Psych II

DJ Jaffe is an advocate for mo’ better outpatient community psych programs.
Psych programs are fertile ground for some junk science concepts for sure.

As an example of psych junk science consider R D Laing and Thomas Szasz, who said schizophrenia was just a different lifestyle and psyche was a tool of the oppressor class. Spend a little time with an untreated Paranoid Schizophrenic or a Manic Psychotic and you will see how silly Laing and Szasz were, even if they were right that psych sometimes imposes diagnoses in some areas that medicalize troubled people inappropriately. A lot of psych is too much medical and too many medications.
DJ Jaffe has a rational approach to inpatient care for the severely disabled and avoiding incarceration for the mentally ill.
Earlier pieces by Jaffe in National Review discuss elements of the problem of mental illness and the impact on society.
http://www.nationalreview.com/article/366222/how-should-we-help-seriously-mentally-ill-d-j-jaffe
http://www.nationalreview.com/corner/360439/treating-mental-illness-seriously-d-j-jaffe
Jaffe Caught my attention in the spring of last year. Everyone shares his concerns, particularly in the wake of notorious public shooting incidents committed by mentally ill or at least severely trouble persons. The litany of incidents is well knows because of the intense coverage. Columbine, Arizona, Sandy Hook/Newtown, Navy Yard. . .
My Interest is as an emergency physician. I have a colleague who has done comprehensive research on public shooting since he was the first physician at the Luby’s slaughter in Killeen many years ago. Tom Stein MD of Pittsburgh, Army Colonel in the Reserves, emergency physician, is an expert.
Here is the pasted copy of that first essay by Jaffe that caught my eye, with my notes, some of them critical. I still think he is right about important things. I have followed his commentaries since because I can’t avoid Psych and I do corrections medicine.
Treating the Mentally Ill
By D. J. Jaffe
April 11, 2013 4:00 A.M. National Review On line
Jaffe:
The Washington Post reports that the mental-health plan proposed by the Obama administration includes spending $130 million to “train teachers and other adults to help recognize early signs of mental illness,” $50 million to train mental-health specialists who work in schools, and $25 million “to address the trauma experienced by children” in schools “where violence is pervasive.” This plan is in reaction to Newtown, but it would do nothing to prevent another such tragedy from taking place. None of these proposals will help solve the problem of getting treatment to people with serious mental illness because identification has never been the problem. Providing treatment is.
In almost all incidences of violence involving people with serious mental illness, the families knew their loved ones were desperately ill, tried to get the mental-health system to help, but were turned away. As I previously wrote in NATIONAL REVIEW, Jared Loughner, who shot Gabrielle Giffords; James Holmes, who shot up a movie theater in Aurora, Colo.; John Hinckley Jr., who shot President Reagan; Aaron Bassler, who shot the former mayor of Fort Bragg, Calif.; Ted Kaczynski, the Unabomber, who mailed explosive packages around the country; Ian Stawicki, who shot five others and then himself in Seattle; Eduardo Sencion, who shot five National Guardsmen at a Nevada IHOP restaurant; Russell Weston, who shot two guards at the U.S. Capitol building; and Adam Lanza, who shot his mother, 26 others, and himself in Newtown, Conn. — all were known to be ill before they became headlines. The problem wasn’t lack of identification. It was lack of treatment.
Dunn note: It’s true—identifying the crazy is usually not the problem, however this writer is off base when it comes to how to identify the violence prone individuals or individuals who would become mass killers. In every instance he mentions above, the perp was discovered in his first major killing event, and was not a serial assassin. Serial killers are a different thing altogether, these public shooter things are often a one-time dramatic suicidal affair for a crazy or malignant character.
Court ordered cooperation with treatment is an option in the adjudication of a case. Name the ones above who would have been under court supervision for criminality before their explosive/killer acts. To re-emphasize, court ordered treatment when indicated can be achieved if the judge is inclined. It’s just that most judges are not inclined. For example our local Judge is more willing than most to consider alternative adjudications as a humane alternative for the seriously mentally ill. Judges elsewhere can too, but hesitate for various reasons. The problem is getting someone before a judge on a criminal charge. Many of the above cases of mass shootings were not preceded by that opportunity.
I would suggest here is where he gets off the facts in his advocacy, which is advocacy for obligatory court ordered mental health treatment that is provided for the mentally ill who are arrested for criminal acts. He’s wrong that his cause will fix the problem of these public shooter/killer cases. Forcing outpatient treatment for the mentally ill may have its benefits, but even in an ideal world, it would not fix the problem of these explosive events that are unique.
Moreover, he ignores another factor, that some of these violent individuals are personality disorders, not psychotics—and there is no proven effective treatment for personality disorders. He displays his blind spot by not recognizing that killing is not indicative of mental illness in all cases. Sometimes it is a behavior disorder not created by psychosis, and the behavior problem may not be treatable. May not even be predictable.
Ever since we allowed the nonsense of RD Laing and Thomas Szasz to become popular and gain a following, there have been too many who think that crazy is just a point of view, crazy was just a difference of opinion; and when deinstitutionalization became all the rage in the 60s and 70s, there has been a problem of the tension between civil rights of the crazy and crazy behavior that endangers the person or those around. As a variant on moral relativism this hands-off tolerance policy has never been good public policy, but many judges and attorneys have a very strict and unyielding rule on danger to self or others, and they discard disabled as a consideration for involuntary detention or treatment, so to be a danger to self has been sometimes unenforceable.
Jaffe again:
How did Obama get so sidetracked? The man who promised to listen to good ideas no matter where they come from is listening to bad ideas from where they usually come from: the Substance Abuse and Mental Health Services Administration. As NATIONAL REVIEW has reported, SAMHSA is almost exclusively focused on the worried well, not the seriously ill, and most of the policies it espouses are either irrelevant to or actually dangerous to those with serous mental illness. NATIONAL REVIEW has also reported on the five steps Obama can take to solve the real problem: getting treatment to the seriously mentally ill.
First and foremost, President Obama should fund a national demonstration project of Assisted Outpatient Treatment. AOT allows judges to order highly symptomatic and problematic individuals with serious mental illness to accept treatment as a condition of living in the community. Even more important, it allows judges to order the mental-health system to do what it won’t do voluntarily: accept the most seriously ill into their programs.
AOT is only for those who have a past history of needless arrests, incarcerations, and hospitalizations. In New York it reduced homelessness (74 percent), suicide attempts (55 percent), substance abuse (48 percent), hospitalization (77 percent), arrests (83 percent), physical harm to others (47 percent), destruction of property (46 percent), and incarceration (87 percent ) among those enrolled. Similar results occurred in California.
To get good advice, Obama should turn to the real experts: police and others in the criminal-justice system. Three times as many mentally ill people are incarcerated as hospitalized. The jails and prisons care for the seriously mentally ill whom the mental-health system won’t go near. While SAMHSA administrator Pamela Hyde fights against AOT, the Department of Justice certified it as an effective crime-prevention program; the National Sheriffs’ Association is asking every state to adopt it; and the New York State Association of Chiefs of Police made it a top priority. Obama should listen to them. Obama can also get good advice from Representative Tim Murphy of Pennsylvania. Yes, Murphy is a Republican, but as a psychologist who has worked in the mental-health system he knows what its tricks are.
Dunn note: This writer is dead wrong on the rate of mental illness when he says 3 times as many mentally ill are incarcerated as hospitalized—because he fails to recognize that the inclusion of mental problems for the incarcerated or the criminal element is derivative of the high rate of personality disorders and mood/substance abuse disorders that are a well established phenomenon in the criminal sector—these people are not criminals because they are mentally ill—they are usually just criminals with bad behavior and lifestyle/mood/substance problems that garner a mental health diagnosis—then the hanky wringing “advocacy” groups use the mental health diagnosis as an excuse for the criminality. Trust me—the seriously psychotic and mental illness cases stick out like a sore thumb for law enforcement and correction/judicial officials—and they get attention for their mental health problems—sometimes entirely too much attention. Mental health professionals over diagnose and over treat—a lot.
Jaffe:
I do believe President Obama wants to help. But like the mentally ill people he’s trying to help, Obama is hearing voices in his head. They are the voices of those who created the problem. And those voices are telling him dangerous things.
— D. J. Jaffe is executive director of Mental Illness Policy Org.
Dunn:
D J Jaffe is a mental treatment advocacy writer—was a mental illness blogger at Huffington Post, whatever that means. And the Mental Illness Policy Org. business is a sole proprietorship as far as I can tell. There is no information on his professional qualifications on the internet. He is big into Assisted Outpatient Treatment (AOT) as described above, which is not a bad idea, essentially a form of adjudication that includes forcing treatment for the mentally disturbed. He has been in favor of a number of State Laws to promote AOT. Good for him, but he’s offering a treatment that ain’t gonna cure shooter incidents. Too many shooters cruise along identified as troubled until they blow. At least that’s what this slug emergency physician thinks.