On Mon, 11 Aug 2003 08:27:31 GMT, "Jeff McCann"
wrote:

refusing to take their meds, or go to outpatient clinics etc.

Basicly..,the Libs created the homeless situation in California, and
in doing so, are responsible for the deaths of hundreds of thousands
of mentally ill folks whom died and are still dying on the streets,
not to mention those that are killed, raped etc etc by the more
vicious members of the homeless nutcases.

Sounds like typical revisionist neo-con spin to me; blame everything on
the "Libs." Cites?

Jeff
Simply cannot accept that the Libs would do that to people? How many
did Stalin kill? Few Libs have ever heard about the Law of Unintended
Consequences, nor would they ever admit that their way is not the
Perfect way.....

http://www.psychlaws.org/GeneralResources/article45.htm
http://www.psychlaws.org/StateActivi...a/LPSoped3.htm
http://www.latimes.com/news/opinion/...1streets.story
http://sftimes.editthispage.com/stories/storyReader$82
http://www.namisonomacounty.org/reflect.htm

Lanterman, Petris, Short Act

The state mental hospitals of the fifties and sixties were
overcrowded. A tug of war existed between the federal government and
the local governments as to which was responsible for the funding of
care for those afflicted with mental illness. California had pioneered
a more progressive program for the care of the committed patients. But
a movement began to stem entry into state hospitals and encourage
community systems to accept more patients. In the climate of the
sixties there were even those who claimed that mental illness was not
a real biological reality but instead a socio-political attitude.
There were some who argued that mental illness was a myth perpetuated
by totalitarian governments.

A pivotal bill called the Lanterman, Petris, Short Act (LPS act) was
signed into law in 1967 by Ronald Reagan which abolished 1700 hospital
staff positions and closed many state operated care facilities. The
intention of the LPS act was for the most part well meaning. It's
intent was to eliminate inappropriate commitment of individuals to
hospitals. It was intended to affirm the civil rights and the right to
fair treatment to those with mental illness. However what should have
happened and did not was having the monies which use to be allocated
to state hospitals be reallocated to areas of community support for
patients entering the community. Instead what happened is a continuing
tragedy today. Patients were turned out in huge number with little
support system in place. Many individuals in this category soon found
themselves in trouble with the law and society. Today we have a
tremendous number of those suffering from mental illness in jails or
homeless.

"...deinstitutionalization has helped create the mental illness crisis
by discharging people from public psychiatric hospitals without
ensuring that they received the medication and rehabilitation services
necessary for them to live successfully in the community.
Deinstitutionalization further exacerbated the situation because, once
the public psychiatric beds had been closed, they were not available
for people who later became mentally ill, and this situation continues
up to the present. Consequently, approximately 2.2 million severely
mentally ill people do not receive any psychiatric treatment." (Out of
the Shadows, Confronting America's Mental Illness Crisis, E. Fuller
Torrey, M.D. , John Wiley & Sons, Inc., N.Y. 1997. pg 10)

"...the total number of homeless people in the United States appears
to have increased between 1980 and 1988 by approximately 300 percent,
whereas the total U.S. population increased by only 7.6 percent.
(402,000 homeless in 1988)"

"If the definition of 'mentally ill' includes alcohol and drug
addictions, then studies indicate that 75 percent or more of the
homeless are mentally ill. If, however only severe mental illness is
the criterion, as defined in 1993 by the National Advisory Mental
Health Council...then approximately 35 percent of the homeless persons
qualify." (Out of the Shadows, Confronting America's Mental Illness
Crisis, E. Fuller Torrey, M.D. , John Wiley & Sons, Inc., N.Y. 1997.
pg 10, pg 17)

"Over the last 30 years, the number of patients who once might have
been in State hospitals, but are now on the streets, or in our jails
and prisons, has risen significantly. In 1968, the year before LPS was
implemented, the year-end population in State hospitals was 35,739.
Today, state hospitals are primarily forensic and house fewer than
4,000 mentally ill patients. Between 20,000 and 30,000 people with
mental illness are in our jails and prisons. At least an equal number
are homeless on the street."(L.P.S., A New Vision for Mental Health
Treatment Laws, A Report by The LPS Reform Task Force, editors: Carla
Jacobs, Elizabeth M.D. , Beth Howard, published by The LPS Reform Task
Force, Long Beach, Calif, March 1999, pg 32-33)

So today we are in the situation in which we have replaced one
inadequate and in some cases inhumane system of care with another
inadequate and often inhumane system or lack of system of care. The
economic cost of this dysfunctional system, or lack of system is more
than a humane and proper system would be. It is not efficient and
inexpensive to deal with individuals with mental illness through the
justice system. It is not efficient and inexpensive to house these
individuals in jails. It is not humane for these individuals to be
living on the streets or in a whirlwind cycle from the streets to the
jails to the hospitals and so on. The result of this lack of system is
too many suicides, too much unnecessary suffering and too much
unnecessary expense and waste. NAMI and other organizations acting as
advocates are proposing a major overall of the LPS legislation.

One of the realities of severe mental illness is frequently an acute
lack of insight about the illness. Consequently advocates for those
suffering the effects of mental illness are, for the most part, seeing
a need for the provision of involuntary hospitalization in some cases.
It is argued effectively that it is inhumane to not have these
individuals hospitalized. Frequently the result of no hospitalization
is untimely death or unnecessary and severe suffering. These advocates
in no way want inhumane conditions in a hospital setting. They
advocate for no unnecessary restriction and respect for patients human
rights within and without the hospital setting. (passim, L.P.S., A New
Vision for Mental Health Treatment Laws, A Report by The LPS Reform
Task Force, editors: Carla Jacobs, Elizabeth M.D. , Beth Howard,
published by The LPS Reform Task Force, Long Beach, Calif, March 1999,
pg 22-44, pg 66-83)

"The passage of California's Lanterman-Petris-Short (LPS) Act in
1967...made rational treatment for the mentally ill increasingly
difficult." (Out of the Shadows, Confronting America's Mental Illness
Crisis, E. Fuller Torrey, M.D. , John Wiley & Sons, Inc., N.Y. 1997.
pg 10, pg 143)


Summary
The stigmatizing of the individual afflicted with mental illness has
always been a significant and major problem. Sadly it sometimes
presents more of a problem for the individual involved than the
illness itself presents. Also historically there has been societal
stigmatization of the family of the individual afflicted with
particular focus on blaming stigmatization of the mother of the
individual afflicted. Some progress has been made in alleviating this
problem through education resulting in a somewhat more enlightened
public. However, regrettably, stigmatization continues to be a major
problem.

The effect of stigmatization has had many ramifications. There has
been a tendency to blame bad parenting, laziness or reckless behavior
on the condition of mental illness. Legal consequences include the
lack of parity in insurance and a resulting inadequacy of hospital
care, the relegating of many afflicted individuals to a homeless
existence and the improper incarceration of many afflicted individuals
in our jails and prisons.

A lack of understanding of the symptoms of mental illness can result
in punitive treatment on the part of society, even on the part of
close family and even on the part of those we call caregivers. It
takes insight on the part of healthy normal individuals to realize
that the afflicted individuals resistance to treatment or dependency
abuse of illicit drugs, the seemingly lack of commitment to showing up
for appointments, the lack of cognitive thinking and the lack of
insight into their own illness is all symptomatic of the illness
itself. These type of dysfunctional behaviors are extremely
frustrating for all involved but there is a serious need to not resort
to punitive treatment. When punitive treatment escalates in our
prisons and even in our hospitals to the unethical use of physical
restraint resulting in actual deaths, the behavior on the part of
caregivers and justice personnel is actually criminal.

There are many legislative issues that need to be advocated and
addressed for those afflicted with mental illness. The closing of
mental hospitals in the 1980's has been a disaster which has
aggravated conditions and resulted in unacceptable conditions for the
vast majority of those afflicted. The body of this paper contains a
short discussion of the major concerns:

-Compulsory hospitalization/lack of insight/humane conditions
-freedom from restraint
-housing
-gainful activity
-juvenile justice
-LPS act


What to do for individuals can be complex especially because the
individual often suffers from a lack of insight into their own
illness. The objective however should be clear. Advocates want
fairness for those afflicted. Fairness should include compassionate
understanding from communities and equitable treatment by insurance
and medical infrastructure. We want to see fair and humane treatment
within hospital settings, within the justice system and in our
communities.

With regards to treatment there is basis for some optimism. Medical
science continues to make significant advances towards the
understanding of mental illness from the biological perspective. New
medications are available and more are being developed which can
provide significant improved help for many.

The emphasis in treatment weighs heavily towards only the biologic and
mechanistic approach. This is promoted in large part by the influence
of the pharmaceutical industry and the economic pressure of managed
care. In my view this approach needs to be balanced with more emphasis
on the whole person and the whole context in which we find the
individual. This should be done avoiding the pitfalls of blaming and
stigmatization. The emphasis of course should be in how to improve the
quality of life for the individual and the family and ultimately even
the whole community. Advocates such as E. Fuller Torrey have
contributed tremendously to our understanding and our compassion for
those afflicted. At the same time there is room for the holistic
approach as well and even alternative methods which are being explored
as a supplement to medications, not as a replacement for the much
needed medications. These are being explored on the growing edge of
psychiatry and will lead to better ways of treatment.

Gunner

"What do you call someone in possesion of all the facts? Paranoid.-William Burroughs