Voices for Mental Healthcare Reform, United at Last!

The documents below usher in a revolution. They describe a bold new movement, a national front organized to break the silence of the stricken and reverse the longstanding political neglect of America’s decrepit mental healthcare policies and institutions.

The advocate and author (Sooner Than Tomorrow) DeDe Ranahan has completed a wide-ranging national canvass of those in the “sub-nation”: the mothers, caretakers and advocates of people suffering from serious mental illness: schizophrenia, bipolar disorder, and related incurable afflictions.

DeDe Ranahan

Her tireless work has produced historic results: the first comprehensive, deeply informed list of things that absolutely need to be done to restore safety, humanity, and hope to a strata of victims that has been marginalized and abused since medieval times.

The dynamic advocacy team of Scott and Leslie Carpenter is distributing these documents to the candidates visiting Iowa prior to the Democratic presidential primaries. The Carpenters have reported that the response so far has been heartening. 

DeDe Ranahan’s survey results are vital both in themselves and as building-blocks toward a future unification of efforts to reclaim the mentally ill and restore them to meaningful lives. She deserves the thanks of everyone who has been touched by this abhorrent malady. It seems that someone, after all and at long last, does care about crazy people.

SMI PLAN

TO: All  2020 Presidential Candidates

SUBJECT: Serious Mental Illness (SMI)

So far, 2020 political candidates make rare mention of serious mental illness (SMI — schizophrenia, schizo-affective disorder, OCD, bipolar disorder, and major depression), and the lack of mental illness care in the US.

* The SMI population represents 4-5% (10 million) of the mentally ill in the US. That’s 10 million families and extended families (voters).

* Ten times as many people with SMI are incarcerated as are hospitalized.

* Some SMI individuals are so sick they don’t realize they’re sick (anosognosia), don’t respond to treatment (if they get it) and end up incarcerated, homeless, missing, suicidal or dead.

  • It will cost billions to create a viable mental illness system. It’s costing billions, now, in prison over-population, homelessness and cities under siege, lost workdays, family disintegration, suicides, untimely deaths, inundated ER’s and hospitals, violence caused by untreated SMI, overwhelmed police, and in uninformed and misinformed criminal justice systems.

The Five-Part Plan enclosed is the collaborative work of grass-roots advocates from across the country —individuals, professionals, writers, journalists, caregivers, and mothers (always the mothers). Our intent is to put this plan in front of every 2020 presidential candidate. Right now, no candidate is talking about SMI. It’s as if it didn’t exist.

The steps in our plan are baby steps. We can’t immediately address everything that needs to be addressed in our messed up mental illness system, but we have to start somewhere. We’re trying to help 2020 candidates — we know you have a lot on your plates and we appreciate your energy and efforts to make our country better. We’ve created this Five-Part Plan to give you a starting point and a way to introduce SMI into political discourse and public conversation.

We’re asking you to take four initial actions:

1. Please read our plan and make it your own.

2. Put your SMI plan on your campaign website.

3. Talk about SMI on the campaign trail and in campaign debates.

4. Talk with members of the SMI community. We’re willing and able to help you as you move forward.

The SMI community is searching for its 2020 presidential candidate. We’re a large, passionate, motivated, frustrated, hurting, and determined block of voters. We look forward to hearing from you.

ENDORSEMENTS

Marie Abbott — Waterford, Michigan,

“My grandson has autism, bipolar disorder, and development delays. Has his civil rights intact.”

Jane Anderson — Illinois

“My 38 year-old son has paranoid schizophrenia. He was diagnosed at 18. My husband and I are caregivers.”

Tim Ash — Arcata, California

“Caretaker of a volatile, unstable SMI family member because there are no options besides jail and the bushes or doorways.”

David Bain — Sacramento, California

“I’m living with chronic depression and epilepsy and working to divert SMI from prison into treatment.”

Marti Rhoden Bessler — Alexandria, Kentucky

“My son’s been suffering from schizoaffective disorder for 19 years within our failed mental health system.”

Alisa Bernard — Jupiter, Florida

Judy Bracken — San Ramon California

“My  30-year-old son has schizoaffective disorder.”

Katherine Smith-Brooks and Bob Brooks — Carlsbad, California

“Our SMI son is now stable and working following effective treatment and the same psychiatrist for 20 years. We were his only advocates for many years.”

Regina Gipson Burns — Hoover, Alabama

Leslie and Scott J. Carpenter — Iowa City, Iowa

“Our son’s been suffering from under-treated schizoaffective disorder for 12 years. He lives in a group home with too few services. He’s been hospitalized 20 times.”

Mark Rippee

Sue Chantry — Vacaville, California

“I’ve lived here for many years and watched Mark Rippee, SMI and blind, on the streets of Vacaville with no mental health services.”

Barb Cobb — Iowa

“My SMI daughter’s been under-treated and under-supported by the current system. She’s endured over 20 hospitalizations and is barely surviving.”

Christine Cushing — Vacaville, California

“There are no resources or places to live for those who suffer from SMI. For a country that’s so progressed, we’re so far behind taking care of those with SMI.”

Lori Daubenspeck — St. Croix, US Virgin Islands

“My SMI son is a US Army vet. There’s no SMI facility here and one psychiatrist for the island. We’re in desperate need of facilities, doctors, and federal action.”

Kathy Day — Folsom, California

“My godson’s been discharged from hospitals many times while considered to be gravely disabled. Laws need to be based on need for treatment rather than time.”

Katherine Flannery Dering — Bedford, New York

“My brother, Paul, suffered with schizophrenia for 32 years of dwindling care. He died at age 48. “

Lois Earley — Phoenix, Arizona

“I’m the mother and legal guardian of an adult SMI daughter. I’ve been battling the behavioral health care system in Arizona since 2004.”

Darla Eaves — Everett, Washington

“My husband committed suicide.  My son died in our psychiatric hospital. My daughter, thank God, is here with me and stays on her medication.”

Donna Erickson — Abington, Massachusetts

“My 34-year-old son has bipolar disorder. He’s been hospitalized 25+ times and cheated out of the life he wanted through no fault of his own.”

Sonia Fletcher —- Mount Shasta, California

“My daughter’s SMI was untreated when she shot and killed her father in a psychotic break. Our family is heartbroken and literally broken apart.”

Anne and Tim Francisco — Orange County, California

“Our SMI son was sentenced to prison for a nonviolent offense while he was in a state hospital. He ended his life by suicide while in solitary confinement.”

Lynne Gibb — Ojai, California

“My daughter’s suffered with schizo-affective disorder for 20 years. She’s been missing, homeless, and hospitalized, but never out of her family’s hearts and thoughts.”

Elaine D. Gilliam — Myrtle Beach, South Carolina

“My eldest son has paranoid schizophrenia. My eldest daughter committed suicide. Two children are wonderful retired military families.”

Jeanne Gore — Shapleigh, Maine

Family member, Coordinator, National Shattering Silence Coalition

Pat Guinn — Lincoln, California

“I have an adopted son with SMI.”

Catherine (CJ) Hanson

Linda (Rippee) and Joseph Privatte Lou Rippee – Vacaville California

“SMI blind son, brother, and brother-in-law. No mental health services for 3 decades. Solano County refuses to conserve.”

Betty Plowman

“I was a neighbor who observed this tragedy for 32 years and tried to help   when no one else would.” 

Chris Plowman

“I’ve watched this man waste away on the streets for 30 years untreated.  Some people need our help and tax dollars; not be abandoned to rot. “

Pam Wilcoxson

“Mark’s family’s been fighting for help for him for many years and still have not gotten anywhere.”

Mark and Laura Harreld — Strawberry Point, Iowa

“Our SMI son was caught in the criminal justice system for non-violent crimes. He ended his life, to avoid another prison sentence, while in a hospital under armed guard.”

Dianne Harris — Grove City, Ohio

“My son died of a co-occuring vascular condition before a treatment was found for his negative symptoms of schizoaffective disorder. More research is needed desperately.”

Janet Hays — New Orleans, Louisiana

“I created Healing Minds NOLA to bring residents, families and stakeholders together to explore alternatives to incarceration, homelessness and death for those suffering with SMI.”

Amy Kerr and Paul Cox —- Pasadena, Maryland

“We’re caretakers for a 23-year-old son who has schizophrenia and a friend with major depression and end stage renal failure. “

Jeannie Kneisly-Manley —  Elizabeth City, North Carolina

“My son has schizophrenia. He has a criminal charge and no court date to get him in the hospital. If I hadn’t bailed him out, he’d still be in  jail waiting.”

Stacy Kollias — Henderson, Nevada

“I’m the mother/caregiver of a 30-year-old son suffering from schizoaffective disorder.”

Dianne Lam — Oakland, California

“My son has a dual diagnosis and schizoaffective disorder.”

Carole McAfee — Salem, Oregon

“My son is living with schizophrenia.”

Sherri McGimsey — Morganton, North Carolina

“My son is a Marine Veteran with schizoaffective disorder.”

Gerri Mele — Cleveland, Ohio

Linda L. Mimms, MA, — Poway, California

“The inability to get our ill family member prompt treatment has led to a worsened condition and uncertain prognosis which was totally avoidable.”

Alison Monroe — Oakland, California

“My 24-year-old daughter is a meth user who has schizophrenia. I’ve tried everything to keep her alive and off the street, with some success.”

Nancy Moody — Cambridge, Ohio

“My son has schizoaffective disorder.  He’s suffering from withdrawal, seizures, tremors, cognitive impairment, and hallucinations. No one wants to help him.”

Mary Murphy  — Springfield, Oregon

“My son has schizoaffective and bipolar illness.”

Lyn Nanos, LICSW — Natick, Massachusetts

Author: Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry.

Karen Newton — Vacaville, California

“My son has bipolar-schizoaffective disorder. While homeless, voices told him to hurt someone. He’s incarcerated while waiting for a bed in Napa State Hospital.”

Kelly Nidey — Vincennes, Indiana

“My son has struggled with bipolar/schizoaffective disorder for almost 15  years.”

Teresa Pasquini — Contra Costa County, California

“I’m mom to Danny who is surviving 20 years of suffering, suicidality, solitary, and schizoaffective disorder. There’s no federal action plan for families like mine.”

Darlene Patrick —Farmington, Maine

“My 32-year-old son has paranoid schizophrenia. He’s been in jail, the hospital, release, repeat.”

Gema Pena — Hialeah, Florida

“My son, Kristopher, was in solitary for 10 years. He attempted suicide, ate his own feces, was catatonic, and lost over 100 pounds.”

Ron Powers with his wife and sons

Ron Powers — Castleton, Vermont 

Pulitzer prize winner, author of No One Cares About Crazy People

“I’m the father of two sons afflicted with schizophrenia. One took his life in 2005.”

Paula and Bruce Quertermous — Clinton Township, Michigan

“Our 39-year-old daughter has bipolar disorder and cognitive disability from birth.”

DeDe Ranahan with her son.

Dede Ranahan — Lincoln, California

Author: Sooner Than Tomorrow—A Mother’s Diary About Mental Illness, Family, and Everyday Life (2019). soonerthantomorrow.com. “My son died in a hospital psych ward in 2014. “


Margaret Reece and Greg Gazda — Butte County, California

“Our SMI son has been hospitalized 5 times, arrested, and is currently in a mental health court program and living in Yolo County with his grandparents.”

Arlene Renslow — Modesto, California

“I have two sons with brain damage. One son has schizophrenia. Unless someone does something, things will get worse for everyone.”

Mary (Courtney) Sheldon — Poway, California

“Mother of 24-year-old SMI son. We’ve winged it for 5 years. My SMI brother died, with his ‘civil rights intact’ behind a dumpster in Anaheim, California.”

Martha Mccollister Sroka — Dunkirk, New York

“My son has schizophrenia. It’s horrible watching your child change, struggle, and suffer. I request that SMI get the same attention and resources as any other medical illness.”

Joanne Strunk — Lexington, Kentucky

“My daughter’s been raped, homeless, hospitalized (40+times), and almost died lost in the woods for weeks. She’s dying of neglect due to SMI.”

Shelly and Scott Switzer — Sandpoint, Idaho

“We’re parents of a 33-year-old son with inadequately treated schizoaffective disorder in Missoula, Montana. SOS We’re barely hanging on.”

Diana Mandrell Troup — Texas

“My daughter spent 16 years in delusion and psychosis because of bad mental health care. She suffered 50+ involuntary holds, multiple tazings, and traumas.”

Laurie Turley — Maine

“My sister died due to HIPAA restrictions. One of the last things she said to me was, ‘They should have let you help me. I wasn’t in my right mind.’”

Monica and Kimmo Virtaneva — Hamilton, Montana

“Our son, Mika, took his life after the disease schizophrenia took his brain and the criminal justice system took his dignity.”

Cheryle Vitelli — Newark, Delaware

“I lived with my SMI son for 6 years while he was dangerous with only he and I in the house. Finally, a compassionate police officer pushed to get him help.”

Darlene Been Watkins — Moulton, Alabama

“My son, Shane, was denied treatment, while in psychosis, because there weren’t enough beds. Two days later, he was shot by police while I watched.”

Anna Wellnitz — Oro Valley, Arizona

“I’m diagnosed with SMI.”

FIVE-PART PLAN TO ADDRESS SERIOUS MENTAL ILLNESS (SMI) 

FOR ALL 2020 PRESIDENTIAL CANDIDATES 

PLEASE ADDRESS THESE TOPICS IN YOUR CAMPAIGN APPEARANCES AND DEBATES 

1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI)) FROM A BEHAVIORAL CONDITION TO WHAT IT IS, A NEUROLOGICAL MEDICAL CONDITION WHY RECLASSIFICATION IS IMPORTANT Reclassification will unlock more research funding and help eliminate discrimination in treatment, insurance reimbursement, and the perception of SMI as “behavioral” condition. SMI is a human rights issue. NIMH ranks SMI among the top 15 causes of disability worldwide with an average lifespan reduction of 28 years. PRESIDENTIAL ACTION * Create a cabinet position exclusively focused on SMI. * Push for Congressional appropriations to include schizophrenia in a CDC program that collects data on the prevalence and risk factors of neurological conditions in the US population. 

2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA) WHY HIPAA REFORM IS IMPORTANT Overly strict HIPAA laws make it extremely difficult for families and caregivers to partner in the treatment of their loved ones, resulting in important life-saving medical information gaps. By eliminating this barrier, family support will be strengthened, reducing the chance of relapse, homelessness, imprisonment, and death. PRESIDENTIAL ACTION * Work with legislators to change HIPAA law to ensure mental health professionals are legally permitted to share and receive critical diagnostic criteria and treatment information with/from parents or caregivers of SMI. 

3. REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD) WHY IMD REPEAL IS IMPORTANT IMD repeal will increase the availability of psychiatric inpatient beds. The IMD exclusion is not only discriminatory of those suffering from neurological brain disorders, it is a leading cause of our national psychiatric hospital bed shortage. It prohibits Medicaid payments to states for those receiving psychiatric care in a facility with more than 16 beds who are 21-65, the age group with the most SMI. PRESIDENTIAL ACTION * Work with legislators to repeal the IMD exclusion. 

4. PROVIDE A FULL CONTINUUM OF CARE WHY A FULL CONTINUUM OF CARE IS IMPORTANT A continuum of care insures that SMI patients receive early intervention at all stages of their illnesses, long- term care when needed, and follow-up treatment (medications and therapies) when they’re released. It reduces visits to jails, ER’s and hospitals, homelessness, and morgues. A continuum of care provides life-time management. PRESIDENTIAL ACTION * Create federal incentives to states which are addressing a full array of inpatient, outpatient, and supportive housing care.

5. DECRIMINALIZE SERIOUS MENTAL ILLNESS (SMI) WHY DECRIMINALIZATION OF SMI IS IMPORTANT People suffering with other neurological conditions like Alzheimer’s and dementia can get treatment promptly without being kicked out of their homes to wander the streets until they are arrested and put in jail or prison rather than a hospital. Serious mental illness is the only disease where the doors to treatment are shut unless a crime is committed. This is pure and simple discrimination with the disastrous results we see in our country today — homelessness, incarceration, the disintegration of families, and death. PRESIDENTIAL ACTION * Work with legislators to change “must be a danger to self or others” criteria. * Work with legislators to change involuntary commitment criteria, alleviating the subjective nature of “gravely disabled” and redefining it in objective terms based on scientific medical need for treatment. Psychosis, like a stroke, is a traumatic brain injury and needs immediate treatment for the best outcome. 

EXTENDED LIST OF SMI NEEDS

This list represents brainstorming ideas of advocates from across the country. They’re individuals, families, and professionals who are living/working with SMI. They have in-the-trenches experience. The list presents a partial picture of the depth and breadth of SMI issues that need to be addressed. 

1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS, A NEUROLOGICAL MEDICAL CONDITION.

2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

  • Present patients and families with a social worker to support the family unit throughout the care process, including medication and psychiatric treatment.
  • Require mandatory HIPAA training for everyone in the medical profession and mandate a test on proven knowledge.
  • Develop a federal program for the administration of an advance directive (PAD) which includes a universal release of information and designates an agent if a patient’s capacity is lost.

3. REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD)

4. PROVIDE A FULL CONTINUUM OF CARE

  • Provide inpatient care (IMD waivers), outpatient care (i.e.,  AOT, Clubhouses), and housing ( a full array from locked stabilization to unlocked intensive, medium intensive, peer run, PSH, asylum).
  • Require a psychiatric standard of care for various SMI diagnoses like other medical specialties.
  • Require prescriptions based on need not ROI for the insurance industry
  • Remove ER’s as entry for mental illness hospitalization. The ER process and its chaotic environment aren’t conducive to the well-being of SMI patients.

5.DECRIMINALIZE SERIOUS MENTAL ILLNESS

  • Eliminate solitary confinement in jails and prisons.
  • Support nationwide civil mental health courts and expand criminal ones that are already established to keep SMI out of jails and prisons.
  • Establish mental health courts on a federal level, and coordinate federal courts and state-run mental illness facilities.
  • Move crimes that SMI commit in the federal system into state courts.
  • Mandate a way for families to provide medical history to jail/prison doctors to inform treatment.
  • Fund a digitized system for medical records in counties/hospitals to jails so information can be transferred immediately upon arrest and incarceration.
  • Provide uniform psychiatric screening of the incarcerated.
  • Use standardized protocols for medication of SMI prisoners.
  • Require strict limits on waiting for trial time.

6. PAY ATTENTION TO SUPPORTIVE HOUSING

  • Provide 24/7 supervised housing for those who cannot live independently.
  • Provide defined levels of support built around a person’s needs, especially long-term care.
  • Clarify Olmstead for SMI. Lease restrictive care isn’t always least expensive or best.
  • Examine, don’t ignore, a person’s ability to handle and benefit from a less restrictive setting.

7. REVAMP INVOLUNTARY TREATMENT

* Use lack of insight (anosognosia) and grave disability as criteria for determining involuntary treatment.

  • Establish a federal standardized “need for treatment” involuntary commitment law.
  • Base restrictive settings on actual abilities, not wishful thinking or one-track plans.

8. INCLUDE EDUCATION

  • Require mandatory, institutionalized education about SMI for judges, sheriffs, attorneys, district attorneys, law enforcement, and first responders.
  • Require units of SMI education for educators — preschool through university.
  • Revamp Crisis Intervention Training and expand training to all counties.
  • Provide a health proxy form for college students to allow them to release medical information and name who can take care of them in a crisis.
  • Hold universities accountable and required to connect students to crisis intervention, especially during medical leave.

9. GIVE INCENTIVES

  • Incentivize the expansion of medical schools to graduate more psychiatrists, child psychiatrists, internists with psychiatry specialties, psychiatric nurse practitioners and physician assistants.
  • Allow loan forgiveness for providers treating SMI.
  • Give incentives for rural psychiatrists.
  • Incentivize more long-term treatment/stabilization of SMI.
  • Give incentives to psychiatrists to accept health insurance, especially Medicaid.

10. EXPAND ASSISTED OUT-PATIENT TREATMENT (AOT)

  • Federally clarify AOT and create a federal model for AOT law
  • Offer AOT immediately to everyone upon diagnosis.

11. IMPROVE HOSPITALS

  • Build regional federal hospital for patients who cannot be treated in their home state’s hospitals because of lack of beds.
  • Improve reimbursements to hospitals which lose revenue on SMI patients.
  • End hospital discrimination against SMI “violent” patients and those “difficult to discharge.”

12. INCREASE RESEARCH AND EPIDEMIOLOGY

  • Fund NIMH research specifically for SMI.
  • Establish a Disability Advocacy Program for legal services for SMI when counties/states fail to provide long-term support services or when insurance/managed care and Medicaid fail to cover/pay for long-term supported services and treatment.
  • Pursue better national epidemiology studies for people with SMI.
  • Establish a federal law that requires states to track each SMI diagnosis with bad outcomes like death, homelessness, and incarceration.

13. REVISIT PARITY

  • Clarify parity for SMI and include Medicaid and Medicare in parity law.
  • Enforce violations against parity law.

14. ADDRESS SOCIAL SECURITY AND DISABILITY INCOME ISSUES

  • Change the way social security income for the disabled is taken by states when a patient is admitted to state operated mental health institutions, residential care facilities, and hospitals.
  • Increase disability income to a level where a person can survive and maintain reasonable housing.

16. CREATE PSYCHIATRIC CAMPUSES

  • Build psychiatric campuses with multiple levels of care, supportive housing from most restrictive to least restrictive, and separate independent living apartments.
  • Provide on-campus coffee shops, gyms, recreational facilities, and gardens where people with SMI could work with support as needed.
  • Provide substance abuse treatment services, AA or NA  meetings.


“Mentally Ill Monsters”

In the aftermath of two traumatic mass shootings, the president re-invokes a horrid, distorted falsehood about the mentally ill.

And there it is: history’s defining damnation of sufferers of incurable damage to the brain, distilled into a three-word phrase of transcendent ugliness and stunted understanding.

The phrase was uttered on Monday. It was uttered to identify the provenance of the weekend’s massacres by shooters using legally purchased high-capacity semi-automatic weapons toward their collective harvest of 31 people dead and some 50 wounded. 

The phrase was uttered by the President of the United States. It left stains, stains which, in moral and intellectual terms, replicated the stains of blood shed by the shooters’ victims. 

Donald Trump | Image Credit Gage Skidmore via Flickr

Blaming “mentally ill monsters” (or “nut jobs,” or “wackos,” or “lunatics”) for such carnage is a morally repugnant, if time-tested device for shifting the public’s passion for safety away from gun control and toward the presumed demons in our midst. The president could not have been more transparent in exploiting the device. “Mental illness and hatred pulls [sic] the trigger, not the gun,” he instructed us, going on to label one of the shooters as “another twisted monster.” 

In fact, it is a settled truth in psychiatric research that victims of brain afflictions are no more prone to violence than the general population. The prominent advocate Dj Jaffe makes an important stipulation: that the untreated mentally ill—those not stabilized by antipsychotic medications—can be more likely to cause harm to themselves or others. Still, implying that mental illness itself equates to degenerate aggression serves only to further isolate and punish the most helpless members of our society; to herd them back toward the dark corners and confinements of “insane asylum” days.

And herein lies the “intellectual” stain that President Trump’s words help spread: most people—like the president himself—do not understand mental illness: what it means, how it occurs, how it differentiates, why its victims behave as they do, and how even its most abject sufferers can be aided, often stabilized, by medications and therapy. In this vacuum of understanding, people tend to substitute prejudice, false science, myth, and hostility toward “crazy people.” 

Briefly: 

“Serious” mental illness—the kind in question here—is rare and unique. And incurable. Unlike alcoholism or anger or depression, serious mental illness is rooted in genetic flaws of the brain. Its various names include schizophrenia, schizoaffective disorder, bipolar disorder—similar yet not interchangeable conditions. It results in a loss of reason and rational control; hallucinations and the hearing of voices; alienation from family and friends; and, yes, sometimes—rarely—violence. 

My wife and I have educated ourselves about serious mental illness because we’ve had to. It invaded our family several years ago, causing the suicide of a beloved son. Unfortunately, this is the painful route to understanding for most people: a loved one is stricken.

The costs of this cluelessness describe a cone of destruction that widens from the stricken individual through society.

The cone draws in and ravages parents and siblings of the stricken. It can cripple the finances of families without adequate insurance to cover treatment and medications. It drains human capital from the workforce, and thus economic revenue. It reduces the budgets of hospitals that can’t get reimbursement for their mentally ill patients. It overburdens police, whose lack of training and, sometimes, self-restraint, can result in death by gunshot of unarmed people in psychosis. It coarsens our criminal-justice system: think of schizophrenic adolescents hustled into jail by untrained or uncaring judges, where they await trial—often for weeks and months—while their unmedicated psychosis deepens. Think of solitary confinement. Think of a brain-afflicted child, perhaps your own (as countless parents must) ensorcelled in a cell, abused by fellow inmates and guards, with no end in sight, no comprehension. No hope.

Now think about “mentally ill monsters.”

Mentally ill monsters are not the source of our current crisis of public massacres. The monster is the gun: too many guns, with too little restraint and oversight regarding purchase. To his credit, President Trump gave lip service to keeping guns away from those “who pose a  grave risk to public safety,” and to strengthening gun laws generally. 

But leave the gun issue aside. Part of any president’s duty—a foundation of his “bully pulpit”—is to educate his fellow citizens on matters of complexity and urgent public import. The nature of serious mental illness, and the reclamation of its victims, comprise one such matter. The president could make a great, galvanizing contribution to ending the centuries-old oppression of “crazy people.” He could lead us in that direction. He could educate us. But first he must educate himself. 

Author Ron Powers to Visit Quincy to Discuss Mental Health

via Herald-Whig

Pulitzer Prize-winning author Ron Powers will visit Quincy on April 26 to help with a fundraiser for Transitions of Western Illinois.
Pulitzer Prize-winning author Ron Powers will visit Quincy on April 26 to help with a fundraiser for Transitions of Western Illinois.

By Doug Wilson Herald-WhigPosted: Apr. 18, 2019 5:10 pm Updated: Apr. 18, 2019 5:24 pm

QUINCY — After Ron Powers’ youngest son committed suicide in 2005, the Pulitzer Prize winner and prolific author swore that he would never write about the “hellish” pain that he and his family went through.

“I was in a daze in the first five years, then the healing began, and I realized after reading more about the disease (schizophrenia) that I really had to do this,” Powers said.

His 2017 book, “No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America” was the result. Mental health myths and misconceptions also will be Powers’ main topic of discussion when the Hannibal, Mo., native comes to Quincy on April 26 to help with a fundraiser for Transitions of Western Illinois.

Powers’ book starts with the words: “This is the book I promised myself I would never write.” But as he began going back through photos, emails and other items that belonged to his youngest son, Kevin, Powers saw the need to tell the world that ignoring mental illness is a terrible mistake and a social injustice.

National statistics indicate that more than 10 million Americans will suffer a serious mental illness each year and with more than three people in the average home, more than 34 million American lives will be disrupted.

Powers’ older son, Dean, was diagnosed with schizophrenia only months after Kevin’s suicide. Thanks to informed treatment choices, Dean’s illness has been controlled.

But too many people with mental illnesses are sent to jails, Powers said.

“The moral necessity for us as individuals, and for our country, is to reclaim these people,” Powers said.

“There’s primal fear and prejudice against the mentally ill and because of that, (society) punishes the mentally ill when we should be treating them.”

Since his book was published, Powers has been scolding the government for spending $31,000 per year to jail the average person with mental illness, rather than spending the $10,000 needed for treatment. He also has promoted programs that help those with mental challenges.

“Organizations around the country, like Transitions, are taking up the slack, and I’m so gratified that people are doing what they can to help,” Powers said.

Barb Baker Chapin, director of development at Transitions, hopes that Powers’ visit will help people see mental illness in a new light.

“One in five of us will suffer from a mental illness at some time in our lives, and yet there’s still such a stigma associated with it,” she said. “I hope Ron Powers’ very personal story can help us have a dialogue about the changes we need to see in the mental health system and the way we’re funding it.”

Powers has written 16 books, including “White Town Drowsing,” which looked at his hometown of Hannibal during the 1980s. He also wrote a biography of Mark Twain, “Mark Twain: A Life” that was a New York Times best-seller and a finalist for the 2005 National Book Critics Circle Award. In more recent years, Powers was co-author of “Flags of Our Fathers” and “True Compass,” which were both No. 1 New York Times hard-cover nonfiction best-sellers.

He was awarded the Pulitzer Prize for his critical writing about television for the Chicago Sun-Times in 1972. He also won an Emmy Award in 1985 for his commentaries on “CBS News Sunday Morning with Charles Kuralt.”

Several of Powers’ books will be available for sale. A complementary copy of “Flags of Our Fathers” will be presented to those who buy tickets to a social hour with the author, and he will do a book signing.

Ticket information for “An Evening with Pulitzer Prize-Winning Author Ron Powers on April 26

Meet and greet tickets are $75 for the 6:30 p.m. social hour, complementary copy of ‘Flags of Our Fathers,’ the chance to meet Powers during a book signing and preferred seating.

Preferred seating tickets are $25 each.

General admission tickets are $15, with doors opening at 7:30 p.m.

Tickets are on sale at the Oakley-Lindsay Center box office at 217-222-3209, or online at http://www.1qct.org/.

Father Of 2 Sons With Schizophrenia Talks Of His Struggle To Save Them

via NPR

March 20, 20171:13 PM ET Heard on Fresh Air

As the father of two sons with schizophrenia, author Ron Powers is familiar with the pain and frustration of dealing with a chronic, incurable disease of the brain.

Powers’ younger son, Kevin, was a talented musician whose struggles with schizophrenia began at age 17. Just before his 21st birthday, in 2005, Kevin took his own life.

A few years later, Powers’ older son, Dean, started experiencing symptoms of schizophrenia and had a psychotic break.

Ron Powers, a Pulitzer Prize-winning journalist and media critic, wrote Flags of our Fathers, which was adapted into a film by Clint Eastwood.Sarah Junek/Hachette Books

“There is no greater … feeling of helplessness than to watch two beloved sons deteriorate before [your] eyes, not knowing what to do to bring them back,” Powers tells Fresh Air‘s Terry Gross.

Powers’ new book, No One Cares About Crazy People, is both a memoir about his sons and a history of how the mentally ill have been treated medically, legally and socially. Although Dean is now medicated and doing well, Powers notes that many people with schizophrenia don’t receive the treatment they need — in part because they often don’t believe they are ill.

“This unwillingness to believe that one is afflicted has led to tremendous problems,” Powers says. “To force that person into being helped is a violation of his or her civil rights … and the law may penalize the care workers who give [people with schizophrenia] medications or admit them to a hospital against their will. … That is the great reigning Catch-22 of the way our society deals — or fails to deal — with schizophrenia.”

Interview Highlights

On why symptoms of schizophrenia often surface around the age of 17

It has to do with the maturation of the brain. … In order to start functioning as an adult brain, the brain must undergo a period of what is called “synaptic pruning,” really a cleansing away of all of the neurons, all of the connective material that is built up since infancy. That is no longer useful and it’s quickly replaced, but there is a period of vacancy, almost, in which the brain is very vulnerable to any kind of disruption. It’s unprotected, and this is the period of life, roughly clustered around the age of 17, when the disease can make its appearance.

On how denial impacted his sons’ treatment

Each of our sons was afflicted with this companion condition called anosognosia. … [It’s] defined as an inability to understand the self, a blockage of insight into what is happening. Many, perhaps most, of schizophrenic victims deny that they are schizophrenic, and this has led to many important social and legal and ideological conflicts. … The denial that took place, with Kevin the symptoms occurred before he reached the age of 18, meaning he could be treated without his consent. He was a juvenile and he was taken into care and custody without his consent.

Dean was over the age [of consent] and resisted treatment, denied that he needed to be treated, and it was only after a series of psychotic breaks that he came around to the understanding that he needed help.

Dean is accountable to a clinician. He has to report; there is a record of him taking his meds. Kevin was taking oral medication only on his own consent and we weren’t sophisticated enough to perceive that instead of taking the meds Kevin might be hiding the meds. This happened in the later stages of his descent and it was after he finally announced to us, “I’m fine. I’m healed. I’m OK, I’m not going to take my pills.”

Within a few months after that, Kevin hanged himself in our basement.

On trying to understand the degree of Kevin’s suffering

He was hearing voices. We know that. We could watch him through the kitchen window as he walked out of the house and toward the hot tub that he loved to sit in. We could see him climb into the hot tub and sit down, his profile was to us, and we could see him laugh. He would laugh, he would giggle. … Something was talking to him, and I think because of that happy response we saw from him we told ourselves that he had made friends with the voices, that the voices were beckoning him, they were coaxing him into their world, and that he finally decided to join them. I don’t know whether that’s true or not. I’ll tell you that it got me through the first five years of trying to figure out where Kevin’s mind had gone.

On still having dreams of Kevin

In the dreams Kevin is alive. He’s a small boy, around 10, 11, 12 years old. We know he’s a gifted guitar player, but he’s stopped playing his guitar, and he won’t start again. The odd thing is that both Honoree and I have had this dream. It might be a metaphor for his death, but he shows up, almost every night, as I say. … I’m glad to see him. In the dreams he is etched so perfectly. The reality of him, the physical sharp-focused reality of Kevin is overwhelming and all of his kindness and his goodness are there.

On the effects of deinstitutionalization in the 1960s on people with mental illness

The advent of the so-called “wonder drugs” like Thorazine … were touted as cures for schizophrenia — they weren’t. At best they were cures for symptoms. But on the strength of Thorazine and its great consumer success and promise, President Kennedy, seeking to do the right thing, signed legislation … in 1963 … that authorized the emptying out of mental asylums and the transferring of their patients, their inmates, hopefully into community care centers that were going to be built around the country to receive them.

Deinstitutionalization was a catastrophic social experiment, one of the worst we’ve ever had. It ended up creating the [mentally ill] homeless population that still plagues us today.

The second terrible effect of deinstitutionalization was that many of the people never ended up in the community centers. The government ran out of money. They couldn’t build enough to contain this outflow of patients, so they ended up on the streets, and from the streets they ended up in prison. Many of them. Today our prisons are overflowing with the mentally ill. Prisons are our de facto mental hospitals.

Marijuana and Psychosis: Real Data, Real Bad

via Christian Headlines

John Stonestreet, Roberto Rivera

The pitfalls and perils of marijuana legalization are well-documented. But whenever we discuss that research here on BreakPoint, we’re accused of not having the right research. What that means is that we’ve used studies that contradict the very vocal advocates of weed.

Well, let’s see what happens when we cite The British journal The Lancet, which, along with the New England Journal of Medicine and the Journal of the American Medical Association, is considered the “gold standard” for peer-reviewed medical research. It doesn’t get more “real” than being published in The Lancet.

A just-published study in The Lancet involving, among others, researchers at King’s College London, compared 900 people who had been treated for psychosis with 1,200 people who had not. Sample participants were drawn from across Europe and Brazil.

Both groups were surveyed on a host of factors, including their use of marijuana and other drugs. The study’s authors concluded that “people who smoked marijuana on a daily basis were three times more likely to be diagnosed with psychosis compared with people who never used the drug. For those who used high-potency marijuana daily, the risk jumped to nearly five times.”

By “high-potency” the researchers meant marijuana with a THC content of more than ten percent. To put that figure in context, a study of the weed seized by the DEA between 1995 and 2014 found the THC content went from about 4 percent in 1995 to 12 percent in 2014.

Today, it’s not uncommon to read of marijuana that’s legally-sold in places like Colorado with THC content above 20 percent, occasionally 30 percent! Legalization advocates minimize the exponential growth in potency by saying that twenty or more years ago, Americans didn’t have access to “the good stuff.”

Well, that misses the point by several astronomical units. The point is that those people who daily use “the good stuff” are five times more likely to find themselves in a hospital suffering from delusions and hallucinations, to name only two symptoms of psychosis.

Now, critics will respond, “That’s correlation, not causation.” And that’s the criticism leveled at journalist Alex Berenson, author of Tell Your Children: The Truth about Marijuana, Mental Illness and Violence, a book I recommend highly. But as I heard Berenson say just last week in Denver, of course it’s correlation and not causation. The only way to prove causation would be to ask half a sample group to experiment with something that may harm them. That’s not ethically possible. By the way, all the studies that made us believe that cigarette smoking causes lung cancer were correlated studies too, but that was enough to convince us all.

Even so, writer Ron Powers doesn’t need a peer-reviewed study to convince him of the link between marijuana use and psychosis. In his 2017 book, Nobody Cares About Crazy People, he tells the moving story of his two sons, Dean and Kevin, who were both diagnosed with schizophrenia in their late teens.

As Powers tells readers, while there is a strong genetic component to schizophrenia, there is no “schizophrenia gene.” Instead, it’s a constellation of genetic and environmental factors that make people susceptible to schizophrenia. One of these, as Powers painfully learned, is heavy marijuana use, especially in the teenage years.

Of course, some people will tell you that they and most people aren’t mentally ill, so there’s little if any risk. But for a host of reasons, no one can know that with certainty. In fact, all pronouncements about how safe marijuana legalization is simply overstates the case.

That’s exactly what happened here in Colorado. The possible pitfalls were denied or downplayed. And so, Colorado now holds the dubious distinction of leading the country in first-time drug use. And the rate of monthly marijuana use among 18-to-25-year-olds in states with legal weed is nearly three times as much as states that haven’t legalized it.  By the way, 18-25 is the age when schizophrenia often begins to manifest.

And since legalization, Colorado has seen a a spike in marijuana-related emergency room visits by people between the ages of 13 and 20.

Given the well-documented mental health risks, especially to not-fully-formed adolescent brains, the rush to legalization is the height of irresponsibility. An irresponsibility that can shatter lives. And don’t just take our word for it.


BreakPoint is a Christian worldview ministry that seeks to build and resource a movement of Christians committed to living and defending Christian worldview in all areas of life. Begun byChuck Colson in 1991 as a daily radio broadcast, BreakPoint provides a Christian perspective on today’s news and trends via radio, interactive media, and print. Today BreakPoint commentaries, co-hosted by Eric Metaxas and John Stonestreet, air daily on more than 1,200 outlets with an estimated weekly listening audience of eight million people. Feel free to contact us at BreakPoint.org where you can read and search answers to common questions.

John Stonestreetthe host of The Point, a daily national radio program, provides thought-provoking commentaries on current events and life issues from a biblical worldview. John holds degrees from Trinity Evangelical Divinity School (IL) and Bryan College (TN), and is the co-author of Making Sense of Your World: A Biblical Worldview.

Publication dateMarch 27, 2019

Photo courtesy: Simone Scarano/Unsplash

LEST WE FORGET

Tyler West is in a prisoner in the Richard Handlon Correctional Prison in Ionia, Michigan. Mark Rippee, blind and severely disabled, as well as severely mentally ill, is at large on the streets of Vacaville, California, where he has somehow survived for twelve years. He is regularly beaten up and tormented by street punks. His sister Linda Privette told me that in addition to food and clothing, she recently provided him with his eighth walking cane in a twelve-month period–the other seven had been taken from him.

Mark Rippee

You may read about Tyler and Mark, and the grossly inhumane reasons for their medieval persecution, elsewhere on this blog. In brief, each is an unconscionable victim of an American state’s official contempt for the mentally ill, contempt that festers from ignorance, indifference, and a lack of organized public pressure to rescue them and their families from their living hell.

I’m sure that many relatives of the mistreated mentally ill would like to see equal attention devoted to their loved ones. My inadequate response is that there are not enough megabytes in cyberspace to tell the story of every American sufferer of mental illness who has been further victimized by our systems. We need to make mental-health reform a massive civil-rights issue. We need a revolution of conscience.

Tyler West

I am posting below a heartbreaking, eloquent message from Tyler’s adoptive mother, Kimberlee Cooper-West. (She submitted it to the Facebook site Circle of Comfort and Assistance Community, and I reprint it with her permission, and it bears close reading.) You can find comments from Mark Rippee’s sisters, Linda Privette and CJ Hanson, elsewhere on this blog.

KIMBERLEE COOPER-WEST

Wish I had good news to share with ya all’ Love my CCA family! Some have asked, so here it is! Today is our son Tyler’s 20th birthday! We were unable to say Happy Birthday, as he is in lock down for 5 days. We drove a little over an hour, to Richard Handlon Correctional Prison, in Ionia, Michigan. This was last Monday. He is number #113697. We had cake with him. He made a cake from 2 honeybuns, smashed peanut M&Ms(sprinkles) and a melted Snickers bar on top. He is inventive. We sang Happy Birthday to him. He is still our boy! Few mention him. Our heart breaks for what, we have lost. This Will be his 3rd year, away, for his Birthday. Next he will miss Thanksgiving and Christmas. He hasn’t been given counseling, education, training, or the proper medications. He was beat up 4 times, since he was incarceration. Why, couldn’t these mental health professionals, keep him, in an, inpatient psychiatric hospital? For the love of God, there was no good reason, to release our son. His safety compromised. No one responsible. He was nearly shot at for trespassing. He was inpatient, 5 days prior, to his arrest.. He was delusional and hearing voices. What is wrong with this country? Why is there, no long term treatment? This is a brain disease, ya all’ Maybe we should start locking up every Grandma and Grandpa who is violent, or disorderly from Alzheimer’s. Serious mental illness a disease. It is prodromal to Alzheimer’s. Prisons are corporations. Their goal is money. They need prisoners. Caught up in the system, it is a real thingl. We are receiving, a criminal justice system education. Months are now years. One caseworker, Ms. Williams, calls many people names like dumb, retarded, idiots and pedophiles etc. Everyone in Ty’s facility is either mentally ill or autistic. She told Tyler a 19 year old kid, who was only supposed to be there for 2 months, your doing 15 years. It leaves me to wonder, how many, have given up from her words.. He is not even provided an inhaler for asthma, and chronic lung disease. He has autism and a serious mental illness. When he was in school he was never suspended. He was a target for bullies, which was, Our main concern. Incarceration, never crossed our minds. Today on his birthday, I sent his appeal papers, certified to a judge. Hopefully he will give him an apeallate lawyer.

Mental Healthcare Reform at the Grass Roots

This Arkansas group, #ARmindsMatter, looks to be a prototype for citizen-based activism in all our states to demand relief from the many failures in America’s systems of mental healthcare.

I would be interested to learn of similar movements in other states. With an active, agenda-driven interlinkage of groups such as #ARmindsMatter, we could forge a powerful watchdog, lobbying, and organizing collective that would establish reform as the civil rights issue of our time and break the inertia that’s destroying the lives of so many mental illness sufferers and their families.

Another Instance of Mental Illness “Rights” Gone Wrong!

I thank the blogger and advocate Dee Dee Moon Ranahan for drawing my attention to this; it first appeared on her own excellent blog  “Sooner Than Tomorrow.”

THE “RIGHT” TO BE SO ILL by Kathy Day

We just had a glaring incident of how untreated serious mental illness impacts the community.

A young homeless man that I know well and love, had an extreme outburst in front of our apartment. I don’t know what set it off. He was eating a box of cereal and drinking some milk. Then I heard him yelling at the top of his lungs. He started chasing another person down the street.

My neighbors across the street called the cops. They were terrified because they have two young boys and they didn’t want them to witness what was going on and they feared the young man could hurt someone.

The officers who came are well trained in crisis intervention. I asked them to try to take him to a hospital. They said they’d try but wanted to let him cool down first.

If he didn’t have the ‘right’ to be so ill, he’d have received the treatment he needs long ago. But the way the system is designed, he’ll have to demonstrate dangerousness, likely in the presence of law enforcement, before he gets any real treatment.

Turns out he was taken to the ER a week ago on a psych hold. The ER discharged him within 24 hours.

If he’s released early again, this family will be afraid of his next incident. It’s not fair that they should have to deal with the failures of the system of mental healthcare.

A better kind of option: Welcome Home Housing, Sacramento, CA

THIS IS A MAN . . .

-Catherine Rippee-Hanson, a sister of James Mark Rippee

Mark Rippee – Mug shot taken for falling asleep on the sidewalk. One out of the more than 100 times he has been arrested in the last year alone. Photo Courtesy Catherine Rippee-Hanson.

You know about Mark Rippee if you live around Vacaville, CA. Or if you read the text of the talk I delivered at the Pathways to Hope conference in San Antonio on August 24. 

Mark Rippee has survived on the streets of Vacaville for nearly twelve years despite being sightless, missing parts of his brain, enduring the pain of an interior metal rod to support his shattered right leg, fifty surgeries—many of them to heal the wounds he has suffered from repeated beatings by passing thugs. . .

. . . And, oh yes: despite his diagnosis of acute schizophrenia (a diagnosis that, weirdly, Mark’s family cannot definitively confirm because of restrictive and nearly useless laws).

Mark Rippee is one of more than one hundred thirty thousand homeless people in California as estimated by the Department of Housing and Urban Development. Most of them are unsheltered. That figure amounts to one-fourth of the national homeless population (553,742). As one legislator wrote,

Homelessness and homeless encampments have become a part of the permanent landscape of California.”

As hundreds of millions of dollars in new-housing money languish in law-court entanglements, the death toll among California’s homeless has been rising: infections, pneumonia, cancer, cirrhosis, and other treatable diseases claim ever-more victims. In 2017, eight hundred thirty-one street people died in 2017, nearly doubling the count of 458 in 2013.

A Los Angeles County study reported by Politifact reported that more than one-fourth of the homeless are seriously mentally ill. Other estimates place the figure at one third.

Mark Rippee – Photo Courtesy Catherine Rippee-Hanson

The homeless mentally ill (in California and elsewhere) exist under twin, paradoxical curses: they are public eyesores. Pedestrians grimace as they step over their inert forms or cross the street to avoid their wild gestures and ranting.

At the same time, they are invisible: faceless statistics, generic, interchangeable, somehow less than human because of their madness.

Mark Rippee is one of these living paradoxes. Perhaps he should be their national symbol. His nearly faceless face is the face of the faceless: the face of our gravely disabled brothers and sisters who live and suffer and howl and die, bereft of help from government, agencies, and many churches, on the streets of our cities. Force yourself to contemplate what is left of Mark Rippee’s face for as long as you can stand to hold his sightless gaze and think about the obscenity of your country’s mental healthcare system.

This is a man who is severely, gravely disabled, living on the streets for 12 years. –Catherine Rippee-Hanson

James Mark Rippee – Photo Courtesy Linda Privette

Thirty-one years ago, Mark Rippee was a handsome and hopeful young man. At age 23, he was a productive member of the Vacaville community, a robust construction worker with a girlfriend, still mapping his life-plans.

Those plans blew to bits in an instant on the Sunday night of June 21, 1987—Fathers Day. On a dark country road, astride a Harley-Davidson motorcycle that he had owned for only a few days, Mark swerved to avoid an oncoming car that had drifted into his lane and tore through an alfalfa field until the bike ploughed at high speed into a grain harvester.

This is a man who left massive amounts of grey brain matter from his Frontal lobes lying in a dark field. This is a man who paramedics transported without sirens at first, thinking he must be DOA. –Catherine Rippee-Hansen

The impact tore a deep T-shaped gash across Mark’s face, destroying his eyes and exposing his frontal lobe, grey bits of which were found around him. His right leg was ripped open from his crotch to his ankle and broken in several places The EMTs who loaded him into an ambulance assumed he was dead until they noticed movement en route to the hospital.

Mark Rippee two years after his accident. He had calmed down and more lucid although doctors warned that it would not last. Photo Courtesy Catherine Rippee-Hanson.

Mark Rippee survived his shattering injuries. His accident, however, struck hard at his close-knit family. His father James suffered a breakdown soon afterward, entering a state of denial that led him to prohibit Mark’s twin sisters, Linda and Catherine, from securing Mark’s commitment in an institution. Six years later, James Rippee suffered a stroke and died. Mark’s mother, Lou, now 78, also commenced a long, slow decline in her health.

For eighteen years Mark managed to live at the borders of a peaceful and secure life, given the givens. His mother and his twin sisters (both of whom married) threw themselves into his welfare with the aid of a part-time caregiver. At intervals, and with support, Mark could maintain his own apartments.

The three women kept hope alive. They never lost their love for the invisible man beneath the disfigurement and the ravaged brain.

This is a man who was described as sweet, caring, willing to share whatever he has, and intelligent. –Catherine Rippee-Hanson

That hope eroded with each of the twenty-odd operations on Mark’s brain to scoop out abscesses (Mark has undergone more than fifty operations in all). Each brain surgery eliminated more grey matter. Each elimination weakened Mark Rippee’s capacity to think clearly and increased his tendencies to erratic, threatening behavior.

“He lost control of his emotions, his anger management, his reasoning,” said Linda. “There was no filter. Since the accident, he has fought depression, sleep disorder, and chronic unimaginable pain.”

And worse.

Mark hallucinated. He heard voices, spoke in the personas of three different people. 

“He called Travis Air Force Base several times to report that aliens were attacking,” Linda (by then Linda Privatte) said. “A voice told him to take a fork and pluck my daughter’s eyes out. He chased me with a stun gun, he began to have conversations with himself and 2-3 other people in his head.” 

Mark’s psychosis deepened. He barred his mother from his apartment, yelling that he would kill her if she came in—he did not believe it was his mother. The sisters feared he would hurt her. His mother stopped caring for him; after twenty years the stress on her was taking a toll.  Shortly afterward Mark was evicted for starting a fire outside his apartment door.

“He was suicidal,” Linda continued. “Mom wrestled a loaded gun from him. He has walked into traffic and tried several times to jump from a moving car. He has tried twice to jump off an overpass twice. He hates us all for saving him.”

Mark Rippee clearly was now beyond the family’s control. A few years earlier, a psychiatrist had diagnosed the young man as afflicted with paranoid schizophrenia. But Mark’s delusions had by then swept him well beyond the capacity to assent to therapeutic treatment or medications.

Mark Rippee Photo Courtesy Catherine Rippee-Hanson who writes, “How my brother looks and lives today 32 years after his accident. Social Services and County services just hold him once in a while for 72 hrs to 2 weeks and then don’t evaluate him, don’t tell the County he needs LPS Conservertorship, and just walk him out to the sidewalk and down a little ways, and leave him standing on the sidewalk…. blind, brain damaged, schizophrenic from the TBI, confused, unable to take care of his own needs and alone. Often in a new town that he is unfamiliar with…. and they don’t even have to tell the family which facility, where he is, or when they released him. He has lost another 30 pounds since this picture was taken… sometimes so weak, he can’t stand up. People beat him up all the time an rob him of everything he has with him. Over and over, over and over. 32 years. When will the State of CA, get it together and change the laws for all Gravely Disabled people?”

The sisters began to search for a therapeutic sanctuary and psychiatric care. In doing so they entered a labyrinthine world, a world that often mystifies most Americans, including relatives of the mentally ill: a world of bureaucracies piled upon bureaucracies: municipal and state government, psychiatric hospitals, police departments. A world of strange acronyms (CBT, CET, CMHC, AB, ADC, HHRMAC, SB, SHIP, SHOP—the list extends into the hundreds.) Behind the acronyms stretched a thicket of rules, restrictions, policies, protocols—all designed, it seemed, to pass the buck, evade accountability, and keep the mentally ill as far as possible from reclamatory help.

The years pass, and the trail of the sisters’ efforts grows long, convoluted, chockablock with blind alleys, false leads, rebuffs, personal humiliation. Not even Linda or CJ can fully reconstruct its nightmare skein.

Among the most infernal of the acronyms was HIPAA.

HIPAA: the Health Insurance Portability and Accountability Act. Congress created HIPAA in 1996. Essentially, it is a misbegotten tool for ensuring the informational privacy of a patient in the health-care system. In practice, HIPAA has deprived countless thousands of family members from information vital to helping them understand what is wrong with their loved one, and what to do about it. Leading advocates for mental healthcare reform have insisted that HIPAA be either radically reconceived or scrapped.

HIPAA rules prevented the Rippee family even from being able to confirm that diagnosis of Mark as a paranoid schizophrenic. (It was relayed to them by a mutual friend of the psychiatrist.) Nor could they ascertain his medication needs.

Nor could they—can they—even have him removed from the brutal mercies of the Vacaville streets and placed safely in an institution. They were—are—stymied by the monumentally absurd, fatally ambiguous system of state laws that sprang up at mid-century to counter the unintended consequences of deinstitutionalization. These laws awkwardly attempt to protect the civil rights of mentally disabled people on the street (140,000 as of 2015, as estimated by the Department of Housing and Urban Development) against involuntary commitment to therapeutic care: unless, that is, if the individual can be judged “a danger to self or others.”

The absurdity of this standard radiates from its description: how is it possible to prove that someone is a danger to self or others unless that person commits an act that is—well, one can see where one is going with this. Yet even committing such an act is no guarantee that the perpetrator will be taken under care. Consider the case of—oh, James Mark Rippee: the loaded gun. The stun gun. The threats of suicide. The threats on his mother’s life. The fire he set. The attempted jumps from moving cars and overpasses.

Yet as I write these words, James Mark Rippee remains blindly, madly, on his own; a man, in effect, without a country. Certainly without a country that gives a damn whether he lives or dies, as long as he just stays the hell out of sight.

This is a man who has no safety net at all, but has the right to die on the streets, because he can say, “No.” –Catherine Rippee-Hansen

Linda and Catherine—the latter by now suffering from cancer that has been diagnosed as terminal—turned their energies to another strategy that seemed reasonable: securing hospitalization for Mark as “gravely disabled.”

“Gravely disabled” describes one of the several lurching measures to slap a tourniquet over the worst bleeding wounds of deinstitutionalization. Encoded in two similar bills, AB 1971 and AB 2156, “gravely disabled” is the standard for which the state would intervene in an uncooperative homeless victim’s life and usher that person to shelter and treatment. A person is considered gravely disabled if he/she is unable to. provide for basic needs for food, clothing, or shelter because of a mental disorder of impairment such as alcoholism.

That’s the theory, at least.

Linda and Catherine—Linda, after her sister weakened from her cancer—showed up at meetings of the Solano County Board of Supervisors to encourage support passage of AB 1971. They spoke up. They wrote volumes of emails to the committee.

For their troubles, they found that “gravely disabled,” like “danger to self in others,” resides largely in the eye of the beholder: the eye being that of the agency in charge of enforcing it.

“Over the last few weeks alone, I’ve contacted more than forty-five agencies and people, trying to convince them that my brother is the definition of “gravely disabled,” Linda told me recently. “I told them he needs a conservator [a certified adult overseer], based on his family’s situation and the fact that he has been homeless for more than a decade.  While I attempted to have patience, I was only told, “Thanks, we’re working on it.”

That was hardly the worst. After one early petitioning visit, Catherine reported that the Board of Supervisors let her know that they consider Mark self-sufficient “if he can eat out of dumpster. They consider him self-reliant if he knows to cover himself with newspapers, or to sleep under a bush to try to stay warm. They consider him self-sufficient if he can panhandle.” (Other relatives of street-people in the state have reported versions of the same response.)

The sisters rejoiced when AB 1971 was passed by the California Assembly, even though it was stipulated only as a five-year pilot program, and only for Los Angeles County, not the entire state.

They rejoiced prematurely. In late August, after a rash of opposition from groups that included, with splendid irony, the California Hospital Association and the Disability Rights Education and Defense Fund, AB 1971’s sponsors pulled the bill. The Rippees, along with tens of thousands of other Californians struggling to reclaim their helpless loved ones from the California streets, are back where they started:

Nowhere.

This is a man who is suffering, body and mind, tormented, and in physical and mental pain every day . . . This is a man who hears voices he hates, like a broken record to the point of pure torment . . . This is a man who had medical doctors abandon him for having angry or unacceptable outbursts . . . This is a man who gets robbed of his income by people who he asks for help to use the ATM . . . This is a man who has family members who under current law cannot make decisions  for him to help him . . . Catherine Rippee-Hanson

With Catherine depleted by her disease and Lou Rippee awash in depression, Linda Privatte struggles on alone to reclaim what is left of her brother.

“I have not been able to as much as look at Mark,” she told me a day or two ago. “I’m feeling guilty about that.”

You are entitled to look away from your brother, Linda (though you won’t, not for long). It is the rest of us who are morally obligated to keep looking into James Mark Rippee’s nearly faceless face, until we accept that this man and all his gravely disabled mentally broken brothers and sisters are our brothers and sisters as well, and that we must not look away until we have inspired or shamed our country into facing them and giving them sanctuary.

For God’s sake, this is a man.  He is not invisible.  He is not expendable.  With any humanity left in us, let us help him. This is a man.  This is a man. This is my brother.

Note: on Monday, September 10, I invited two members of the Solano County, CA, Board of Supervisors to respond to comments by CJ Hanson and Linda Privatte that addressed their comments and policy positions. At this writing neither has responded. I will post any comments from them should they come in.

I invite and encourage repostings of this blog entry from other sites, from newspapers and magazines, and from other print and online journals. No further permission is required.

Montana had the highest suicide rate in the country. Then budget cuts hit.

Further evidence of cluelessness and indifference in too many of our state governments.

via NBCNews.com

Suicide has been a persistent problem in Montana — and it’s getting worse. Now, some who have lost loved ones are mobilizing to stop the deaths.

Michael Lee, 13, died of suicide on July 27 and is buried next to his mother, who died of suicide just over two years ago. Frederick Lee and Colleen Timmins-Lee, Michael’s father and stepmother, are urging everyone they know to reach out to those who may need help.Annie Flanagan / for NBC News

WOLF POINT, Mont. — Mourners in this small town in northeast Montana, where a strip of appliance shops and bars are dwarfed by vast ranches, packed into a church this month to pray for Michael Lee.

A week earlier, Michael, a 13-year-old who dreamed of playing for the NFL, had killed himself in his family’s red clapboard home. At the funeral on Aug. 3, a row of Michael’s middle-school football teammates sat behind his relatives and friends, wearing maroon jerseys and white armbands with “R.I.P.” handwritten on them. A handful of strangers were there, too; the funeral announcement said anyone affected by suicide was welcome.

That seems to include just about everybody in the state these days.

The church was silent as Colleen Timmins-Lee, Michael’s stepmother and a state trooper, rose to speak, trembling.

Michael Lee with his father. Courtesy family

“If you or someone you know that you even think might be going through this, then please, please get them the help they need,” she said through tears. “Please, please just reach out and just tell one person and try to prevent another tragedy like this.”

For those who sat in the pews wiping their eyes, or who stood by the entrance of the church, where a table was covered in pamphlets on suicide prevention, the message was both urgent and familiar. Montana has the highest suicide rate of any state in the country, and while people here don’t often speak openly about sadness or loneliness, many have firsthand experience with loss.

That already included Michael’s family. Just over two years ago, his mother, Kimberley Evans, also died of suicide.

Afterward, Michael struggled. He saw counselors at a children’s mental health clinic in rural Wolf Point, but after it burned down last year, the closest available counselor was 50 miles away. Michael’s stepmother and his father, Frederick Lee, a patrol officer with the Montana Department of Transportation, couldn’t afford time off to take him there, and they said the counselors Michael had seen told them that he had improved.

Now, weeks after their son’s funeral, they were left wondering what else they could have done — and what Montana can do — to stop this from happening.

“When it comes to depression and suicide in our community,” Lee said, “it’s out of control.”

A GROWING CRISIS

Suicide has been a persistent problem in Montana — and it’s getting worse. The state saw 25.9 suicides for every 100,000 residents in 2016, nearly double the national average, according to Centers for Disease Control and Prevention data that is age-adjusted. Since 1999, that rate has risen 38 percent, even faster than the 30 percent national rise in suicides.

The challenges Montana faces are many. It’s sparsely populated — the fourth-largest state by area, it’s 44th in population, with just over a million people — and it has less than a quarter of the mental-health care providers required to serve its residents, according to the Health Resources and Services Administration. A strong gun culture and high rate of heavy alcohol consumption fuel the problem, as does lack of daylight in the winter and high altitude, which have both been linked to depression. And then there’s the stigma associated with reaching out for help, which many Montanans see as a sign of weakness.

“We have a perfect storm when it comes to suicide,” said Karl Rosston, suicide prevention coordinator for Montana’s Department of Public Health and Human Services. “We have a lot of factors that are all happening at the same time.”

Then, last year, came another blow: Facing a projected $227 million budget shortfall, Montana’s Republican-led legislature and Democratic governor made cuts to the state’s health department, including to mental health funding. As a result, more than 100 mental health professionals were laid off across the state and 10 rural health care programs were forced to close because they couldn’t afford to pay their employees, according to the Behavioral Health Alliance of Montana, an advocacy group for the state’s mental health providers.

Now, some who have lost loved ones to suicide — frustrated by the budget cuts and driven by the state’s urgent needs — are mobilizing to do whatever they can to stop the deaths. They are veterans and Native Americans, social workers and public health officials. They’re studying suicide prevention and opening clinics and speaking to students. But they still fear that, in many cases, their efforts will not be enough.

‘ONE IS TOO MANY’

When Ryan Ranalli was growing up in Helena, Montana’s capital, there was at least one suicide in his high school each year. Later, after he joined the military and served in Iraq as an Army infantry squad leader, he lost more friends to suicide. More than 200 Montana veterans killed themselves from 2013 to 2016, representing nearly a fifth of the state’s suicides in that time, according to the state Office of Vital Statistics.

Ryan Ranalli attends Mass at the Cathedral of St. Helena. Ranalli has been going to the same church since he was 3 years old.Annie Flanagan / for NBC News

“It’s one of those things, especially if you’re a male, not to ask for help,” Ranalli, 39, said. “People I served with, they don’t want to reach out and say ‘Hey, I’m having some problems, and I need to talk to somebody.’”

For Ranalli, the problems started in 2005 after several Army buddies in his unit were killed in Iraq, some by a bomb, others in a firefight. The same year, on his second deployment there, Ranalli was hit by a roadside bomb, ending his dream of a long Army career. He returned home with a traumatic brain injury, stuck in a cycle of nightmares, flashbacks, anger, depression and anxiety. The following year, two more friends died while fighting in Iraq. By 2012, Ranalli was overwhelmed by survivor’s guilt and frustration over his inability to rejoin the Army. One night, his wife found him in their garage, blackout drunk and attempting suicide.

Left: Roses in Ranalli’s backyard. Right: Ranalli wears a bracelet as a tribute to two close friends killed while serving in the military. Annie Flanagan / for NBC News

“I felt like a burden,” he said. “I’ve seen what [suicide] does to families, but at the time, you just don’t think about it.”

Ranalli’s wife convinced him to get help, but it eventually became clear that the treatment he needed wasn’t available in Helena. There was a traveling VA clinic that came through once a month, but nothing permanent, so he underwent months of treatment out of state, in San Diego.

After his health improved and he returned home, Ranalli decided to channel his frustration with Montana’s mental health care shortfalls into action. He worked on a letter-writing campaign for a permanent veterans mental health clinic in his hometown, and this spring, the Helena Vet Center held its grand opening. So far, it’s provided over 1,055 mental health visits to nearly 150 veterans and family members. Ranalli is one of them; he receives treatment there for post-traumatic stress disorder.

Ranalli spends an evening with his family. He plans to be open with his six children about his mental health so they feel comfortable discussing any struggles with him.Annie Flanagan / for NBC News

In the fall, Ranalli, who has six children, plans to begin speaking about suicide prevention in local schools.

“To me, one is too many,” he said, “whether it’s a vet or a high school student.”

‘YOU LOSE A LOT’

At 19, Laurencia Starblanket, a member of the Salish Tribe, has already lost more than half a dozen close friends and relatives to suicide.

Nearly a decade ago, Starblanket’s aunt killed herself. Soon after, Starblanket’s grieving mother became addicted to pills, then heroin and methamphetamine, which has landed her in prison on and off.

Laurencia Starblanket has lost more than half a dozen close friends and relatives to suicide. Annie Flanagan / for NBC News

 

Then Starblanket lost three friends, two cousins she called brothers and an uncle she considered a father figure — all died by suicide, all within the past two years.

“It’s hard. You lose a lot. A lot comes out of you,” said Starblanket, who lives in Arlee, a windswept town of about 600 on the Flathead Indian Reservation in the shadow of the Rocky Mountains. “After my [uncle] passed, I was just numb. I didn’t want to go to school. I didn’t want to do anything. I just laid in bed.”

Starblanket, seen at the state fair in Missoula, is dedicated to reducing the high suicide rate among Native Americans. Annie Flanagan / for NBC News

From 2005 to 2014, the suicide rate among the indigenous population in Montana was 22 percent higher than the state’s average, according to the Department of Public Health and Human Services. And youth suicide was more than twice as common in Montana than in the country as a whole during that period.

A little over a year ago, after her cousin died, Starblanket started drinking for the first time and soon began considering suicide herself. Her family sent her to Canada to spend time with relatives, and when she returned home, she decided to go to school to study tribal governance so she could address the high suicide rate among Native Americans.

Laurencia Starblanket with her boyfriend and siblings at the state fair in Missoula. Annie Flanagan / for NBC News

This year, after Starblanket came home, her younger sister attempted suicide. That only doubled Starblanket’s resolve. This summer, she worked as a camp counselor at a suicide prevention program at the Tribal Health Department in St. Ignatius, Montana.

“Ever since seeing my sister in a hospital bed because she wanted to kill herself,” Starblanket said, “I look at it as: I want to save someone else’s little sister.”

‘WE LITERALLY DON’T HAVE THE CAPACITY’

The mental health clinics serving Montana’s wide-flung communities were already struggling to meet the state’s growing needs. Then, over the course of 2017, the Department of Public Health and Human Services was hit with about $95 million in cuts, which resulted in the loss of at least as much money from federal matching funds, according to the Montana Budget & Policy Center, a nonprofit that analyzes budget issues and advocates for government investment in health care, education and the environment.

Montana — the fourth-largest state by area and 44th in population, with just over a million people — has less than a quarter of the mental-health care providers required to serve its residents. Annie Flanagan / for NBC News

State officials declined to say how much of the health department cuts directly affected mental health services. But two cuts hit mental health care providers particularly hard. The state reduced the Medicaid reimbursement rate by 2.99 percent, which meant that clinics received less money when they treated low-income patients. And the state slashed Medicaid reimbursements for case managers by more than half, so that clinics receive $8.19 across the board, rather than $17.38 for children and $18.22 for adults, for every 15 minutes that case managers spend with their clients.

In response to the funding reductions, the Sunburst Community Services Foundation, a Montana nonprofit that offers mental health care as well as arts and education programs, cut anything that could be considered extra, from office supplies to training. Yet the organization is still losing about $60,000 a month and may close two of its six locations.

“They’re my people and I really care about them, but it’s like a fool’s errand,” Megan Bailey, a licensed clinical social worker who leads Sunburst’s program development, said of their clients. “We literally don’t have the capacity to hold this up any longer.”

Gov. Steve Bullock has said mental health is a priority for his administration. His office has released figures showing that mental health funding in the state has increased by millions of dollars since 2011, two years before he took office, even with the recent cuts. Still, Montana’s mental health budget lagged behind states with a comparable population from 2009 to 2015, according to data compiled by the National Alliance on Mental Illness.

A mural in Libby, Montana, located in Lincoln County. The county, which has a population of nearly 20,000, has just one behavioral health employee. Annie Flanagan / for NBC News

Following a public backlash, including a lawsuit by the Montana Health Care Association, Bullock announced plans in July to restore funding for Medicaid reimbursements and partially restore Medicaid case manager funds. Those plans, including details on restoration amounts, will be made public by Sept. 1, the governor’s office said.

“Governor Bullock remains committed to fighting for Montanans and the essential services they deserve,” the governor’s office said in a statement. “He will again propose a budget that invests in mental health and ensures vulnerable Montanans have the health care they need. He will continue to engage in statewide partnerships to implement evidence-based programs aimed at reducing suicide in Montana.”

But struggling mental health care providers say that it may be too little, too late, and it would take years to reopen shuttered clinics and regain the community’s trust. In the meantime, Montana’s suicide toll continues to rise.

‘WE CAN’T WAIT FOR FUNDING’

Libby, Montana, is tucked between the Kaniksu and Kootenai National Forests, surrounded by mountain ranges crisscrossed with trails roamed by moose and bears. Reader’s Digest named it the state’s most charming small town this year.

Libby, Montana, lost its mental-health clinic to budget cuts. Annie Flanagan / for NBC News

But beneath the natural beauty is a growing frustration.

Libby is in Lincoln County, which has a population of nearly 20,000 but just one behavioral health employee, Amy Fantozzi, a graduate student who oversees the county’s contracts with medical providers who do mental health assessments.

The town had a clinic run by the nonprofit Western Montana Mental Health Center, the largest service provider in the region, which had 12 clinics serving 15,000 clients across 15 counties. But after the cuts were announced last year, the center laid off more than 60 case managers and shut down three clinics, including the one in Libby. That left hundreds of patients without access to therapy, medication and a case manager to check on them.

Amy Fantozzi is the only behavioral health employee for Lincoln County.Annie Flanagan / for NBC News

Now, when those patients are in crisis, their only option is the emergency room at Lincoln County’s lone hospital. Once they check in, Fantozzi gets a call, and she must decide whether to spend $100 of her $18,500 annual budget on a mental health assessment. Depending on the results, she could then spend an additional $300 to have the patient evaluated and involuntarily committed at the nearest mental institution 90 miles away.

There have yet to be any publicly reported deaths by suicide as a result of the local clinic’s closure, but county officials fear the current system of mental health triage won’t hold up.

The recently closed Western Montana Health Center in Libby.Annie Flanagan / for NBC News

“Right now it just feels like a Band-Aid on every patient,” said Jennifer McCully, 32, Lincoln County’s public health manager. “Is it going to work this time? Maybe, but we probably will see them again.”

On a recent Thursday morning, more than a dozen Lincoln County health officials, law enforcement officers, teachers, community leaders and medical providers gathered around a horseshoe of folding tables at Libby’s high school to discuss how to fill the gap left by the budget cuts. One idea was to create a list of people who may be at risk of suicide and deploy volunteers to check on them regularly.

“We can’t wait for funding,” said Liz Erickson, who provides faith-based counseling through the Libby Christian Church. “We cannot wait for the grant. We cannot wait for that help. We just have to start the dang thing ourselves.”

‘WE CAN’T GO BACK’

In Wolf Point, Michael Lee’s father and stepmother are grieving for their son, who would have started high school this fall. They are also urging everyone they know to reach out to those who may need help.

But they are well aware of Montana’s many challenges when it comes to suicide prevention, which Frederick Lee said made the recent mental health funding cuts all the more infuriating. “They’re cutting back things we need,” he said.

Frederick Lee and Colleen Timmins-Lee hold each other by 13-year-old Michael Lee’s graveside. Annie Flanagan / for NBC News

Lee hopes to help in any small way he can. He will soon begin a three-year course in a suicide prevention method known as QPR — which teaches participants to question, persuade and refer those thinking of suicide — so that he can train others in northeast Montana. And he plans to leave his job with the Department of Transportation to find work as a deputy in a school. He wants to talk to kids throughout the day and check in on them.

“If we had one more minute to talk to Michael about his depression, if we had one more minute to tell him that we loved him, maybe the depression wouldn’t have taken him,” Lee said, his voice breaking. “But we can’t go back. The problem is we have to go forward.”

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or visit SpeakingOfSuicide.com/resources for additional resources. Montana residents can find a list of local resources here.

Phil McCausland reported from Helena, Libby and St. Ignacius, Montana; Elizabeth Chuck reported from New York; Annie Flanagan reported from Wolf Point, Montana; and Mariana Keller reported from Missoula, Montana.

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