The Crisis of Jail Inmates with Mental Illness

Following the informed debate generated by my post about deinstitutionalization of mentally ill patients, I am passing along this short, powerful PBS segment. Some people with mental illness who used to be in state hospitals are now in independent or semi-independent housing, but others are in the worst place imaginable for them: Behind bars. This segment’s account of a psychotic inmate who is released without support onto the street and immediately harms himself and threatens public safety is as powerful as it is sadly familiar.

Watch Prisons and the Mentally Ill on PBS. See more from Religion & Ethics NewsWeekly.

And here’s a save the date for you if you live in the San Francisco Bay Area: We plan to debate these issues further at the Stanford Health Policy Forum on October 10 from 11:30-1:00pm on Stanford campus. Our guests will be L.A. County Sheriff Lee Baca, Stanford Psychiatry Department Chairman Laura Roberts and University of Chicago Professor Harold Pollack, whose piece in the Washington Post was the kicking off point for my original post. Forum events are free and open to the public; room information will be available closer to the date on the Stanford Health Policy Forum website.

Prof. Thomas S. Szasz, M.D. (1920-2012)

Tom Szasz died on September 8, 2012. I met him in the early 1990s, when he was in Cambridge to participate in a symposium on drug policy. Keep in mind, please, that what I know about public policy, psychiatry and the War on Drugs could fit into a teaspoon. Mark asked me to help him host a post-forum dinner for the panelists solely because of his faith in my social skills. Two of the men at the party were known to square off against each other based on a difference of ideology, and Mark wished to avoid unpleasantness. I was touched by his groundless belief that good manners could prevent a food fight, and I resolved to do my best.

As things turned out, there was no need for oil on troubled waters. The dinner guests kept it civil, and I got to meet Tom, who was seated across from me. I don’t want to sound melodramatic, but it was a life-changing experience for me. Continue reading “Prof. Thomas S. Szasz, M.D. (1920-2012)”

Reporting on suicide, responsibly

NFL Hall of Famer Junior Seau committed suicide the other day. His death may be related to the concussion issue. It may not be. Whatever happened, media coverage of such celebrity tragedies really matters. Sensationalist or ill-informed coverage spreads myths. It can also foster dangerous behavioral contagion. Good coverage can increase public understanding of a complex issue. It can also point people in mental pain or at suicide risk towards sources of help.

A useful set of media guidelines is available here. The below snapshot of coverage “do’s and don’ts” is especially useful. This is important.

“God knows where I am” Rachel Aviv on insight and mental illness

If you haven’t read Rachel Aviv’s latest article about mental illness in the New Yorker, you should.

Given the work I do, and the fact that I teach hundreds of young adults entering the helping professions, I encounter many women and men facing mental health concerns. Most of these women and men have difficult or painful experiences, but are able to surmount these obstacles to lead successful and productive lives. Most mental health concerns come to light because the people experiencing painful symptoms and consequences of depression, anxiety, or bipolar disorder actively seek help. In many cases, the hardest people to help are those who do not believe that they have a mental health disorder at all. Almost half of the people diagnosed with a psychotic illness do not believe that they have these disorders. This lack of insight into their own conditions obviously poses huge obstacles to
effective care.

Rachel Aviv’s New Yorker story, “God knows where I am,” is a perceptive and humane account of Linda Bishop, an appealing and intelligent woman who was never able to recognize the basic fact of her severe mental illness. In her comments to others and in her private writing, Bishop combined striking lucidity with an adamant inability “to modify her self-image to acomodate the fact of her illness,” even as she found herself living in a vacant farmhouse subsisting on backyard apples while “awaiting further instructions” from God. Those instructions never came, with catastrophic results.

If you haven’t seen this piece, you definitely should. I don’t agree with everything Aviv has to say about deinistitutionalization and other matters. But it is an amazing, heartbreaking read. If I could only write like that, too.