Monday, February 1, 2010

NAMI's political philosophy has resulted in a great increase in the stigma attached to mental illness

One of the laudable goals of NAMI (the National Alliance on Mental Illness) is to reduce the stigma associated with mental disease. The idea is to make Americans aware of the fact that psychiatric problems are not the patient's fault. They are not the product of bad parenting or moral weakness. They are biological illnesses, like cancer or the flu. They are not contagious and they can be treated effectively with a combination of pharmaceuticals and psychotherapy.

The hope is that by reducing stigma patients with mental issues will then seek out treatment, get well and be fully accepted as regular contributing members of society.

Ironically, however, NAMI's political philosophy has resulted in a great increase in the stigma attached to mental illness.


NAMI opposes involuntary treatment for the seriously mentally ill. NAMI's ideology is that the mentally ill are the same as everyone else and as such, they should not be forced into treatment. If we have to force some patients to take anti-psychotic medications, that would suggest that those folks really are not the same as you and me.

But allowing all patients to decide for themselves if they want to take anti-psychotic drugs means that many won't -- particularly those who, due to their disease, cannot understand that they are really sick -- and therefore we will necessarily have thousands of very sick mental patients all over the country not receiving treatment. Those untreated patients will act in a bizarre fashion and sometimes commit horrific crimes. And nothing does more to increase the stigma of mental illness than when a person with serious psychiatric problems becomes a danger to society.

More people today associate mental illness with violent crimes than they ever did in the past. And the greatest source of stigmatization of mental illness is its association with violence, according to the Surgeon General.

If you were trying to create a stigmatizing scenario about someone with serious mental illness on the loose, you could do a lot worse than portray Kain Figuereo. Everything about him right now screams "be afraid; he is dangerous."

Mr. Figuereo is a large man with paranoid schizophrenia. He is not being treated for his illness. He is confused and extremely paranoid. He has a background in the military, which probably means he knows how to use weapons. And authorities don't know where he is.

If Kain Figuereo commits a violent crime, stigma for the mentally ill will increase.

Here is the latest news from the Standard Speaker in Hazleton, Pennsylvania:
State police at Hazleton are looking for a missing man with a history of mental illness.

Police said Kain Figuereo, 50, was last seen at Ramada Inn, state Route 309, Hazle Township, on Jan. 15.

He was diagnosed with paranoid schizophrenia and hasn't been taking his medication, which may make him confused and extremely paranoid. He is an Army veteran and has been committed several times in the past for mental evaluations.


Leslie said...

I'm writing in complete exasperation. Wherever did you get the notion that NAMI, the National Alliance on Mental Illness opposes involuntary treatment? Here is NAMI's position on Involuntary Treatment. Please do some research before you make off-the-cuff remarks. All you needed to do is google "NAMI Involuntary Treatment" to find the following:

Involuntary Commitment/Court-ordered Treatment

NAMI's Position on Involuntary Treatment 

(9.2.1) NAMI believes that all people should have the right to make their own decisions about medical treatment. However, NAMI is aware that there are individuals with serious mental illnesses such as schizophrenia and bipolar disorder who, at times, due to their illness, lack insight or good judgment about their need for medical treatment. NAMI is also aware that, in many states, laws and policies governing involuntary commitment and/or court-ordered treatment are inadequate.

(9.2.2) NAMI, therefore, believes that:

(9.2.3) The availability of effective, comprehensive, community-based systems of care for persons suffering from serious mental illnesses will diminish the need for involuntary commitment and/or court-ordered treatment.

(9.2.4) Methods for facilitating communications about treatment preferences among individuals with serious mental illnesses, family members, and treatment providers should be adopted and promoted in all states.

(9.2.5) Involuntary commitment and court-ordered treatment decisions must be made expeditiously and simultaneously in a single hearing so that individuals can receive treatment in a timely manner. The role of courts should be limited to review to ensure that procedures used in making these determinations comply with individual rights and due-process requirements. The role of the court does not include making medical decisions.

(9.2.6) Involuntary inpatient and outpatient commitment and court-ordered treatment should be used as a last resort and only when it is believed to be in the best interests of the individual.

(9.2.7) States should adopt broader, more flexible standards that would provide for involuntary commitment and/or court ordered treatment when an individual, due to mental illness

( is gravely disabled, which means that the person is substantially unable, to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety; or

( is likely to substantially deteriorate if not provided with timely treatment; or

( lacks capacity, which means that, as a result of the serious mental illness, the person is unable to fully understand–or lacks judgment to make an informed decision about–his or her need for treatment, care, or supervision.

(9.2.8) Current interpretations of laws that require proof of dangerousness often produce unsatisfactory outcomes because individuals are allowed to deteriorate needlessly before involuntary commitment and/or court-ordered treatment can be instituted. When the "dangerousness standard" is used, it must be interpreted more broadly than "imminently" and/or "provably" dangerous.


Leslie said...

NAMI's Position cont

(9.2.9)State laws should also allow for consideration of past history in making determinations about involuntary commitment and/or court-ordered treatment because past history is often a reliable way to anticipate the future course of illness.

(9.2.10) An independent administrative and/or judicial review must be guaranteed in all involuntary commitment and/or court-ordered treatment determinations. Individuals must be afforded access to appropriate representation knowledgeable about serious mental illnesses and provided opportunities to submit evidence in opposition to involuntary commitment and/or court-ordered treatment.

(9.2.11)Responsibility for determining court-ordered treatment should always be vested with medical professionals who–in conjunction with the individual, family, and other interested parties–must develop a plan for treatment.

(9.2.12) The legal standard for states to meet to justify emergency commitments for an initial 24 to 72 hours should be "information and belief." For involuntary commitments beyond the initial period, the standard should be "clear and convincing evidence." Involuntary commitments and/or court-ordered treatment must be periodically subject to administrative or judicial review to ascertain whether circumstances justify the continuation of these orders.

(9.2.13) Court-ordered outpatient treatment should be considered as a less restrictive, more beneficial, and less costly treatment alternative to involuntary inpatient treatment.

(9.2.14) Efforts must be undertaken to better educate justice systems and law enforcement professionals about the relationship between serious mental illnesses and the application of involuntary inpatient and outpatient commitment and court-ordered treatment.

(9.2.15) Private and public health insurance and managed care plans must cover the costs of involuntary inpatient and outpatient commitment and/or court-ordered treatment.

What is most frustrating is that you, I & NAMI most likely are on the same page or close to it regarding involuntary treatment but your rash words and inaccurate claims generate anger & confrontation. A true Lexicon Artist would not be writing in this manner.

These are complex issues. Personal rights & choice are at the heart of our society. We can't go around locking people up because we think they're crazy.

In my own jaded opinion, the real issue is money. There are no funds to provide adequate treatment. Patient's rights are often used as an excuse to delay or deny involuntary hospitalization until jail or prison becomes the treatment society provides. Witness our vastly overcrowded jail and prison system here in California.

NAMI is not the enemy . We are out there advocating for adequate and timely treatment for people with mental illness, for insurance parity, for better legislation. We are out trying to educate and help family members deal with mental illness; to help people with mental illness learn about their condition and take better control of it. There's so much more that NAMI does. What it doesn't do is oppose involuntary treatment!

You should also know the majority of NAMI are family members who have someone they love who has a mental illness.

If NAMI had its way, Kain Figuereo would have been in community treatment or part of an A.C.T. team (look it up) where his situation would have been monitored and he could have been hospitalized if necessary.

Your words are powerful-you have a platform and are a good writer. You have a responsibility to your readers to get the facts straight. This is such an important issue for so many people on so many levels. My hope is that you continue to educate yourself about mental illness and involuntary treatment and become an advocate of change, viable change that will help society better treat people living with mental illness so that everyone benefits.

Leslie said...

p.s. I hope you know about Laura's Law, passed in 2002 and authored by
Helen Thomson who was Yolo County's Assemblywoman at the time.

See: Laura's Law

The law was never implemented in California because no funding was provided for implementaion.

Also, I see you're reading or have read E. Fuller Torrey so I assume you fully understand how some people with mental illness are unaware of their illness, a condition called "Anosognosia " and know about the Treatment Advocacy Center