Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

Milwaukee County’s Mental Health Reform Successes

In a local publication, the Urban Milwaukee online newsletter reports on the beginnings of success in Milwaukee County’s difficult reform process addressing their overstressed mental health services delivery system. Milwaukee County had made the national news more than a few occasions in the last three years or so, as its deficiencies came to light. The reader is encouraged to use any search engine to see such accounts as this, to get a feel for what the advocates, patients, public mental health agencies and the local county government, were facing. It sounded even to this reader and observer, like another example of failure, governmental funding neglect, inadequate services, etc., that would take its place alongside numerous other instances of local and regional failure in mental health services delivery. It was also very much in doubt that adequate solutions would or could be organized, funded and put into place.

However, the local groups involved in Milwaukee County from county officials to agencies, advocacy groups, patients, and mental health providers, pledged to address the issues jointly, and they did so for over two years. Their efforts, I am sure, were extremely difficult and daunting to everyone involved. But they persevered under very stressful circumstances, and as the television commentators would say, ‘they pulled it off.’

In an article entitled “Milwaukee County’s Approach in Mental Health Reform is a National Success Story,” this unusual effort is detailed anyone interested in this national and local issue to read, take heart from, and to learn from.

One of the signal features of their effort was truly bringing all the “stakeholders” together to work in a very unified manner, encouraging novel ideas. Very different worlds, from police to clinicians and local governmental officials of all stripes formed working groups in a “multidisciplinary” way[another current buzzword that I often detest, but seems to apply in this effort]. One example is that early on in their work process, the reformers for lack of a better term overcame the usual city-county splits of governmental entities, clinical entities, and police law enforcement groups. Too often I have seen all kinds of efforts ranging from budgetary matters to who pays for the pro football team’s new stadium to where the next trash landfill will be located. In greater Milwaukee, the city-county entities worked together [gee, I wish Congress could do that…]

So, if you are interested in mental health reform and need an example of success to strengthen your own resolve, please read about Milwaukee’s efforts.

Virginia’s Mental Health Reform Legislative Progress

Continue reading “Virginia’s Mental Health Reform Legislative Progress”

Larned State Hospital Turns to Law Enforcement Figure for Hospital Superintendent

I am calling attention once again to the long-standing troubles at one of the two Kansas state psychiatric hospitals, Larned State Hospital, which has had over the last few years a host of staffing, management, clinical and accreditation problems. I am reaching back a bit, now six months to refer to an article, published June 29 of last year, 2016, by the online arm of KHI News Service of Topeka, “Longtime Kansas State Attorney Name Larned State Hospital Superintendent by Bryan Thompson.” The new hospital superintendent is Mr. Bill Rein, long experienced in state mental health affairs. Mr. Rein brings a vast amount of experience with him, including his former positions as the former chief counsel for the Kansas Department for Aging and Disability Services, which oversees the state’s mental health hospitals in Larned and Osawatomie. He also had been the former chief counsel for the Kansas Department for Aging and Disability Services, which oversees the state’s mental health hospitals in Larned and Osawatomie. He also had supervised attorneys representing the state hospitals from 1984 to 1987. So this man has had an unusual career of experience in mental health policy planning, drafting mental health-related legislation and direct experience in a vital sector of legal representation of the state’s mental hospitals.

Bill Rein the new superintendent of Larned State Hospital since June 2016

CREDIT FILE PHOTO, KHI News Service, Topeka KS

When Mr. Rein was appointed he spoke of the tasks facing him and showed an unusual and encouraging grasp of the magnitude of the problems that face this hospital in particular which mirror those of other state hospitals around the country, including long-term inadequate funding, overworked staff forced into overtime work shifts much too frequently causing high staff turnover, difficulties recruiting care and professional staff at all levels because of the very rural location of the hospital with a small’ish surrounding population base, and particular difficulties attracting professional mental health staff because of low salaries that are noncompetitive.

This man is shouldering a very large task and this writer hopes he can turn this hospital and vitally needed system around in time. I hope to watch and monitor developments and bring them to the reader in the future. Kansas hopefully can become an example to other states of what it will take to put in place quality based reforms at the state psychiatric hospital system level for other states facing almost exactly the same problems, of which there are more than a few in this country.

Community Support Like Gheel Belgium in Frederick Maryland

Since the 1400’s, the town of Gheel (also spelled Geel) Belguim has done an incredible “community project,” that as a psychiatrist I have read about periodically, and marveled at for decades. In short through an unbelievably improbable religious fluke of an event of historical Christianity, started a custom of taking in the mentally ill by families. In Gheel, families would care for the mentally disabled for as long as they could. If the parents of the caretaking family died, and the disabled ‘adopted’ member of the family was still alive, the grown children would take over their care. The system was unique in the world and still is. In fact, in some ways because of its historical longevity, it has in some ways become stronger. All this occurred centuries before any semblance of modern mental health care and it worked. Of course some of the mentally ill were so disturbed they could not be housed in families’ home but most could. The above link takes on to one of the best all around explanations of this social experiment, namely a Wikipedia article. In modern times, hundreds of social researchers and mental health professionals have made pilgrimages to Gheel to observe and study this centuries-old social ‘experiment.’

In an article entitled, “Unique programs offer people with mental illness a place in their communities, published recently in the New Haven Register, a somewhat similar social good work was profiled in the Frederick VA area, with photographs from the Washington Post. I have excerpted the following pictures and captions from that article, taken by the Post photographer and given due credit.

David Weiss, who is interested in Buddhism, seeks peace and calmness at the Tibetan Meditation Center in Frederick, Md. A favorite mantra is “Pull a weed, plant a flower.”

David Weiss, who is interested in Buddhism, seeks peace and calmness at the Tibetan Meditation Center in Frederick, Md. A favorite mantra is “Pull a weed, plant a flower.” Washington Post photo/Katherine Frey By Colby Itkowitz, The Washington Post

POSTED (in the Washington Post: 01/22/17, 8:32 AM EST

David Weiss, above, who is successfully dealing with several serious mental health conditions, plays a song he wrote about his sister Faith while his cat, Bab-Babes, rests close by in Weiss’s one-bedroom apartment in Frederick, Maryland. Way Station provided Weiss with the apartment as well as a case manager. Washington Post photo/Katherine Frey

The profiled recipient of this comprehensive program, though lives on his own, attends community college classes, receives his care through clinical services of the renowned Shepherd Enoch Pratt Hospital system and lots of what we would call “ACT team wrap around” services in his apartment with visiting clinicians and by appointments in a clinic in the traditional manner. But he is overseen and in touch frequently and regularly by caring clinicians. And he still has active schizophrenic symptoms of hallucinations. He has had, it sounds like very good, cognitive therapy to help him manage his hallucinations and live with them with little or no disruption to his everyday social functioning.

Most of all he has his dignity, continues his education part time at age 64, has his dignity and his own “digs,” or place to live on his own.

His clinic program and home base for his outpatient care is a unique organization/clinic called Way Station which works very much in nontraditional ways, with its emphasis on integrating and maintaining clients in the community. It is an American derivation of sorts of the Gheel approach and seems to work well for at least some patients. The article cited above gives much more detail and background and is worth reading.

But programs like this are still too few are far between. What is usually happening now in this country is that such programs are not yet the norm, not funded and largely nonexistent. Patients who do have their own families to live with upon discharge are placed in “placements,” which range from nursing homes to entrepreneurial small to large group homes run by operators all over the country. And there are usually few to none of the social outlets, programs, educational or otherwise to further prepare and integrate clients into the ordinary fabric of our society.

We still have these new remnants of the “welfare hotels,” that were so prevalent most famously of all in New York City where out of business hotels or projects buildings, were renovated more or less well, and persons on disability income or the discharged mentally ill were housed in small hotel rooms as apartments. These places were rife with crime. They still exist typically in very large cities and are often little better managed or integrated into active treatment or rehabilitation programs and have turned into wellsprings of crime and drugs and all that goes with those scourges.

But now the funding nationally with the perhaps certain repeal of Obamacare may seriously in the future be threatened. One would hope not, and that instead these sorts of programs are replicated nationwide with links to education, employers and the levels of outreach outpatient care that is needed. But again it all boils down to money in this country. It costs money and a fair amount of funds to sustain these people-labor intensive community-based programs. We have made substantial progress in moving patients out of the state hospitals. But our high recidivism rates, readmission rates, at all state hospitals in this country demonstrate clearly that the above minimal “placement,” endpoints we now rely on, are neither working all that well nor sufficient. Let us hope that gradually our national commitment to those needed these levels of services becomes the norm in the future.

The New Grim Origin of Mental Illness Stigma

In an article entitled: “Airport shooter shows challenges of nation’s mental health system,” published this week of January 15, 2017 in the San Diego Union-Tribune, authored by Paul Sisson & Jeanette Steele, the very difficult shortcomings of our mental health care system which is based in a system of laws that provides for basic human rights as much as we possibly can, is full of holes and flaws. This article eloquently shares with us the very perceptive thoughts of two local figures of the San Diego area, one from the field of psychiatry and one from law enforcement. They discuss the incredible impossibilities facing us now as we see self-radicalized severely mentally ill turn into mass shooters with perhaps slowly increasing frequency.

Continue reading “The New Grim Origin of Mental Illness Stigma”

Progress at Western State Hospital in Washington State: A Good Example for Other Beleaguered Hospital Systems?

Western State (psychiatric) Hospital has been in operational distress for more than a year now and following the travails of this facility and its staff from the line ward workers and behavioral care technicians, nurses and professional staff has been quite sad and discouraging for anyone interested in mental health reform and service delivery policy.

Continue reading “Progress at Western State Hospital in Washington State: A Good Example for Other Beleaguered Hospital Systems?”

Washingston State Hospital System Fined

IN a very recent story of less than a week ago, entitled: “Washington accrues almost $7.5 million in contempt fines,” written by Martha Bellislea of the Associated Press published in many major newspapers across the country, the sad story of the travails of Washington’s Western State Hospital continues to showcase the plight of a number state public psychiatric hospitals.

Continue reading “Washingston State Hospital System Fined”

What the New 21st Cure Mental Health Law Brings with It Locally

From the Christian Science Monitor newspaper, comes a good article, New reforms to alleviate pressure on local mental health system that lays out what the newly passed this week 21st Cures Act can bring with it at a local area and gives a hint of the tremendous expectations that will arise around this bill.

In the article, the author outlines some of the major features of the bill, but more importantly, shows how its provisions, especially in the legal arena may be expected to both furnish and require the provision of nonexistent services for the mentally ill in the justice system.

Continue reading “What the New 21st Cure Mental Health Law Brings with It Locally”

New State Hospital Already Destined to be Closed

In an article, “New state hospital may close,” published in the Bulletin of the Salem’s Central Oregon region, the Associated Press reported December 3, 2016, that Oregon’s Governor Kate Brown had suggested she had decided or was in the process of deciding to close a new state psychiatric hospital, in the Eugene, OR area, near Junction City. which is the new site of the original Oregon State Hospital.This hospital has a total capacity of 100 beds.

The hospital which has been open only 18 months and cost $130M to build, is slated for possible/probable closure in mid-2018. Its closure was heralded as necessary to save the economically beleaguered state much-needed monies. No real details are given by the state personnel’s’ announcement concerning this drastic move except there is a large budgetary “hole” in the state’s health care departments’ budgets and closing the hospital, which has 422 employees will save the state $34.5M a year.

Continue reading “New State Hospital Already Destined to be Closed”

Does It require a killling to get a state hospital admission still…?

In yet another unbelievable horrible tragedy, a chronically mentally ill man in Washington state was finally admitted after a few months of court orders by a judge, a fine of the state mental health department to the tune of $2,000per day and ceaseless and desperate advocacy for inpatient psychiatric treatment for their relative.

I must confess that in the above first paragraph, I did a little dishonest thing, an intentional literary device. I implied that it only after all those pushing and shoving well placed and well-intentioned efforts, did this man get the help he needed. No, those efforts were the unsuccessful prelude…

This middle aged man murdered his elderly father and THEN he was admitted to the state hospital. The article, “David Altman finally gets a bed at Western State Hospital,” makes for a very sad read. As I read it for the first time, the old colloquial phrase, “a train wreck in slow motion,” came to mind.

This tragedy is even worse in a way than the Gus Deeds tragedy in Virginia over two years ago. In that ‘case,’ Gus Deeds was a mentally ill psychotic young man in his early 20’s. His mental illness was known to the family and well managed as the father, a Virginia state legislator, is a Ph.D. clinical psychologist. He also saw the warning signs of spiraling psychosis and immediate need for acute inpatient psychiatric admission. Under the then peculiar obstacles in Va’s state hospital admissions procedures a bed could not be found for Gus and he was released from an emergency after four days. Within 1 or 2 days as I recall, he had tried to stab his father to death and then ended up suiciding.

Clinicians around the country years ago began warning of these kinds of tragedies in the 1990’s. I remember joining the shrill and desperate warnings in those days at various levels of my own participation in state and then in my younger days, the national organizations as we advocated for our patients. I recall realizing along with many others that our estimates and assumptions about the weight of our influence in the ‘halls of power,’ were vastly self-deluding. ‘We’ were not only not listened to, but I recall as those in power and frankly zealots in the new wave of the then growing world of mental health restructuring, viewed us as psychiatric Luddites, old fogies who were no longer ‘with the program’ so to speak. Mental health professionals were viewed as stumping to preserve their own positions of power or whatever and our warnings were not only resented but also labeled as being rather like Chicken Little shrieking “the sky is falling!” As we continued our dissent and disturbingly factual predictions of what kinds of tragedies that reductions in training programs, inpatient, and outpatient resources would produce, we began to be denigrated, ignored and accused of holding up progress. Well, truly not to gloat utilizing families’ incredibly sad tragedies to do so, I must state the obvious, “We are not Kansas anymore,” and the predictions a generation of mental health professionals repeated over and over that fell on deaf ears, have to come to occur and confirm not how smart us mental health nags and gadflies were, but that those actions were to have dire and tragic consequences and for the last decade or more we have seen them materialize in front of us.

But on an optimistic note, we have turned the corner I firmly believe. The growing number of bills in legislatures at the national and state levels are now openly addressing and discussing the issue of the failures of mental health reform. Pieces of legislation are looking at many of the correct entre’ points for cultivating solutions: increasing training funds for all types of mental health professionals, financial incentives to go into the traditionally underpaid careers with loan forgiveness programs and other responsible incentives, starting up new training programs, restoring services, and spending monies by states and the nation even (gasp) talking of ‘enhancing revenue streams,’ (read new modes, methods of taxes, horror of horrors) to make any and all of these corrective measures possible.

Corrective legislation will have to be written to facilitate the immediate and easier mobilization of emergency psychiatric admission and legal mandated involuntary psychiatric hospitalizations to help to stem these kinds of horrific tragedies and save lives. And the balance of the rights of the person so involved will have to be redrawn in a different conceptual framework so that it is not virtually impossible to hospitalize someone who is psychotic and dangerous as it still is in some venues.