In scathing ruling, judge rips insurer for putting ‘bottom line’ over patients’ health

A federal court ruling will hold United Healthcare accountable for failing to provide coverage to a class of 50,000 people denied coverage for mental health-related claims. It’s rare for these giants to be challenged, so the opinion is a refreshing read.

https://www.cnn.com/2019/03/06/health/unitedhealthcare-ruling-mental-health-treatment/index.html?fbclid=IwAR1N8GDdyaLGYv8ATxZOtajsK5LISAg7opKOJjz4jzd-lmf95dhMr4lFBEM

Dangerous Trend Toward Involuntary Commitment of People Who Are Not Dangerous

Pennsylvania has now joined 46 other states that have adopted laws allowing “assisted outpatient treatment” (AOT) of people who are mentally ill but not dangerous to themselves or others. Rather, the standard is whether the court finds that a person is unlikely to survive safely in the community without supervision. We believe this standard is unconstitutionally vague. Further, while AOT is touted as being voluntary, the facts of how these cases are handled indicate otherwise. Certainly, that was true in Andrew’s case. See our blog post at http://andrewsvoice.org/involuntary-outpatient-commitment-whats-the-big-deal/

Kudos to Mental Health America @mhasheb https://www.mhasheboygan.org/for opposing this law and for articulating the very real dangers it poses to civil liberty:

People who are “coerced” into mental health treatment risk becoming alienated from support services, said Sue Walther, who heads the Mental Health Association of Pennsylvania.

“There are lots of studies that show this, about coercion, how forcing someone into a system they don’t want to be part of negatively impacts their willingness to go into it in the future,” Walther said.

The Mental Health Association was one of several mental health groups in Pennsylvania that opposed the passage of the law last fall.

Walther said the criteria for committing someone are too vague.

#MHA #mentalhealth #stopthemadness #VOICE

No Link between Gun Violence and Mental Illness

Since I began advocating for protecting civil liberty for the mentally ill, the comment I hear most often is this: “But what if we let them control their own treatment, and they go and shoot up a school?” Sadly, this is a widely-held misconception. The truth is that mentally ill people are far more likely to be the victims of violence than the perpetrators of it. As stated by one of the authors of the study, “Much of the limited research on gun violence and mental illness has focused on violence among individuals with severe mental illnesses or rates of mental illness among individuals arrested for violent crimes. What we found is that the link between mental illness and gun violence is not there.”

https://www.sciencedaily.com/releases/2019/02/190207102607.htm

Support Urged for New Expungement Bill

In January of 2019, Wisconsin Senator Alberta Darling introduced a bill that would make expungement of criminal records easier in Wisconsin. Wisconsin is the only state that requires expungement decisions to be made at the time of sentencing, rather than after sentences are completed. Only in Wisconsin are closed cases not eligible for expungement. Further, Wisconsin is one of a handful of states that limit expungement to defendants under the age of 25 (see the Public Policy Forum’s analysis, the source of this information, here: https://www.wpr.org/proposed-law-would-broaden-eligibility-criminal-expungement ) If this bill had been law a year ago, it could have saved Andrew’s life. As we said in his story, he was prosecuted for being a drug addict, and saddled with a felony conviction for possession of a very small amount of heroin.  The collateral consequences of this conviction robbed him of his future.  Sheboygan County prosecutors argued against expunging his record, meaning that serving time for the offense was not enough—rather, he was to serve a life sentence that included forever denials of educational, housing and occupational opportunities. He was understandably despondent regarding his circumstances. It’s time to change Wisconsin’s status as an outlier on this issue.

https://www.wpr.org/proposed-law-would-broaden-eligibility-criminal-expungement

UPDATE: We just learned that AB 33, on expungement, is up for public hearing before the Assembly Committee on Criminal Justice and Public Safety tomorrow, Thursday, March 7. The hearing is 10:00 AM in room 225 Northwest of the Capitol in Madison. I urge anyone whose life (or whose loved one’s life) has been affected by a criminal record, especially a record related to convictions for drug use, attend and offer your perspective to the legislators. Wisconsin has the most restrictive expungement statute in the nation. This has created a whole subculture of people who, because of addiction, have been denied the ability to do their time and get on with their lives. Instead, they serve a life sentence of forever denials of education opportunities, job opportunities, and housing opportunities.

Dangers of Solitary Confinement of the Mentally Ill

The disastrous effects of solitary confinement on people with mental illness is well-known and well-documented. Yet the practice continues in jails, prisons, and even in mental health institutions. As an attorney for people subject to involuntary commitments, I have personally reviewed many medical records reflecting the use of “seclusion rooms” (i.e., solitary confinement) for behavioral modification purposes that have nothing to do with dangerousness or violence. One of my clients who was involuntarily confined at a mental institution was thrown into the seclusion room one or two times each week for misbehavior like failing to take a shower or missing a meal. This is unlawful–but very, very common. In many detention centers, the isolation cells are the size of a parking space. They contain only a steel “bed,” with no mattress, sheets or blankets. Food is slipped through a crack in the door. The inmates have no human contact, and are kept in the cell 23 out of 24 hours each day. Oftentimes, they are given a paper gown to wear, supposedly to protect them from self-harm, but completely inadequate to keep them warm in a cold cell. Solitary confinement is a form of restraint, and is only to be used when necessary to prevent a violent person from harming himself or others. But instead, it’s become a tool of convenience for corrections officers and care providers at mental institutions. And this unlawful conduct continues unchecked, because people subjected to it, like Andrew, can’t make their voices heard.

#wecanandmustdobetter #mentalillness #voice

https://acluva.org/en/silent-injustice-solitary-confinement-virginia

Mental Health Courts

We need mental health courts in Sheboygan County, and in every county in Wisconsin. These courts can identify people charged with crimes as people in need of mental health services, and divert them from the criminal justice system. We need to stop using our jails and prisons as substitute mental health institutions.

“Our prisons are loaded with people who are mentally ill — some who maybe if they had the right treatment the taxpayers wouldn’t have to pay for them being in prisons. It’s the next step in Mississippi in mental health reform. I think this would save us money in the long run and be better for Mississippians. And, it’s the humane thing to do.”

Trouble in Illinois

TREATMENTS

Most Inmates With Mental Illness Still Wait For Decent Care

CHRISTINE HERMAN • FEB 3, 2019  

The Joliet Treatment Center, southwest of Chicago, is one of three facilities now providing mental health care to some of Illinois' sickest inmates. It's a start, say mental health advocates, but many more inmates in Illinois and across the U.S. still await treatment.
The Joliet Treatment Center, southwest of Chicago, is one of three facilities now providing mental health care to some of Illinois’ sickest inmates. It’s a start, say mental health advocates, but many more inmates in Illinois and across the U.S. still await treatment.CREDIT CHRISTINE HERMAN / ILLINOIS PUBLIC MEDIA
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Ashoor Rasho has spent more than half his life alone in a prison cell in Illinois — 22 to 24 hours a day. The cell was so narrow he could reach his arms out and touch both walls at once.

“It was pretty broke down — the whole system, the way they treated us,” says the 43-year-old Rasho, who has been diagnosed with several mental health conditions, including severe depression, schizophrenia and borderline personality disorder.

Rasho says little things would trigger him, and he’d react violently. Although he’d been sentenced to prison initially for robbery and burglary, his sentence was extended over and over for assaults on prison staff.

“Even if they would label us schizophrenic or bipolar, we would still be considered behavioral problems,” Rasho says. “So the only best thing for them to do was keep us isolated. Or they heavily medicate you.”

He spent most of his 26-year prison sentence in restrictive housing, or solitary confinement, where he had hallucinations, engaged in self-mutilation and tried to kill himself.

In 2007, Rasho and 12,000 other inmates with mental illness sued the Illinois Department of Corrections, alleging that the agency punishes inmates with mental illness instead of properly treating them.

settlement was reached in 2016, when the state agreed to revamp mental health care and provide better treatment.

But a federal judge has ruled that care remains “grossly insufficient” and “extremely poor.” The agency has not hired enough mental health staff to provide care to everyone who needs it, and inmates with mental illness suffer as they continue to wait for long-overdue treatment.

Punishment, not treatment

Dr. Stuart Grassian is a psychiatrist who spent 25 years at Harvard studying how the conditions in solitary confinement cause harm — especially for people who are mentally ill.

“You’re looking at the population of a state psychiatric hospital,” says Grassian, who has met hundreds of inmates like Rasho who have served long sentences in extreme isolation.

“They’re not the worst of the worst,” Grassian says. “They’re the sickest of the sick; the wretched of the Earth. Maybe they weren’t even that bad before they got in, and they just get worse and worse. It’s a tragedy — absolutely immoral — to see that happen to people.”

Inadequate treatment of mentally ill prisoners is a problem across the U.S. When psychiatric institutions began closing down in the 1950s, they weren’t replaced with mental health services in the community. So, many people with mental illness have scrapes with the law, and end up in prisons that are ill-equipped to treat them.

According to federal data on state and federal prisons from 2011 to 2012, nearly 40 percent of inmates reported having been told by a mental health professional that they had a mental health disorder.

Yet among those who met the threshold for having serious psychological distress at the time of the survey, only about half were receiving treatment — medication, counseling, or both — for their illness. And they were more likely to be written up or charged with verbal or physical assault against correctional staff or other inmates than prisoners without an indicator of a mental health problem.

Correctional facilities in the U.S. are considered the largest provider of mental health services. Yet many prison systems are facing fiscal crises and struggle to provide constitutionally adequate treatment, even after lawsuits lead to court mandates for access to mental health care.

The problem is particularly bad in Illinois, which has long ranked near last in terms of the amount of money it spends on health care for inmates, according to the Pew Charitable Trusts.

And when prison inmates don’t receive the mental health care they need, they’re more likely to cycle in and out of the criminal justice system.

Alan Mills, one of the attorneys representing inmates in the 2007 class-action lawsuit, has made numerous visits to Illinois prison facilities in recent years.

“When you walk through these galleries, you get overwhelmed by the pain and suffering that you see in front of you,” says Mills, director of the Uptown People’s Law Center in Chicago.

An obvious problem

Even state officials acknowledge the prison system has not done well for inmates with mental illness.

“Corrections in Illinois was a little slow to recognize we are the mental health system for Illinois,” says John Baldwin, who directs the state’s corrections department. “Whether we want to be or not, we are; and we have to start acting like it.”

Baldwin says since he took over in 2015, the department has hired more mental health staff and provided training to all employees on how to engage with people who are mentally ill.

Most inmates now spend at least eight hours a week out of their cell and see a therapist once a month.

And about 765 of the inmates who are most ill have been transferred to new residential treatment facilities — where they are finally receiving appropriate care, Baldwin says.

But Mills points out: That’s a small fraction of the 12,000 who are mentally ill.

“And for the vast majority of those, not a lot has changed,” Mills says. “They simply aren’t getting the kind of treatment they need in order to improve their situation at all.”

A sign of progress

The Joliet Treatment Center in the southwest suburbs of Chicago doesn’t look like a typical prison facility.

Half a dozen single-story buildings — called dorms — surround a big grassy area. Walking paths connect the dorms.

“I always refer to it as the quad,” Warden Andrea Tack says, as she takes me on a tour. “It reminds me of some of the college campuses that have [a] big center lawn area and then all the classrooms surround it.”

But, unlike a college campus, this facility is surrounded by two layers of barbed wire fencing.

A few years ago, Illinois spent $17 million to convert what used to be a youth detention center at Joliet into a mental health treatment facility for inmates with serious mental illness.

The dining hall is at the center of the quad; the gym is just to the east, and a building to the south houses a library, medical clinic and classrooms where inmates take GED courses and receive job training.

Tack says the inmates here spend about 30 hours a week out of their cell in various activities, according to their individual treatment plans.

She says she’s seen inmates who’ve been transferred to the Joliet facility make huge strides over the past year.

People who were attempting to hang themselves and acting out aggressively, “now, they’re out and about in the community — going to classes, going to meals, interacting with others,” Tack says. “Some are serving as mentors for other residents.”

Mills says he, too, has seen this transformation in some inmates.

“And it’s a difficult transition,” he says, “because you’ve been treated in a place where you’re continually traumatized, and then you get to a place where actually people care about you.”

It takes time, Mills says, for many to learn that they can trust and receive help, instead of acting out aggressively the way they’ve been conditioned to do for so many years.

‘Culture of abuse’

The atmosphere at the Joliet center stands in stark contrast to the experience at some of the state’s other prisons, such as Pontiac Correctional Center, located about 60 miles south of Joliet.

There, inmates with mental illness are often kept isolated and are lucky to get even one hour of mental health treatment a month, says Dr. Pablo Stewart, a psychiatrist. He was appointed by the federal court to oversee the settlement in the lawsuit.

In his most recent report, Stewart singled out the prison at Pontiac for having a “culture of abuse and retaliation” against mentally ill inmates.

“Almost everyone at the mental health unit at Pontiac should be at Joliet,” Stewart says.

If they were getting that same level of mental health care, Stewart says, they wouldn’t have as many behavior issues.

The Pontiac prison has a high concentration of inmates with behavior problems; the most challenging inmates are transferred there from prison facilities across the state.

And the facility lacks the necessary mental health staff to provide treatment to everyone who needs it.

As a result, Stewart says, many mentally ill inmates are isolated from the rest of the prison population, with little or no meaningful social interaction. The conditions cause them to deteriorate, he says, making them more prone to acting out.

Mentally ill prisoners isolated this way “end up throwing feces or urine at staff; end up exposing themselves [or] masturbating in front of female staff,” Stewart says.

Inmates with untreated mental illness also often get into fights with other inmates and prison staff.

Stewart says the workers themselves are traumatized from their job, and that can make them prone to retaliate. Based on interviews with both inmates and staff, Stewart says he’s absolutely convinced that some staff members abuse inmates at Pontiac.

Asked about those abuse allegations, a spokesperson for the corrections department, Lindsey Hess, writes in an email that the agency takes allegations of excessive force seriously and investigates them.

In an interview prior to the latest court monitor’s report, Baldwin said he would “be surprised” if inmates with mental illness were being abused today.

“We take swift action to refer [any reports of abuse] we get to the state police or the state’s attorney,” he said. “We will not tolerate that.”

As for prison staff who may be traumatized by their job, Hess says the agency has implemented several initiatives in recent years to improve the mental, physical and emotional well-being of employees.

These include peer support groups for staff, access to professional counselors and a recurring class — called “From Corrections Fatigue to Fulfillment” — that teaches staff members about the psychological dynamics of working in the field of corrections.

Stewart says Joliet is one Illinois facility that is finally providing inmates with adequate mental health treatment. That should be the norm everywhere, he says. But it’s not.

“That’s the standard of care that’s required,” Stewart says.

A lingering problem

When I interviewed Rasho last May, he’d been out of prison for more than a year. But his many years spent in solitary confinement still haunt him.

“I don’t sleep right,” he told me. “Any little thing triggers something in me.”

Last fall, Rasho was arrested again, so he’s now back in the prison system.

Mills says the situation in Illinois shows that lawsuits don’t always solve the problems — at least not right away.

“A court order is great, but it’s a piece of paper,” he says. “It’s not actually treatment.”

The orders from U.S. District Judge Michael Mihm continue.

Days before Christmas, he ordered Illinois’ prison agency to correct widespread deficiencies. He gave the agency until March to hire enough mental health staff to provide adequate care to all inmates who need it.

This story was produced by Side Effects Public Media, a news collaborative covering public health. Christine Herman is a recipient of the 2018-2019 Rosalynn Carter Fellowships for Mental Health Journalism. Follow her on Twitter: @CTHerman.Copyright 2019 Illinois Public Media – WILL. To see more, visit Illinois Public Media – WILL.

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Involuntary Outpatient Commitment: What’s the Big Deal?

The term “involuntary civil commitment” covers more than just forced incarceration at the psychiatric ward of a hospital or mental institution. In substantially increasing numbers, Wisconsin residents have been subjected to outpatient involuntary commitments, which more often than not are extended year after year on little more than a rubber stamp, all at taxpayer expense.

On the surface, it may seem as though the outpatient involuntary commitment is only a minor intrusion on the rights of the “subject,” as the person is referred to in the applicable statute. After all, the individual is free to live and work in the community, subject only to the terms of the involuntary commitment order. Those terms typically require that the individual comply with any terms of treatment that might be imposed by the treating psychiatrist, including involuntary administration of psychotropic and other medications, most of which have debilitating and often irreversible side effects. Additionally, the standard involuntary commitment order requires the individual to abstain from non-prescribed drugs and alcohol, and includes a lifetime ban on possession of firearms. And the order gives the treating psychiatrist troubling authority to order arrest and incarceration of the “subject” if the doctor—without inconvenient limitations of due process of law—determines that the conditions of the order have been violated.

A psychiatrist in conversation with me once likened the involuntary outpatient commitment to “training wheels;” simply a “safety net” to assure that a person diagnosed with a mental illness would not stray from the rigors of prescribed treatment. Such a description reflects a lack of understanding of the very significant intrusion involuntary commitment represents to the civil liberties of the individual so restricted. It is difficult for a person accustomed to freedom—one who has always had the ability to go about his or her business unfettered—to appreciate the massive intrusion represented by involuntary commitment, be it inpatient or outpatient.

Imagine a scenario where one of us not subject to an involuntary commitment is driving to a doctor’s appointment. Our car stalls in traffic. We pick up our cell phone, dial the doctor’s office, and explain the situation to the receptionist. We apologize, and re-schedule our appointment. For Andrew, as the “subject” of an involuntary outpatient commitment, the situation is much different. His car stalls in traffic on the way to his appointment; he calls the only number he has been given for the doctor’s office; he listens to a pre-recorded message, which then goes to dial tone with no opportunity to speak to a person or leave a message. He deals with the stalled vehicle and goes home. Then, he waits for the inevitable … a squad car arrives at his house, lights flashing. Curious neighbors come to their porches and windows to see what is going on. The officers pound on the front door, in full view of the neighbors. Then, when Andrew emerges, he is hand-cuffed, thrown into the back of the squad car, and delivered to the lock-down psych ward, where he is shot up with medication and held for 72 hours, risking loss of his job, loss of his home, loss of his pets, and other significant consequences which are of no apparent concern to the County or its appointed doctors.

Here are Andrew’s words on the subject, taken from the transcript of his December 2, 2018 recommitment hearing:

“I feel [the commitment] is unnecessarily restrictive…You know, those appointments they said that I missed. I don’t feel that I got any type of proper notice to come and show up. I got arrested almost the day after the appointment [in] both cases. The cops showed up at my house—in front of my house and made me look bad in front of my neighbors and came and cuffed me and brought me to K-1. [Note: K-1 is a reference to the lock-down psychiatric unit at Aurora Memorial Hospital in Sheboygan, WI.] Somebody could have called me and asked me to come to K-1. I would have showed up, you know…[They] make it sound like it’s all really nice and good and helpful and everything, but it’s not really the same when you’re going through it on the other side. And, you know, I mean, I’m trying—I do my best to comply with all the rules and everything, but to me it seems like a never-ending process. Honestly, like, some aspects of it seem borderline unconstitutional.”

Andrew was right. He had a constitutional right to due process of law, which the current system denies to him and others similarly situated when doctors arbitrarily order “subjects” to be arrested and incarcerated for perceived minor violations of the terms of the commitment order. Further, he had a constitutional right to application of the “least restrictive alternative” in all aspects of his treatment. Clearly, picking up the phone to ask him to appear for a missed appointment is less restrictive than the heavy-handed arrest, complete with flashing lights, door-pounding, handcuffs and incarceration.

We can and must do better than this.