funding.
The 2003 Presidential New Freedom Commission on Mental Health concluded that our nation’s mental health system is “fragmented and in disarray,” and recommended that the government “address mental health with the same urgency as physical health.” But until our leaders make it a priority to create and fund a community mental health system, our prisons will remain the nation’s de facto mental institutions.
Mind Your Health: May is Mental Health Month
The following article appeared in The Day on Sunday, May 20, 2007, and was written by Jennifer Gross, Community Educator of Sound Community Services.
In 1909, a young American businessman named Clifford W. Beers published an autobiography “A Mind That Found Itself,” that described his incarceration in public and private mental institutions. Beers witnessed and experienced unspeakable abuse. His book was hailed as a triumph in mental health advocacy. Beers set into motion a reform movement that became known as the National Mental Health Association and more recently, as Mental Health America.
This national citizens’ group promotes mental health and improve conditions for children and adults living with these health problems. The organization later established a national celebration known as Mental Health Month, and for more than fifty years, our country has celebrated this event each may to raise awareness about mental illnesses and the importance of mental wellness for all.
As we prepare to celebrate Mental Health Month nearly 100 years after Clifford Beers wrote his ground-breaking work, it seems appropriate to reflect on a field whose history, dating from ancient Egyptian times, has been often brutal, but astoundingly innovative. Since the beginning of the 20th century in particular, the field of psychiatry has advanced so much, it is barely recognizable as the same science.
As the 20th century opened, the states had assumed custodial responsibility for “lunatics”, who were warehoused in barbaric asylums with the elderly population and those with insanity resulting from syphilis. Though a shift was also occurring towards the exploration of mental illness as a biological disease, doctors were using drugs that had not been adequately tested and other crude treatment techniques, such as insulin shock therapy, induced seizures, wet sheet packs, fever therapy and lobotomies. The lobotomy, which was often performed with an ice pick on the frontal lobes of the brain, was particularly brutal and deprived patients of their social skills and judgment.
Professionals utilized these unproven therapies in the extremely remote hope that they would produce some improvement in symptoms. None focused on helping the individual live a better life or experience less distress, but rather were intended to control behavior.
The first significant improvement in services to individual with mental illness came at the end of World War II, when the appalling conditions of the asylums were exposed to the public. In the wake of the 1946 Mental Health Act and the establishment of the National Institutes for Mental Health (NIMH), the federal government became directly involved in establishing standards for care in mental health institutions. Together with increased awareness of psychiatry as a legitimate science and the recognized need for treatment of mental symptoms of soldiers who had served in the war, these conditions served to increase public awareness of mental health care in the United States.
In the next few decades, pharmacological advances had a dramatic effect on the reduction of symptoms and the ability of those with mental illness to maintain productive lives. Lithium, discovered as a treatment in 1949, was a significant scientific discovery in the treatment of bipolar disorder. In 1952, the discovery of Thorazine had amazing success in reducing symptoms associated with schizophrenia. However, its side effects were serious, resulting in a condition known as tardive dyskinesia, marked by involuntary and embarrassing movements. The first antidepressants followed in the late 1950’s. In contrast to the use of force that dominated treatments of the past, these treatments were aimed at reducing the psychic discomfort experienced by the patient.
Since then, research has shown us that chemical and structural changes take place within the brains of individuals with mental illnesses. For example, depression results in a lower level of the neurotransmitter serotonin, and a new generation of antidepressants (SSRI’s) has been developed to correct this problem. Similarly, research has led to the development of the atypical anti-psychotics, which reduce symptoms in schizophrenia with fewer side effects.
A wide spectrum of brain imaging technologies, such as positron emission tomography (PET) and magnetic resonance imaging (MRI) are available to scientists as vital research tool, but still cannot be used as reliable diagnostic tools. Certain genetic markers have been discovered for depression and schizophrenia; however, scientists remain unsure as to how much genetic factors balance with environmental and social triggers. More psychiatric research is needed and vital funding in this arena is lacking.
The consumer advocacy movement has had a lasting effect in the mental health field, shifting the focus from management of symptoms to recovery and rehabilitation. Supportive housing has a proven success rate in Connecticut, enabling clients to receive wrap-around case management supports, and to keep their homes even if a relapse should occur. The Individual Placement and Support model of employment allows a client to begin work immediately, and is an evidence-based practiced statistically proven to increase competitive employment among individuals with mental illness.
Extraordinary advances have been achieved in a mere 100 years, but as this year’s celebration draws near, we remain acutely aware of all that remains to be done to raise the standard of care to that found in the treatment of other chronic diseases. The theme of Mental Health Month is “Mind Your Health”, which suggests that mental health and physical health are inextricably joined. Evidence bears this out. According to the American Psychiatric Association, stress is linked to the six leading causes of death, heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. Moreover, says the APA, people with untreated mental health problems use more general health services than those who seek mental health care when they need it. Sadly, while mental illness has better treatment outcomes than heart disease, cancer and diabetes, and is more likely to occur to the average American, it receives the least research funding of these disorders and is the most under-diagnosed. This is due to lack of education and the fear of stigma associated with having a mental illness.
A recent report by the National Association of State Mental Health Program Directors (NASMHPD), “Morbidity and Mortality in People with Serious Mental Illness” exposes a national tragedy of alarming proportions. According to the report, individuals with serious mental illness are now at risk of dying 25 years younger than those in the general population. This news underscores the critical need for the integration of primary and behavior health care services. Medical conditions—cardiovascular disease, diabetes, respiratory disease, and infectious disease (including HIV/AIDS)—are responsible for 60% of the premature deaths, with suicide accounting for 30%. Many of the risk factors for the medical conditions, the study goes on to explain, such as smoking, obesity and inadequate medical care, are modifiable.
It is past time to eliminate the barriers to providing quality care and quality of life for those with mental illness. It is nothing short of scandalous that a person’s life should be cut short just as the recovery phase is gaining momentum. In a country where 22 percent of individuals currently have some form of mental illness, we must demand action from our political leaders--at all levels.
Finding a College for a Different Kind of Kid
From the Desk of Jennifer Gross (the first of a series of articles to published in The Times Group Papers):
Last year at about this time, I had a revelation of sorts when I realized that I had been thinking that my son was going to somehow “grow out” of his ADHD. I knew better, but with college a little more than two years down the road, the reality was finally undeniable. Not only was I going to have to accept that my son’s ADHD would never be “cured”, but I was also going to have to help him prepare to take over managing his own life in time to live independently on a college campus
For so many years, the day-to-day challenges that accompanied having a child with ADHD and depression were almost overwhelming. I often couldn’t bear to imagine what the next day or the next week would bring. It’s not surprising that the college admissions experience seemed like something to worry about in the hazy and very distant future. Suddenly, though, there we were, poised on the threshold of what is for the average family, a terribly stressful process, but for a family whose child has ADHD or a similar disability, the stakes are much higher.
Where to begin, I wondered? My child can’t even remember to take his own medication in the morning. How can I even begin to consider sending him to college? And yet, with his intellectual capacity, he yearns for the college experience without even knowing it. So it is with both anticipation and trepidation that I have begun this journey with my son. I fully realize the college admission process is more competitive, stressful and perhaps more complex than when I attended college. But I remember the college search process as one of the most exciting times in my life, and I want my son to experience this same excitement, the same sense of endless possibilities that life has to offer.
This exceptional young man, whom I am proud to call my son, has battled many odds in his seventeen years, and is remarkably lacking in bitterness. He has learned empathy and tolerance for others, and he has learned a great deal about himself as well. He wants to study history and math, and teach at the high school level. When something captures the imagination of my son, he embraces it with his mind, heart and soul. Experts say this is true for many children with ADHD.
For the next year and a half, my son and I will be working closely with local college admissions consultants Perkins & Murphy, to navigate through the potential quagmire of SATs, college fairs, campus visits, applications and financial aid. Because kids with ADHD have additional challenges in the areas of basic social interaction and impulse control, the coaching that these professionals can offer my son will be invaluable. I know, too, that their expertise will coax a great deal of information from him about what he wants in a college, with far more success than I ever could. After all, this is his college choice, not mine or his father’s, and he will live with it for the next four years.
And because I truly subscribe to the adage “information is power,” I’m already visiting the website of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) to learn more about testing accommodations and colleges that offer programs for students with disabilities like my son’s. I wonder if there is a manual anywhere that gives instructions on how to let go when the time comes.
Approaching the College Years
From the Desk of Jennifer Gross (the second of a series of articles to published in The Times Group Papers):
On the last Saturday in April, my son Michael and I found ourselves sitting on a bench outside a convention hall in Providence feeling as if we were about to go into battle. Only it wasn’t a battle; it was our very first college fair. Why, I was wondering to myself, hadn’t we done the smart thing and started off small with the small college fair at Fitch High School earlier this spring? Instead, we had chosen the National Association for College Admissions Counseling (NACAC) College Fair, at the Rhode Island Convention Center, with over 200 college admissions representatives in attendance.
There we were, formulating strategy on which tables to visit first and what questions to ask; we even conducted a role play on the spot, with me as the admissions representative, and Michael as, of course, the would-be applicant. Still, we were completely unprepared for the immediate sensory overload that hit us as we walked into the huge convention hall. I’m fairly certain that for Michael, it felt very much like riding into combat. Having to approach a complete stranger, shake hands, look that person directly in the eye, and conduct a two-to-five minute “interview” on the spur of the moment can be excruciating for someone with ADHD.
Fortunately, we had “The List”, assembled in partnership with Betsy Perkins and Tim Murphy of Perkins & Murphy after several meetings held at their New London office. As part of the process, Michael and I both filled out in-depth questionnaires about Michael, our family, and our expectations of his college experience; then went over them in detail with Betsy and Tim. Surprisingly, Michael and I had very similar thoughts on what kind of college he should attend.
After this meeting, Betsy did a great deal of research and came up with a list of prospective colleges tailored exclusively to fit Michael’s needs. We went over this list carefully in a separate meeting with Betsy and discussed how and why she had formulated “The List”. Next on the scene was Tim, who introduced Michael to a nifty program chock full of every kind of detail one could wish to know about every campus in the United States. For instance, with a click of the mouse, we can easily find out which colleges have the best programs for students with ADHD and are the most likely to accept accommodations for such individuals.
At the college fair, we limited ourselves to visiting colleges on the list, which meant Michael went through the routine ten times. Each time, he became a little more comfortable and a bit more polished. At one point, he asked the admissions representative from the University of New Hampshire about the campus library. When she told him that students choose to attend just for the library, his face completely lit up. I think that was the moment when college became real for him.
The Perkins and Murphy team provides something beyond our contract that can’t be purchased. Michael likes and trusts them and he knows instinctively that they want what is best for him. For me, this is a precious commodity. Throughout Michael’s battle with ADHD and depression, he has endured humiliation and shame at the hands of others, due to the reactions his symptoms have engendered. So he has been conditioned to believe that change is a negative thing, and he tends to cling desperately to the status quo. Every transition in Michael’s life has been protracted and painful for both him and for us as a family.
As this relationship grows, they will build on the trust they have been given, providing mentoring in a myriad of areas, which will prove invaluable as we begin what Tim calls campus visit “boot camp”, and then the application process. Michael is already beginning to realize that he is capable of handling many situations and feels empowered by the experience.
Michael was exhausted as we finished up our rounds at the college fair that Saturday, but beneath the battle-weary exterior was a young man who had emerged just a bit more from his cocoon. I could see that he was walking a bit taller, taking pride in the accomplishments of the day. Just days ago, the future had intimidated him with its prospects of unwelcome change, now it is full of exciting possibilities.
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