Mental Illness Expert: How to Prevent Future Sandy Hook-Type Tragedies

While the mainstream media reflexively tries to focus all discussions about the Sandy Hook Elementary School massacre around gun control, mental illness expert D.J. Jaffe, who directs the Mental Illness Policy Organization, wrote a compelling article about steps federal and state governments can take to "prevent violence related to mental illness." 

The issue of mental health in America may be a more important, urgent, and relevant topic of discussion than gun control in light of reports that Adam Lanza, the shooter who killed 20 children and six adults last Friday, may have had a mental illness:

1. Assisted Outpatient Treatment.

    Jaffe first suggests starting demonstration projects of the Assisted Outpatient Treatment (AOT) program, which allows “courts to order individuals with mental illness to stay in treatment as a condition of living in the community” throughout the country. He notes New York has Kendra’s Law and California has Laura’s Law to enforce this statute.

    Because AOT would only be “applicable to the most seriously ill who have a history of violence, incarceration, or needless hospitalizations,” it is “proven to keep the patients, the public, and police safer.” Jaffe notes the Department of Justice has certified it as a crime-prevention program, but “mental-health departments are reluctant to implement AOT because it forces them to focus on the most seriously ill.”

    2. Allow parents to the mentally ill to get their children's medical records. 

    Jaffe suggests writing “exceptions into the Health Insurance Portability and Accountability Act (HIPAA) so parents of mentally ill children can get access to medical records and receive information from their children’s doctors on what is wrong and what the children need:”

    Right now, for reasons of “confidentiality,’ doctors won’t tell parents what is wrong with their kids or what treatment they need, even as they require parents to provide the care.

    3. End the Institutes for Mental Disease (IMD) exclusion in Medicaid law. 

    According to Jaffe, this provision in the law basically tells states: “If you kick someone out of the hospital, we will pay you 50% of the community care costs.” 

    “This causes states to lock the front door of hospitals and open the back door, regardless of whether the community is an appropriate setting,” Jaffe writes. “If you have a disease in any organ of your body, other than the brain, and need long-term hospital care, Medicaid pays. Failing to pay when the illness is in the brain is federal discrimination against persons with mental illness.”

    4. Don't let federal standards for "mental health" kill the "mentally ill." 

    Perhaps most importantly, Jaffe argues that under current federal law, funds that should be used to treat the seriously "mentally ill" are instead going to programs that cater to the those he calls the "worried well" that are deemed to have "mental health" issues. Jaffe writes "government agencies now claim that 40 percent or more of Americans have a mental ‘health’ issue," but funding isn't going to those within this group who need it the most.

    Jaffe argues that only five to nine percent of Americans have a serious mental illness, but agencies and programs that treat them are the least likely to get the federal funding that should be explicitly earmarked for them. Jaffe says the government needs to be spending money on these "mentally ill" people and not the so-called "worried well," as he calls those in federal programs to improve mental health. 

    "There is more than enough money in the mental-health system to prevent Newtown-type incidents, provided it is spent on people who are truly ill, not the worried-well," Jaffe claims.

    In a previous article on the subject, Jaffe wrote that there has been:

    intentional, disastrous and massive migration in America away from treating the seriously mentally "ill" in favor of improving mental "health," which is defined as "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

    Jaffe noted that "mental health" services "focus on making the worried-well less worried," while mental illness, which is a "biologically based no-fault medical problem that resides in the brain's chemistry or neuroanatomy," left untreated can "lead to irrational thinking, and therefore irrational behavior" and often goes untreated. 

    Jaffe explained that "hardly anyone is still fighting for the mentally ill" and that "it is no longer even considered politically correct to use the term 'mental illness,'" and that "one must say 'mental health.'" He also noted that it is not politically correct to says "patients... you are supposed to say 'consumers,' as in 'consumers of mental health services'":

    The people we see under 12 layers of smelly lice-infected clothing talking to themselves, fearing their hallucinations as they forage through garbage cans looking for food are not "consumers". They should be patients, but no one wants them. Oops. Was that politically incorrect? I don't care.

    Jaffe also said those who say spotlighting the plight of the mentally ill is stigmatizing to them is like "saying focusing on women who need mastectomies is stigmatizing to those opting for enlargement."

    5. Eliminate the Substance Abuse and Mental Health Services Agency (SAMHSA). 

    The program, according to Jaffe, costs $3 billion annually to run and is "the epicenter of what is wrong with the American mental-health system... SAMHSA actively encourages states to engage in mission creep and send the most seriously ill to the end of the line."

    In a previous article on the subject, Jaffe highlighted four ways SAMHSA makes it more difficult for the mentally ill to get treatment: 

      1. SAMHSA makes it harder for people with mental illness to get treatment. SAMHSA provides massive funding to groups that believe if an individual -- because he is psychotic -- does not recognize their need for treatment, that person should not be allowed into treatment until after they become danger to self or others. Rather than prevent violence, they want to require it.
      2. SAMHSA has failed to exercise oversight over the Protection and Advocacy for Mentally Ill Individuals program. This program funds public interest law firms that are supposed to help people with mental illness get treatment. Instead, many of these law firms have decided to do the opposite: prevent people from mental illness from receiving treatment. In Maine, mentally ill William Bruce killed his mother with a hatchet after SAMHSA-funded PAMII lawyers taught him how to avoid involuntary treatment.
      3. SAMHSA has failed to exercise oversight over the block grant program. SAMHSA sends $2 billion to the states in the form of block grants. But SAMHSA allows the funds to be diverted to programs that don't have anything to do with mental illness.
      4. SAMHSA wastes money. SAMHSA uses its funds to create, publish and distribute children's books that have nothing to do with mental illness like A Day in the Park, brochures on Making and Keeping Friends and Building Self-esteem. They create, manufacture and market multicolor stickers kids can wear saying, "I am cool" and "I listen well." Looking for online games for your kids to play? SAMHSA creates those too.

    At the state level, Jaffe argues that states should make greater use of the AOT program. He notes Connecticut did not have an AOT law on its books.

    Jaffe also feels states should make sure their civil-commitment laws include all the following categories instead of simply looking to determine whether someone is a "danger to self or others":

    (A) Is “gravely disabled”, which means that the person is substantially unable, except for reasons of indigence, to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety, or (B) is likely to “substantially deteriorate” if not provided with timely treatment, or (C) lacks capacity, which means that as a result of the brain disorder, the person is unable to fully understand or lacks judgment to make an informed decision regarding his or her need for treatment, care, or supervision.

    He also believes that when the "'dangerousness standard" is used, it must be interpreted more broadly than "imminently" and/or "provably dangerous," and state laws should consider a "patient’s record in making determinations about court-ordered treatment, since history is often a reliable way to anticipate the future course of illness."


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