Tuesday, March 27, 2012

Interesting article

For mentally ill inmates, health care behind bars is often out of reach

A man who was declared suicidal by a New Mexico jail and alleges he was then left to rot in solitary confinement for nearly two years is just one of many former inmates who say they were denied essential mental health services while incarcerated at that detention center, which like others across the country has struggled with how to treat the mentally ill.

Stephen Slevin, 57, made headlines last week when a jury awarded $22 milion after he alleged inhumane treatment in the Dona Ana County Detention Center following his arrest in August 2005 on charges of driving while under the influence and possession of a stolen vehicle.

But a search of Dona Ana County court records reveals the detention center was also hit with a class-action lawsuit six months prior to Slevins', in which 13 former inmates alleged their constitutional rights to mental health care had been "continually and persistently ignored."

The lawsuit was settled in 2010, with a judgment of $400,000 for the plaintiffs and a commitment from the county to change its practices.
According to criminal justice experts, many other jails and prisons have struggled to adequately handle mentally ill inmates. Few areas of the country, they say, have the money and resources and staff to handle such a challenging population.

"The Supreme Court has established that you have a constitutional right to a basic level of adequate health care, which now includes mental health care," Thomas Hafemeister, an associate professor at the University of Virginia School of Law, told msnbc.com. "They've recognized that there tends to be limited resources in this setting. As long as a qualified professional has examined the inmate and exercised his or her judgment as to what needs to be done, that's all that is required."

'Cruel and unusual'But Hafemeister, who has written about alternatives to the traditional criminal justice system for the mentally ill, explained that the definition of a "qualified professional" is a loose one.

"Some would argue for inmates, all that is required is medication," he said, meaning anyone with a medical degree, from a physician to a psychiatrist, could be considered qualified.

"Often it's very expensive. They're only willing to come in for an hour a week, and they zoom through very quickly. It can be a very cursory examination," Hafemeister said.

Slevin was detained for 22 months, released in June of 2007 without ever having been given a trial. By the time he was freed, he was deemed mentally incompetent, and his charges were dropped.

Slevin claims the only response he got while in Dona Ana Detention Center to his repeated requests for antidepressants was an increase in sedatives. Other mentally ill inmates at Dona Ana, according to the class-action lawsuit, struggled to get adequate care as well. One allegedly was punished by a medical technician, who discontinued his medications for two weeks; others complained of side effects but were not offered alternatives, the suit said.

“A jail like Dona Ana County was trying for years to cut costs, and nothing would force them to spend the money that they’re constitutionally required to,” Brendan Egan, an attorney who represented the plaintiffs on behalf of the ACLU and is now in private practice, told msnbc.com. “It’s cruel and unusual punishment. They weren’t willing to put money into it, even though they made money off of this jail. They’re paying the price for how they treated people for years.”

The primary plaintiff named in that suit, Jaime Bravo, was jailed from April 2007 until February 2008 after a domestic dispute. Bravo had depression, anxiety and acute psychosis, the suit said.

Four times during his detainment, Bravo attempted suicide, and each time he was then put in a padded cell or a restraint cell, said court documents.

“On or about November 15, 2007, Mr. Bravo made a fourth suicide attempt, by cutting his arm with a razor blade, necessitating stitches. DACDC staff placed him in a padded cell as a consequence … On or about November 16, 2007, Mr. Bravo tore out his sutures. DACDC staff placed him in a restraint chair as a consequence.”

In jail, mental illness will 'get exponentially worse'
While Dona Ana County was ordered to pay a total of $400,000 to the plaintiffs, a small amount compared to Slevin’s judgment, the bigger reward was that the jail changed how it handled mentally ill inmates, Egan said.

The jail renovated an entire section and “turned it into a very humane and real mental health unit,” he said. Officials also dedicated beds at a separate mental health hospital staffed by jail guards for the sickest detainees.

“Even if you take someone who has a slight mental illness like depression and you put them in a regular jail, they get worse,” Egan said. “[At Dona Ana County], they would just lock them in. They already had issues and you lock them up 22, 23 hours a day – they’re going to get exponentially worse.”

Just last month, the county approved a $2 million plan for a crisis triage center, which would offer an alternative for mentally ill people other than jail – something Egan believes will help.

“There were no mental health facilities or treatment for homeless people on the street, so you would have people on the street getting arrested basically for being mentally ill,” Egan said. “But once they got arrested, the county commissioners didn’t provide resources.”

According to Fred Osher, director of health systems and services policy at the Council of State Governments Justice Center, people with mental disorders are overrepresented in the mental health system.

"There's a variety of factors that contribute, but one of the research studies... looked at two jails in Maryland and three in New York. Seventeen percent [of inmates] met the criteria for mental illness," he told msnbc.com.

Nationwide, prevalence of severe mental illness among inmates is at least 15 percent, said Richard Bonnie, director of the University of Virginia’s Institute of Law, Psychiatry, and Public Policy.

“There are many factors at work here, but many us involved in this field are convinced that diversion from the criminal justice system into mental health services … can alleviate the problem without compromising public safety,” he told msnbc.com via email.

Jail diversion options include drug courts, where a substance abuse program is worked out instead of a jail sentencing; mental health courts, where a behavioral contract including drug tests and treatment appointments is drawn up; and sometimes, assignment to a mental health probation officer who is trained to handle mental issues and knows how to direct someone to health services.

"Lots of people have recognized there's this population with severe mental disorders that just isn't going to do well in a prison population," said Hafemeister, from the University of Virginia Law School.

Care doesn't have to cost more
And it doesn't always have to be expensive to divert those with mental issues, added Osher.

"What many systems are coming to realize is if you provide alternatives, then you can reduce length of stay. You can actually have this be a resource-neutral event. It doesn't necessarily require an infusion of dollars," he said. "We're spending tons of money warehousing, having people in a revolving door without producing good outcomes."

He cited Montgomery County, Md. as a successful example.

"They do a really nice job in screening and identifying folks with mental illness and diverting them when possible," he said. The county also tries get to them in psychiatric programs and help them with re-entry into the community, which reduces chances of them returning to jail, and helps them with their medication management as they transition out.

Similar programs are also happening at Alleghany County Jail in Pittsburgh and Miami-Dade, he said. Riker's Island in New York is undergoing a major transformation with their mental health care as well.

"Good things are happening at Riker's because of a settlement. The folks at Rikers with mental illness were ... without any resources to fend for themselves," he said. Baltimore and Memphis jails have also reformed their mental health care after being subject to lawsuits.

Training police officers to recognize mental illness is another key, Osher said, so those who need medical help can hopefully get diverted to emergency rooms or psychiatric centers before they are sent to jails in the first place - but only if that's not where they should be.

"We're not giving people a pass because they have mental illness," Osher said. "We're not being soft on crime. For those individuals that don't pose a public safety risk, there are these alternatives. There are treatments that can be provided."

Link to the article

I will write another post tomorrow about my thoughts, feelings and first hand knowledge of what this article speaks about.  Some of you may know that I used to work as a case manager and community integration specialist with severely mentally ill individuals who had gone through the criminal justice system and were reentering the community. This topic is something I feel very strongly about.

Friday, March 16, 2012

I tend to doubt these statistics because many people do not get treatment for their illness.  Therefore, I do not feel this number is completely accurate, it is most likely larger than what you see.  There is no way to account for all the individuals who never receive mental health treatment for their illness.

Thursday, March 15, 2012

I have had so many people say, "my (insert family member or friend here) has Bipolar and this blog could really help them" (in their own words of course).  If I can make a difference in just one person's life in knowing that they are not alone in this battle, this entire blog is worthwhile and I have achieved one part of my goal!  To know that I have already helped more than one person just by telling my own story is absolutely amazing to me! Keep spreading the word, I can't do it alone!

Tuesday, March 13, 2012

Where does stigma come from?

Welcome Back!

A little about stigma today...
I have dealt with a decent amount of stigma surrounding mental illness in my lifetime.  Even if the stigma was not directed towards me, it still had an effect on me.  More often than not, I find myself in a situation in which I am embarrassed or ashamed to admit that I have a mental illness.  I have found myself in many situations where those around me did not know of my Bipolar Disorder and have said things that were no doubt offensive to me and I just took it all in and never said anything.  I wasn’t at a point in my life until very recently that I felt comfortable enough to talk about my illness with others and not feel ashamed or embarrassed.  I can honestly say that I am still not at the point where in the middle of a conversation where someone was negatively discussing mental illness that I could diffuse it and educate.  That takes a lot of courage, I know I am well on my way to that point, but I’m not there yet for sure.  The only real way to get rid of stigma is to educate people about mental illness and to open up to people about your own mental illness so they can see that we are just like them.

What is stigma?

Stigma is defined by Webster’s dictionary as: a mark of shame or discredit.

Where does stigma come from?

Stigma comes from:
  •  Stereotypes 
  •  Ignorance
  • Misconception
  • Fear
  • Hollywood portrayal

"Stigma leads the public to avoid people with mental disorders. It reduces access to resources and leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking, and wanting to pay for care. Stigma results in outright discrimination and abuse. More tragically, it deprives people of their dignity and interferes with their full participation in society."  (U.S. Surgeon General Dr. David Satcher)

Stigma makes those of us with a mental illness ashamed and afraid to talk about our mental health.  The fact is NO ONE should ever be ashamed of an illness that they have.  No one is at fault for having a mental illness; unfortunately, society tends to make us feel at fault for our illness and therefore ashamed of it.

So what can be done to begin to change this cycle?

For starters… Education! Education! Education! Knowledge is key!

Other than that, take a look at SAMHSA’s list of Myth’s and Fact’s about Mental Illness for some knowledge and some ideas on how to begin to end the cycle of stigma:

Myth: There's no hope for people with mental illnesses.
Fact: There are more treatments, strategies, and community supports than ever before, and even more are on the horizon. People with mental illnesses lead active, productive lives.

Myth: I can't do anything for someone with mental health needs.
Fact: You can do a lot, starting with the way you act and how you speak. You can nurture an environment that builds on people's strengths and promotes good mental health. For example:
  • Avoid labeling people with words like "crazy," "wacko," "loony," or by their diagnosis. Instead of saying someone is a "schizophrenic" say "a person with schizophrenia."
  • Learn the facts about mental health and share them with others, especially if you hear something that is untrue.
  • Treat people with mental illnesses with respect and dignity, as you would anybody else.
  • Respect the rights of people with mental illnesses and don't discriminate against them when it comes to housing, employment, or education. Like other people with disabilities, people with mental health needs are protected under Federal and State laws.
Myth: People with mental illnesses are violent and unpredictable.
Fact: In reality, the vast majority of people who have mental health needs are no more violent than anyone else. You probably know someone with a mental illness and don't even realize it.

Myth: Mental illnesses cannot affect me.
Fact: Mental illnesses are surprisingly common; they affect almost every family in America. Mental illnesses do not discriminate-they can affect anyone. 

Myth: Mental illnesses are brought on by a weakness of character.
Fact: Mental illnesses are a product of the interaction of biological, psychological, and social factors. Research has shown genetic and biological factors are associated with schizophrenia, bipolar, depression, and alcoholism. Social influences, such as loss of a loved one or a job, can also contribute to the development of various disorders.

Myth: Once people develop mental illnesses, they will never recover.
Fact: Studies show that most people with mental illnesses get better, and many recover completely. Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life. For others, recovery implies the reduction or complete remission of symptoms. Science has shown that having hope plays an integral role in an individual's recovery.

I picked out the few ones that I related to the best, if you would like to see the entire list, you can visit SAMHSA’s site at:  Myths and Facts about Mental Illness

One of my favorites that SAMHSA mentioned and that I’d like to expand upon is referring to someone as being a mental illness.  I am not Bipolar, I am Sara.  However, I do have Bipolar.  Saying that I am Bipolar is defining me as my illness.  Many do this with no harm meant; however, know that it can be offensive.  I work very hard to remain as asymptomatic as possible; I don’t want to be defined as Bipolar.  I want to be defined by my hopes, dreams, aspirations and accomplishments.

“Follow the path of the unsafe, independent thinker. Expose your ideas to the dangers of controversy. Speak your mind and fear less the label of 'crackpot' than the stigma of conformity. And on issues that seem important to you, stand up and be counted at any cost. “ -Chauncey Depew

Thanks for reading! Until next time….

-Kissing Stigma Goodbye-

Sunday, March 11, 2012

Thursday, March 8, 2012

Catherine Zeta-Jones

“This is a disorder that affects millions of people and I am one of them. If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it. There is no need to suffer silently and there is no shame in seeking help.” -Catherine Zeta-Jones

Beautifully said- I couldn't agree more! 
Replace Bipolar II with Bipolar I and I could've said it!

Wednesday, March 7, 2012

Marilyn Monroe

This blonde bombshell beauty was said to have had Bipolar Disorder.

“I’m selfish, impatient and a little insecure. I make mistakes, I am out of control and at times hard to handle. But if you can’t handle me at my worst, then you sure as hell don’t deserve me at my best.”
- Marilyn Monroe

That is one of my all time favorite quotes- Maybe because I can relate...

What do all these famous people have in common?

They all have/had a diganois of one of the major mental illnesses!

Tuesday, March 6, 2012


Medicating Bipolar Disorder can be touchy and tricky and dangerous and everything else for number of reasons.

For starters, medicating Bipolar Disorder properly consists of the perfect blend of medications.  It is unlikely that someone with Bipolar Disorder will need only one medication for treatment.  A combination of mood stabilizers, anti-depressants and anti-psychotics are used to treat Bipolar Disorder.  

Examples of mood stabilizers include: Lithium, Depatkote, Tegretol, Trileptal, etc.
Examples of anti-psychotics include: Risperdal, Geodon, Seroquel, Abilify, etc.
Examples of anti-depressants include: Prozac, Paxil, Zoloft, etc.

The perfect blend of medications is different for each person with Bipolar Disorder.  This makes successfully medicating a patient with Bipolar Disorder a very tricky task for a doctor.  There is no real rhyme or reason (at least not that is known as of yet) for why one combination of meds works for one person and not for another.  If you talk to 50 different people with Bipolar Disorder it is very unlikely that any of them are taking the same mix of meds as another and even if they are taking the same medications, it is highly unlikely that they are taking the same dosages.  There is no simple blood test or any other testing out there to help determine what medications are necessary.  It truly is trial and error and can sometimes take trying quite a few combinations to find what works for that person.

Not everyone requires all 3 types of medications to gain and maintain stability, I myself do.
The medications used to treat Bipolar Disorder have the potential to cause dangerous side effects.  They each have a multitude of side effects that you need to watch out for if you’re prescribed them.  One should always be aware of the possible side effects of any medication they are taking.  When you’re taking multiple different medications it can be tricky to discern which medication is causing the unwanted side effects.  Medications such as lithium have the potential cause detrimental side effects long term.  It is important with Lithium and some of the others to keep up with your routine blood work to ensure that the medication is at a healthy level and not causing any damage.

Unfortunately with Bipolar Disorder, many people start to feel better from their medications and will go off them thinking that they don’t need them anymore.  Another reason people with Bipolar Disorder will go off their medication is because they have lost the creativity and the energy that they had with their mania.  This is extremely detrimental for many reasons.  Going off of your medication should never be considered an option.  The side effects may not be enjoyable, you may not have as much creativity or energy, etc., but going off of your medication is very dangerous.  It has been discovered that someone who completely stops taking the medication that they have been stable on is not likely to regain the same stability on those medications again when they begin taking them again.  Often times, they are never the same and cannot find that level of stability they once found comfort it.
Moral of the story…. If you have Bipolar Disorder (or any other mental illness)-you are feeling better because of the medications- you cannot stop taking them because you feel better.  


Even if you feel they are not working- don’t stop taking them- talk to the doctor so they can adjust them.  I can’t stress how detrimental going off of your medications can be!

There are medical reasons that may lead someone to need to get off their medications (i.e. abnormal liver functions), but this would of course be done in conjunction with a health care provider.

Alright… Off my soap box about medication and how important it is.  Just remember how important it is to keep up on the blood work associated with the medication as well to make sure you’re healthy.  That is equally as important as taking the medication every day.

“Medication can be like a pair of glasses. Bipolar disorder distorts your view of things; medication may allow you to see clearly again”. –WebMD-

Thanks for reading! Until next time…

-Kissing Stigma Goodbye-