House Approves 2010 Funding for Mental Illness Research and Services

July 27, 2009

On July 24, by a vote of 264-153, the House cleared legislation that includes funding for mental illness research and services for FY 2010. The bill, known as the FY 2010 Labor-HHS-Education Appropriations bill (HR 3293) includes a $52 million increase for mental illness research at NIMH, as well as an $8.4 million increase for the PATH program (outreach services for homeless individuals with serious mental illness) and a $17 million for the Childrens Mental Health program. The Senate takes up the FY 2010 Labor-HHS-Education Appropriations bill in Committee next week.

Mentally Ill Immigrants have little hope for care when Detained

Mentally ill immigrants have little hope for care when detained
11:20 PM CDT on Sunday, July 12, 2009
By EMILY RAMSHAW / The Dallas Morning News
eramshaw@dallasnews.com
AUSTIN – Jose Fernandez Sanchez was delusional when he broke a window to enter his neighbor's apartment. The schizophrenic and epileptic 45-year-old, who had gone to an Austin hospital the day before, complaining of hearing voices, told police he was trying to light a candle for his dead mother. But instead of taking Sanchez to get medical attention, authorities started deportation proceedings against him, leaving the legal permanent resident in a detention-center cell for eight months. By the time a judge saw Sanchez, he was so catatonic that he couldn't answer a simple question.
Sanchez was one of the lucky few: His siblings pooled their money to hire an attorney, who made a compelling case to an immigration judge. Sanchez went from the detention center to a San Antonio psychiatric hospital, where he should have been all along.
But most mentally ill immigrants aren't so fortunate. They get limited mental-health care while in detention, advocates say – and that's only if they're diagnosed. They aren't entitled to competency hearings before standing trial. And the majority of them face judges without legal counsel, and with little recourse to defend themselves from deportation.
"I felt like I didn't have the power to get help. They didn't care how they were taking care of me," said Sanchez, who emigrated from Mexico in 1988 and received amnesty in the United States. "I was very scared, because I knew if I was sent back to my country, they wouldn't be able to help me like the U.S."


National guidelines

Immigration detention officials say they have strict guidelines for mental-health care in detention centers. All inmates receive a mental-health screening as part of their intake exam, they say. Those with suspected mental illness are referred for more tests and treatment. In fiscal 2008, detention-center personnel performed nearly 30,000 mental-health interventions – including providing emergency care to detainees seen as suicide risks.
"We are continuing to work ... to improve the services and the availability of health care to those in our custody," said Tim Counts, spokesman for U.S. Immigration and Customs Enforcement.
But immigration court officials acknowledge there's little guidance for how to handle mental health once these detainees come before a judge. Although judges can't accept an admission of guilt from an "unrepresented incompetent," there are no immigration-court proceedings to determine a person's competency. Judges have to go with their gut – which can be tough to gauge with language barriers and the frequent use of long-distance video conferencing.
"There are no rules or any guidelines or any laws related to determining mental competency," said Elaine Komis, spokeswoman for the Executive Office for Immigration Review, which oversees deportation hearings for the U.S. Department of Justice. "When judges encounter someone who seems to be mentally incompetent, they do try as much as possible to arrange for some kind of pro bono counsel."
Social-justice advocates say that's not good enough. Researchers from the nonprofit advocacy group Texas Appleseed have teamed up with pro bono attorneys from the Akin Gump law firm to study mental-health procedures in detention and deportation proceedings. Their focus is on Texas, which houses a third of the country's immigrant detainees and is home to eight of the nation's 55 immigration courts.
These advocates say detention facilities don't consistently follow mental-health standards, and often don't have enough mental-health workers to handle the estimated 15 percent of detainees suffering from mental illness.
Until early this year, they say, two Texas detention centers housing a combined 2,700 people shared a single psychiatrist. As a result, they say, detainees who receive mental-health treatment in the community rarely get it once they're incarcerated. They miss medicine doses, get misdiagnosed or are prescribed drugs with which they aren't familiar.
"There are no real standards for diagnosing or dealing with mental-health issues while in the system," said Steve Schulman, a partner with Akin Gump who heads the firm's pro bono practice.

Lack of hearings

Advocates say that even if someone is diagnosed with mental illness in the detention setting, it's rare for that to get passed along to a judge.
Unlike in the criminal- justice system, there are no mental-competency hearings. Fewer than half of detainees have legal representation. Immigrants represented by attorneys are 50 percent more likely to avoid deportation, but the government has no obligation to appoint counsel for those who can't afford it.
"The end result is that people are being deported without regard for their mental health," said Ann Baddour, senior policy analyst at Texas Appleseed.
In one case, advocates say, a severely mentally ill woman was nearly deported to Russia because she told authorities she was a Russian immigrant. She was actually a U.S. citizen from Indiana. In another, a Haitian immigrant whom a criminal court had declared incompetent to stand trial was taken into custody by immigration officials at a psychiatric hospital.
Sanchez's siblings are sure their brother would have wound up back in Mexico – or worse, dead – if they hadn't been able to hire an attorney.
"He was never evaluated properly, never given proper treatment," said Sanchez's brother, who asked not to be identified because of his immigration status. "He was all alone in there. We feared the worst, that he would be deported or even take his own life."

Loved One Refusing Meds in the Hospital?

In the state of Texas, even if a person is committed involuntarily to the hospital for treatment, that person has a right to refuse medication. So what can be done to help your loved one? An application can be made to the county judge under Texas Health and Safety Code § 574.104. "PHYSICIAN'S APPLICATION FOR ORDER TO AUTHORIZE PSYCHOACTIVE MEDICATION." This can actually be done at the same hearing for the commitment order, but may be done as far out as 30 days after the application is filed with the court. Or, if the hospital is in a different county (as Rusk State Hospital and Terrell State Hospital is for Smith County) the original county court may transfer this type of jurisdiction to the hospital's county court. This way the person does not have to be transported back to their original county for the hearing. Sounds logical doesn't it?

So how does Smith County compare? Smith County has typically longer hospital stays than other counties with a cost to taxpayers of $363 per person per day as indicated in this DSHS report. Statewide, the average length of stay in a state hospital is 36 days. For Rusk State Hospital it is 45 days. Why is this? Are the patients getting more treatment? Actually the opposite is true. For those from Smith County and refusing medications, the application for court ordered medications is probably sitting on the county judge's desk. These hearings are not scheduled in an expedient manner and the Smith County Judge refuses to transfer the jurisdiction to Rusk County because this costs a few hundred dollars. So, by saving a few hundred dollars, the county judge is costing the taxpayers thousands.

Now, I have mentioned the financial impact not because that's the most important concern, but, because (1) it's easy to follow the tax dollars, and, (2) dollar signs speak louder to politicians than humanity issues. Nothing speaks louder than dollar signs to politicians seeking re-election except for maybe voters calling and stating their concern. What can you do about it? Contact the Smith County Judge and tell him you are concerned about the probability that applications for court ordered medications are not being handled in an expeditious manner. Or, just ask him questions about how long this process takes or how it happens. Be polite and your concerns will probably be taken seriously. This is the grassroots way of making a change in government.

Please leave your experiences in the comments section.

Public Comment on Community Mental Health Block Grant Plan

Public Comment on Community Mental Health Block Grant Plan
The Texas Department of State Health Services (DSHS) is submitting an application to the Substance Abuse and Mental Health Services Administration (SAMHSA) for Block Grant funding for Federal Fiscal Year (FFY) 2010 for Community Mental Health services for youth and adults throughout the state’s 11 health and human services regions. These federal funds provide approximately 31 million dollars a year to Texas for the provision of Community Mental Health Services.

The Mental Health Block grant program awards funds to states to establish or expand an organized, community-based system for providing mental health services for adults with serious mental illness (SMI) and children with serious emotional disturbances (SED). Funds awarded are to be used to carry out the approved state plan, to evaluate programs and services set in place under the plan, and to conduct planning, administration and educational activities related to the provision of services under the plan. The Community Mental Health Services Block Grant accounts for approximately 7% of DSHS expenditures of Community Mental Health.

For complete details on submitting public comments on the Draft Mental Health Block Grant (MHBG) Plan, please see the MHBG page. Comments must be received by 5:00 p.m. Central Daylight Saving Time, Thursday, August 14, 2009.

Criminal Justice Symposium at NAMI Convention

The Criminal Justice Symposium at last week’s NAMI Convention in San Francisco featured excellent presentations by Judge Stephen V. Manley of Santa Clara County’s Mental Health Court and Kathleen Connolly-Lacey who co-founded San Francisco’s Behavioral Health Court. Santa Clara’s Mental Health Court is the largest such court in the nation, serving 1,600 individuals with mental illness and substance abuse disorders, most of whom have been charged with felonies. San Francisco’s Behavioral Court is a collaboration in the best sense of the word between the court system and the mental health system. Individuals served by the Court (also primarily charged with felonies) have access to an array of services, including Assertive Community Treatment, supportive housing, and supported employment.

A particularly moving moment occurred when Judge Manley introduced a young woman who was a graduate of his Court five years ago. Since her arrest and diversion, she has made great progress in recovery, has moved to Albuquerque, NM and was attending the NAMI Convention as a representative of NAMI-New Mexico. She later told me that she believes that Judge Manley’s compassion and support “saved my life.”

Prior to speaking at the Convention, Judge Manley, this year’s recipient of NAMI’s Sam Cochran Criminal Justice Award, stopped by the studio’s of KQED, Northern California’s public radio station, and gave an interview about the Santa Clara Court. Here is a link to that interview.

http://www.californiareport.org/archive/R907090850/a

Thanks to Judge Manley and Ms. Connolly-Lacey for their excellent presentations and for compassion and strong commitment to recovery for people with mental illnesses.

Doc puts inmates' mental health first

From my SA news:
By Melissa Fletcher Stoeltje - Express-News


It's become a given among mental health professionals that jails are now the largest psychiatric hospitals in the country. In Bexar County, as in others around the nation, roughly one out of four inmates suffers from some kind of mental illness.

That translates into some 800 inmates at the county jail being treated for a psychiatric disorder — hundreds more than patients being cared for at the San Antonio State Hospital.

Dr. Sally Taylor, administrator of psychiatric services at Bexar County Jail, has been on the front lines of the struggle to treat and rehabilitate mentally ill prisoners.

Before that, she was the medical director of the psychiatric emergency room at University Hospital for 17 years, dealing with some of the most disturbed and violent patients and training scores of medical students and other health professionals.

But she's done more than that. By all accounts, Taylor has been a tireless advocate for the mentally ill in San Antonio, working with local advocacy groups to reduce stigma about mental illness, encourage churches to address mental disorders and promote education and community awareness about mental disease.

Recently, she worked with other mental health groups on legislation to compel mentally ill prisoners to take their medication.

This is important for those who have been found incompetent to stand trail and are in jail awaiting transfer to an inpatient competency restoration program.

This will allow treatment for those with severe mental illness who are a danger to self or others or who lack the capacity to understand the risk of refusing treatment, and who have been excluded from court ordered treatment simply because they are located in jail.

It might even help some inmates enough that they could enter outpatient competency restoration.

The bill was signed into law by Gov. Rick Perry.

Because of her work, Taylor was recently one of 41 psychiatrists around the country to be given the prestigious 2009 Exemplary Psychiatrist award by the National Alliance on Mental Illness, for which she was nominated by the local NAMI chapter.

“Psychiatrists who are honored have really gone the extra mile,” said Michael Fitzpatrick, executive director for NAMI. “We awarded Dr. Taylor not only for her work in (University Hospital's psychiatric ER) but for her engagement with us on policy, corrections and faith-based initiatives. She's just outstanding.”

Yolanda Alvarado, chairwoman of the Bexar County Mental Health Task Force, said Taylor was the driving force behind the compelled medication legislation.

“I know that it came from her brain,” Alvarado said. “She got the judges involved, too. She actually went to testify. Because she's a doctor, she carries such credibility.”

Speaking from her office inside the jail, Taylor, who earned her medical degree from the University of Texas Health Science Center, said mentally ill people off their medication often commit petty crimes — criminal mischief and the like — then wind up in jail.

Before the legislation she worked on became law, they couldn't be compelled to take medication in jail, unlike in mental health facilities. They would be judged incompetent to stand trial.

“And then what happens is they end up languishing in jail for two or three months because there are no open beds at the state hospitals,” she said.

“And for all that time they're deteriorating and getting worse. I worry that some of these people might never be restored because the brain stays sick for so long.”

Sometimes an inmate goes into the state hospital for competency restoration, then comes back to the jail and again refuses medication — which sends him or her back to the hospital. It's becomes a cycle.

Taylor, to appease advocacy groups that resist the idea of compelled medication, helped craft the legislation to apply only to those inmates who are deemed a danger to themselves or others.

But her goal is not just to help restore sick inmates to competency. In 2008 she advocated for more than 100 inmates who had committed misdemeanor crimes to have their charges dropped so they could then enter treatment programs, rather than incarceration.

“In coordination with the district attorney's office, the probate court, the jail staff and the Center for Health Care Services, we were able to get civil commitments sending them to the state hospital,” she said. “That may not sound like a lot of people, but for us it was a brand new process, and it became a well-oiled process.”

Taylor applauds the city's award-winning jail diversion program, which trains police officers to recognize mentally ill law-breakers and take them to ERs and other treatment facilities instead of jail.

But she said much more needs to be done with regard to the long-term needs of mentally ill lawbreakers.

“We do a great job recognizing the (mentally ill) at the front door, but the problem is the back door,” she said. “Bexar County is one of the lowest counties in per capita funding for mental health in Texas, and Texas is 48th or 49th out of the 50 states in terms of funding for mental health.

“You can do all the screening and all the jail diversion that is possible, and I'm completely in favor of that, but you've got to have services for people when you send them out in the world.”

Too often, she said, released mentally ill inmates confront a host of obstacles on the outside that hobble them in being compliant with their medical care. And then they re-offend.

“If somebody comes to the jail because it's a place to sleep and eat, you want to be able to provide that on the outside,” she said. “We don't have enough residential units, we don't have enough housing, we don't have enough supported employment, we don't have support services, we don't have intensive case management. So we drop the ball.”

Taylor, who swims and makes jewelry to de-compress from her high-pressure job, said she is drawn to working with the prison population because she is able to help give voice to the voiceless.

“I like helping people that the rest of society shuns,” she said.

Annual NAMI Texas Conference in October