Is There Help for Mentally Ill Who Can’t Fend for Themselves?

Photo by E. Wagele

Photo by E. Wagele

Black Lives Matter is a constructive movement that brings unfair and criminal attitudes and practices into the light so we can improve them. Restorative justice is catching on more and more so high school students have a way to work on behavior and other problems without being expelled from school. And there is a bill in Congress that expands treatment, called assisted outpatient treatment, or A.O.T., for those with a long history and pattern of proving a danger to themselves or others. Norman Ornstein wrote an article in the New York Times about his hope for this bill and how it might have helped his son, Matthew, who died at age 34 in January.

Matthew’s mental illness was particularly frustrating because it included anosognosia, the inability of a person to recognize that he or she is ill. Many of us have known people with this inability to discern their own affliction. Also, Ornstein writes, “Matthew became very religious after his break, and he was convinced that taking medication was dishonorable and would offend God.”

Since Matthew was over 18, neither family nor professionals had legal authority to get him treatment for his symptoms. Ornstein insists the true insanity is that our laws leave those who suffer to fend for themselves. “But Congress is now ready to grapple with the issue in a bipartisan bill introduced by Tim Murphy, a Republican from Pennsylvania and the only clinical psychologist in the House, and Eddie Bernice Johnson, a Democrat from Texas who is a psychiatric nurse.”

The bill improves the financing, treatment and delivery of services across the range of mental illnesses, and in particular it has provisions aimed directly at helping those like Matthew.

“Most critically, the Murphy-Johnson bill provides incentives to fund assisted outpatient treatment, only for those with a long history and pattern of proving a danger to themselves or others. The specifics of A.O.T. vary by state, but judges can order patients to undergo treatment while they live in the community instead of in prison or a hospital. It has been proven to reduce crime by or against those with illnesses, as well as suicide. In some states, the treatment is ordered through the intervention of medical professionals or law enforcement; families do have to be involved. In many states, families can petition the court directly based on the likelihood that their loved one has a grave disability or condition.

“But A.O.T. is not carte blanche: It still requires court action and has strict criteria to limit treatment to the most seriously ill. Five states… currently do not have such treatment; in those states that do, the options are often limited. The bill’s provision is a carrot, not a stick, to encourage states to create or expand A.O.T. by providing bonus money in block grants for those that do.

“The bill would also create a new position at the Department of Health and Human Services, an assistant secretary for mental health and substance abuse, and put the existing dysfunctional agency, known as the Substance Abuse and Mental Health Services Administration (Samhsa), under his or her supervision. Samhsa has used much of its budget to deal with less pernicious conditions like trauma and stress. It has also funded activist groups that oppose medication and mainstream psychiatric care for the seriously mentally ill.

Ornstein concludes, “The bill tries carefully to avoid coercive means and leaves protection to the courts to prevent or minimize abuses. Action by Congress would help keep other parents and siblings from suffering as we have.”

• Wagele’s 8 books, with their original humorous cartoons, make good gifts. “Finding the Birthday Cake” introduces young children to the Enneagram. “The Happy Introvert” is for all ages. See also






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