Police Chief Testifies: Stop Pretending About Mental Illness, Violence and Voluntary Treatment

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MICHAEL C. BIASOTTI’S BRIEF TESTIMONY BEGINS AT 35:37 and ENDS AT 40:27

“We have to stop pretending that violence is not associated with untreated serious mental illness. We have to stop pretending that everyone is well enough to volunteer for treatment and self-direct their own care. Some clearly are not.’ –Michael C. Biasotti

Police Chief Testifies: Stop Pretending About Mental Illness, Violence and Voluntary Treatment
by Pete Earley

MICHAEL C. BIASOTTI’S BRIEF TESTIMONY BEGINS AT 35:37 and ENDS AT 40:27

“We have to stop pretending that violence is not associated with untreated serious mental illness. We have to stop pretending that everyone is well enough to volunteer for treatment and self-direct their own care. Some clearly are not.’ –Michael C. Biasotti

U.S. Representative Tim Murphy (R-Pa) continued his campaign last week to reform our nation’s failing mental health system by holding what his colleagues described as one of the best hearings in recent memory about serious mental illnesses.

Entitled: “Where Have All the Patients Gone? Examining the Psychiatric Bed Shortage,” the Commerce and Energy Subcommittee heard from a panel of ten experts who not only discussed current barriers to getting treatment but also provided the subcommittee with a primer on why jails and prisons have become our new mental asylums.

Today’s blog post focuses on testimony by Michael C. Biasotti, Chief of Police and Immediate Past President of the New York State Association of Chiefs of Police, and the parent of a daughter with a serious mental illness who has been involuntarily committed more than twenty times.

Biasotti warned that we currently are operating two mental health systems.

We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment.

Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. Officers in the survey were frustrated that mental health officials seemed unwilling to recognize or take responsibility for this second more symptomatic group. Ignoring them puts patients, the public and police at risk and costs more than keeping care within the mental health system.

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I wouldn’t necessarily equate refusing mental health treatment with being too sick to seek treatment voluntarily. Yes, it is true that having an impaired awareness of one’s illness is one reason why people with schizophrenia refuse treatment (usually medications), but that’s not the only reason. Sometimes the medications used to treat schizophrenia have unbearable side effects or simply make the symptoms of the illness worse. Most of the antipsychotics that I tried left the fatigue that comes along with my illness much worse. Granted, I wasn’t well before I began treatment, but I knew that. I hoped more than anything else when I went through my medication trials that the medications would adequately relieve at least some of my symptoms while still being tolerable side effect wise, but I’m afraid that the only medication of those that I’ve tried that fits this description is the Abilify that I take now. And even the medication that I take now mostly just suppresses my “positive” symptoms while doing little for the symptoms that seem to cause the most impairment. The rest of the antipsychotics that I’ve tried clearly worsened some of my worst symptoms and in my view did more harm than good – two medications that I tried even worsened my “positive” symptoms.

Comments such as the one that I quoted seem to me to be awfully dismissive of the experiences that people with schizophrenia go through with respect to medications. The argument seems to be that if we refuse treatment that it must be because we can’t think rationally enough to understand that the medications can only do good. As a patient with schizophrenia who’s tried a lot of the antipsychotics used to treat the illness, I vehemently disagree, and I think that if more people would actually listen to the reasons that people with schizophrenia give for not taking medications that they would find that there’s a lot more going on than just the patients being too sick to understand that they’re ill.

shadow

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I agree that not all non compliance can be put down to lack of insight. I am sure that if i had had the horrendous side effects some have had, coupled with the mediocre therapeutic benefits i have had, i would be more reluctant to take medication.
I do wonder through my own experience whether in reducing things like delusions and paranoia they also can worsen things like apathy and motivation.

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I think that I am also perhaps more apathetic on my medication (Abilify) than I was before I started taking it. Having said that, I do think that the good that my current medication does outweighs any harm that it might doing. Unfortunately, I can’t say that about the other antipsychotics that I’ve tried.

I’m glad to see that you agree that not all non compliance is due to lack of insight. And I’m not saying that refusing treatment due to lack of insight isn’t a problem. I think that it’s a big problem, but I think that protecting those who might be harmed by a mentally ill individual who is a danger to himself/herself or others needs to be balanced with protecting those with mental illnesses from the harm that can come from the use of forced medication.

shadow

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I think mental illness needs to be the next civil rights movement. We have to say what we need. WHAT do we need? It is serious, but how do we define what is needed so we can stop the violence, and any other negativity associated with this diease? Advocacy? There are a lot of groups out there who do this. However, Im not seeing any commercials or media attention. Where are the doctors, nurses, institutes, lobbyists? We just have leaks here and there. Sorry-Im off the subject…

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I think that one of the reasons why the messages being put forth by advocacy organizations aren’t as strong and visible as they might otherwise be is that the different mental health advocacy organizations have different messages and different agendas. On one extreme, there’s the Treatment Advocacy Center, which, if my understanding is correct, has an agenda favoring more involuntary commitment and forced medication laws. From what I’ve observed, those associated with the TAC are quick to point out that some with severe mental illnesses are too impaired to make their own treatment decisions and that society ought to step in and provide those with severe mental illnesses with treatment for their good and for the good of the community, even if it’s against the will of the individuals with severe mental illness. Then, on the other extreme, there are groups like the Icarus Project, which put forth the idea that mental illnesses aren’t illnesses at all, but are instead “dangerous gifts” in need of cultivation and differences that shouldn’t be deemed to be pathological. Finally, there are groups like NAMI (the National Alliance on Mental Illness), which seek to disseminate information that seems to be mainly consistent with the medical model of mental illness to the public and also to instill in those with mental illness a sense of hope about recovery from mental illness being possible.

Now of course, not all of those involved with advocacy efforts concerning mental illness fit neatly into one of the three groups that I identified. Individual opinions on what mental illnesses are and what should be done about them seem to be as unique as the individuals themselves, and to an extent, I think that that’s a good thing. Those of us with mental illnesses ourselves have different views on what advocates for issues surrounding mental illness should advocate for, and I think that the advocacy organizations do what they can to represent the views and interests of those with mental illnesses.

Personally, I think that one thing that could be a game changer would be better treatments for mental illnesses. That would be my answer to your question of “WHAT do we need?” The available treatments for mental illness only work so well and in many cases have some serious drawbacks. Although some individuals seem to be helped substantially by today’s mental health treatments, others seem to be helped to a much lesser degree, and if Robert Whitaker is to be believed, those in the latter group don’t seem to be just a small minority of patients, if they’re even a minority at all. I think that if we had better treatments for mental illnesses that there would be more agreement on how to advocate for those with mental illnesses and there would be less controversy over whether certain treatments should be used. Basically, those opposed to treatment would have to argue against the idea that treatment is highly effective in a vast majority of cases and comes with few if any drawbacks, and they wouldn’t be able to make the kinds of arguments that they make today (like Robert Whitaker’s argument that psychiatric medications are fueling an “epidemic” of mental illness).

How likely is it that better treatments for mental illness will be found? I don’t know. I think that if scientists can find some definitive common causes of mental illness that might even show up in multiple illnesses, then it should probably only be a matter of time before solutions to the causes can be found. However, if scientists find that the causes of mental illness are quite vast in their numbers (like, for example, there being more than 100 different factors that contribute to causing an illness like schizophrenia), then I think that coming up with solutions will of course be more difficult.

Well, I wrote more than I thought I would, but you asked some thought-provoking questions, Bridgecomet, and I thought that I’d share my views.

shadow

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Re meds here’s something i wrote elsewhere.

If people want to come off meds then fine but let’s stop the definitive blanket ‘meds are wonderful’ / ’ meds are evil’ extremes as for most people they are neither of these things. Most people get a degree of help with a degree of side effects throw in. Is that good enough after 60 odd years of antipsychotics being around? I would have to say ‘no’ but that is not the same as saying they’re evil/bad.
The biggest problem for people with schizophrenia is the cognitive/negative symptoms and not the more dramatic positive ones. In this respect antipsychotics don’t score that highly. Initial trumpeting of the atypicals was highly positive, but more recent research suggests they are not much better than the first generation drugs(with the exception of clozapine, a drug i would not like to be on).
For those that want to persist with medication there’s a great need for better meds. For those who want to try alternative routes there needs to be greater access available. No one route in terms of effect and preference is going to be better for all.

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Maybe slowly but I think it is changing. I have been seeing commercials here in Canada from the CAMH (Centre for Addiction and Mental Health) regarding mental illness. Recently I know there has been news about better training for first responders. One step at a time and we will get there.

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**No problem! It would be great if everyone could share their views publicly. I am always racking my brain trying to come up with something—more money, more and better housing, etc. My sister is trying to start a Clubhouse in California. I love this idea-but so much more is needed. Take a look: www.iccd.org…the one she is trying to get started: californiaclubhouse.org…
With a little help, I think if everyone banded together and made some noise-WE could help improve things. We want better health insurance, meds, housing, we want to manage our own lives, better programs, employment that works with our illness. In my opinion, people with mental illness have to live by the current system. Well, can`t we have our own system in place? What my sister is trying to do is a start. There just has to be more noise about it.

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Definitely more money for research…