DJ Jaffe’s Quote for June 9th, 2021
No officer wants to pull his gun. It is a sign that something has gone terribly wrong. Professionals in law enforcement are advocating for improved care for the seriously ill, but the mental health “advocates” stand in their way. Too many mental health programs want to continue to receive their public funds but don’t want an obligation to use them for the seriously ill. They are fine with shifting responsibility for the most seriously ill to police and sheriffs. Too many advocates continue to spout platitudes like, ‘the mentally ill are no more violent than others,’ which disingenuously hides the reality that some of the most seriously ill, when allowed to go untreated, are more violent than others. Hence, the calls to the police.
DJ Jaffe’s Quote for June 2nd, 2021
As a result of advocacy by some in the mental health industry, almost all new investments in mental health go to the highest functioning individuals or irrelevant programs like ‘public education,’ not treatment programs for the seriously ill.
Until legislators force the mental health system to accept, rather than shun the most seriously ill, police training is at best a Band-Aid.
DJ Jaffe’s Quote for May 26th, 2021
Question: Why do people call the police to handle someone with mental illness?
Answer: Because calling the mental health system is almost always useless.
DJ Jaffe’s Quote for May 19th, 2021
From an interview with Pete Earley in 2018
- You have a reputation for being a policy geek. Your book contains numerous recommendations, but what do you think are the two biggest changes that need to be made on the federal level to improve the lives of individuals with mental illnesses?
Globally we have to focus existing mental health funds on those who need help the most, not the least. We have to send the most seriously ill to the head of the line, rather than jails shelters prisons and morgues. We have to prioritize, not marginalize the seriously ill. We need to support programs, like Clubhouses, that have proven track records of improving the most meaningful metrics which are rates of homelessness, arrest, incarceration, violence, suicide, and needless hospitalization of the seriously ill. Two specific policies on the federal level to help accomplish that are:
DJ Jaffe’s Quote for May 12th, 2021
From an interview with Pete Earley in 2018
- You played a key role in working with former Rep. Tim Murphy (R-Pa.) in getting the Helping Families In Mental Health Crisis legislation passed. Are you satisfied with that legislation and do you see any credible changes because of it?
I am happy with some of it, but not all of it. But that’s the nature of politics. Funding AOT pilot programs and allowing DOJ to fund them was huge, because once localities try it, they realize how much it helps the seriously ill. Murphy also required the collection of metrics on incarceration of the mentally ill. That will lead to efforts to reduce it. He tried to insert language to require peers to work within the purview of medical officials and to have a basic understanding of the role of treatment but the CMHS-funded peer community succeeded in getting those provisions removed. They also had the HIPAA provisions watered down so much as to be meaningless.
DJ Jaffe’s Quote for May 5th, 2021
From an interview with Pete Earley in 2018
- How can police not be a stakeholder?
Criminal Justice knows a lot about serious mental illness because the mental health system offloads so many seriously ill on them. They would be able to tell a CMHS stakeholder meeting how more hospital beds, easier to meet civil commitment criteria, greater use of AOT, group homes, long-acting injectables and other interventions could help stop the mental illness to jail pipeline. Without them there, the meeting would likely focus on things that have nothing to do with helping the seriously ill, such as educating the public and using person-first language, worthy endeavors, but largely irrelevant to solving the biggest problems.
DJ Jaffe’s Quote for April 26th, 2021
From an interview with Pete Earley in 2018
- Where are you focusing your advocacy right now?
I lost my wife of 27 years recently after a long illness so during that period I scaled back my work, and cancelled speeches, but I am back up and running full speed ahead. The biggest thing taking up my time is giving speeches designed to seed the theme developed in my book, Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. In it, I argue that we have to spend less improving mental wellness in the masses and more on delivering treatment that reduces homelessness, hospitalization, incarceration and needless hospitalization of the seriously ill. I continually provide information to the media and legislators and advocates on that.
I am using the release of Andrew Goldstein who pushed Kendra Webdale to her death to bring attention to the incredible success of Kendra’s Law so it gets more widely used. I am also looking to do more with Manhattan Institute. I lean very liberal and they lean conservative, but I have found that Dems have been taught by the mental health lobby that throwing more money at mental health is the same as delivering treatment to the seriously ill and they are not. Conservatives on the other hand, may be tighter with money for social services, but do understand that when it is spent it should go to solving the most important problems not the least important. I’m also working with attorneys on an emergency room initiative.
DJ Jaffe’s Quote for April 24th, 2021
From an interview with Pete Earley in 2018
- Your views are often considered provocative. How do you answer critics who see you as being a disruptive source in mental health rather than one who builds collaborations?
I disagree. (Grin).
Respectfully, having ideas that are provocative and disruptive is a good thing, not a bad thing.
But I understand what you mean. The first thing I tell most people is that I am not a “mental health” advocate at all. I am a “mental illness” advocate. I advocate for the most seriously ill. To put it in perspective 20% of adults have something in the DSM but only 4% have a serious mental illness, such as schizophrenia or bipolar, that has a major impact on their ability to function. The needs of the most seriously ill differ from the higher functioning and explains why what I say is different from what the mental health advocates are saying. That’s why they consider me as being provocative and disruptive.
Take the issue of violence.
After every mass tragedy, the mental health advocates fire off “mentally ill are no more violent than others” press-releases because the 20% of adults with a mental health condition that they represent are no more violent than others. But as an advocate for the 4% who are seriously ill, I highlight that the seriously mentally ill who go untreated are often more violent than others. I do that so we can take steps to reduce the violence. People in the mental health industry know the connection to violence I’m talking about is there, but they want it to be our little secret. They know psychiatric units are locked and heart units aren’t. They know nurses in psych units wear panic buttons and those in liver units don’t. They know we train police to deal with the mentally ill not those with psoriasis. And they know our outreach workers go out in pairs for their own safety. It may be provocative and disruptive to acknowledge the connection to violence but it’s also true and it’s necessary if we want to reduce the violence.
Globally, I don’t think it’s accurate to say I don’t collaborate.
For example, even though I am critical of Mental Health First Aid (MHFA), Linda Rosenberg of the National Council on Behavioral Health, demonstrating more class than I’ll ever have, invited me to give a no-holds-barred TedTalk to her group that’s become one of their most popular. And she presented me with another opportunity to participate in a violence reduction initiative. I’ve been invited by scores of local NAMI’s and behavioral health centers to share my ideas with them. I would love to work with more mental health groups. But it has to be on issues most important to the seriously ill, such as increasing hospitals and assisted outpatient treatment, removing HIPAA Handcuffs from parents, and enacting more humane civil commitment standards.
I haven’t found many interested in that.
Because the mental health groups are averse to working on those issues, most of my collaborations are with others outside the mental health industry. This includes police, corrections, and others in criminal justice. It includes think tanks and the public at large. They find my ideas make sense. For example, I’m very liberal but have been doing a lot of work with Manhattan Institute, a conservative think tank that has done some great work in this area. I just helped The Marshall Project, which focuses on incarceration put together their story that ran in New York Magazine about Kendra’s Law. I’ve spoken to judges at the National Mental Health Court Summit, and police at CIT Conferences. When mental health folks say I don’t join collaborations, I think what they are saying is that they don’t want to join the ones I’m in because they focus on sending the seriously ill to the head of the line. If any mental health group wants me to speak to them, they can reach me via our website.
DJ Jaffe’s Quote for April 17th, 2021
From an interview with Pete Earley in 2018
You have served on the NAMI and TAC boards. Why did you feel it necessary to start your own website and group?
The group I started, Mental Illness Policy Org focuses on the group NAMI National no longer does: the 4% who are the most seriously ill. Disaffected and disaffiliated NAMI are the core of Mental Illness Policy Org’s support.
Here’s the problem, to get more members NAMI felt it had to expand beyond families of the most seriously ill, which used to be their core constituency. Today, the NAMI national office, like MHA, CMHS, and others look at the existence of the seriously mentally ill as a public relations disaster. So they sweep them under the rug. For example, bringing attention to the fact that when the most seriously ill go untreated, they are more violent than others and how to reduce that violence, would make it harder for NAMI to convince the public of the platitude that the mentally ill are no more violent than others.
Bringing attention to the fact that some SMI needs hospitals and not everyone recovers is counter to their goal of convincing the public that everyone recovers and if we had more community services we wouldn’t need hospitals.
Focusing on the fact that the biggest barriers to care for the seriously are the lack of services, doctors, clubhouses, group homes, transportation options, etc., is counter to their goal of convincing the public that the biggest barrier to care is stigma.
Focusing on the fact that anosognosia, being unaware you are ill, is a real problem facing 40% of the seriously ill is counter to their goal of convincing the public that everyone should be empowered to self-direct their own care.
So the seriously ill are shunned, marginalized, and ostracized by NAMI, MHA, and others. They are not the poster children for the recovery they want to associate with. Now having said that some state organizations and the local affiliates still focus on the seriously ill and the Family to Family program offered by locals is excellent.
The Treatment Advocacy Center (TAC) is different. While I have no official connection, I am still hugely supportive and donate money to it as I encourage everyone to do. Much of my work relies on theirs. They are our voice in DC.
But so much needs to be done that TAC can’t do it all. If you have an advocacy initiative that doesn’t make TAC’s cut there’s nowhere else to go. They were the only game in town. That’s where Mental Illness Policy Org tries to help, not by ‘leading’ the effort but simply providing high-quality easy-to-access policy information and a place where advocates can organize with others locally or nationally. What Mental Illness Policy Org is trying to do is empower and help grassroots advocates to organize and inform themselves.
Our efforts tend to focus on five areas: civil commitment reforms that allow treatment before the tragedy, expanding assisted outpatient treatment, increasing the number of hospital beds, freeing parents of HIPAA handcuffs, and improving the consequences of ‘not guilty by reason of insanity findings.
But for example, in California, conservatorships and a housing ballot initiative recently became an issue. California advocates were able to do some of their organizing on pages we set up without the need for any help from TAC or Mental Illness Policy Org.
DJ Jaffe’s Quote for April 10th, 2021
From an interview with Pete Earley in 2018
- You have a reputation for being a policy geek. Your book contains numerous recommendations, but what do you think are the two biggest changes that need to be made on the federal level to improve the lives of individuals with mental illnesses?
Globally we have to focus existing mental health funds on those who need help the most, not the least. We have to send the most seriously ill to the head of the line, rather than jails shelters prisons and morgues. We have to prioritize, not marginalize the seriously ill. We need to support programs, like Clubhouses, that have proven track records of improving the most meaningful metrics which are rates of homelessness, arrest, incarceration, violence, suicide, and needless hospitalization of the seriously ill. Two specific policies on the federal level to help accomplish that are:
- Eliminate the IMD Exclusion. It prevents Medicaid from reimbursing states for seriously mentally ill adults who need long-term hospital care. It applies to no other population than the mentally ill. It’s a blatant form of government discrimination and created the hospital bed shortage. Rep. Eddie Bernice Johnson (D., TX) has been the leader on this and worked with Rep Tim Murphy to chip away at this in the Helping Families in Mental Health Crisis Act but the most important IMD ameliorating provisions were removed from the final bill
- Robustly Fund Assisted Outpatient Treatment (AOT). AOT allows judges to order a tiny group of the most seriously ill to comply with treatment if they have a history of multiple arrests, incarcerations or hospitalizations as a result of not complying. It reduces homelessness, arrest, incarceration in the 70% range, an extraordinary result given that it is only for the most seriously ill. It would be great if the Centers for Medicaid and Medicare Services (CMS) made the $2,000-$5,000 court costs of AOT Medicaid reimbursable. They are essentially case management services.And because you asked for two, I won’t mention housing, which I know you’ve been working on through the Corporation for Supportive Housing.
DJ Jaffe’s Quote for April 10th, 2021
From an interview with Pete Earley in 2018
- You played a key role in working with former Rep. Tim Murphy (R-Pa.) in getting the Helping Families In Mental Health Crisis legislation passed. Are you satisfied with that legislation and do you see any credible changes because of it?
I am happy with some of it, but not all of it. But that’s the nature of politics. Funding AOT pilot programs and allowing DOJ to fund them was huge, because once localities try it, they realize how much it helps the seriously ill. Murphy also required the collection of metrics on incarceration of the mentally ill. That will lead to efforts to reduce it. He tried to insert language to require peers to work within the purview of medical officials and to have a basic understanding of the role of treatment but the CMHS-funded peer community succeeded in getting those provisions removed. They also had the HIPAA provisions watered down so much as to be meaningless.
DJ Jaffe’s Quote for April 3rd, 2021
From an interview with Pete Earley in 2018
- You recently were able to scuttle a SAMHSA expert panel event by working behind the scenes. Why did you not want this panel to happen?
That’s not really a fair statement. First of all, I am a huge supporter of all Assistant Secretary of Mental Health, Dr. Elinore McCance-Katz has done to focus SAMHSA on helping the seriously mentally ill and center it around science rather than political correctness.
But the Center for Mental Health Services (CMHS) unit at SAMHSA still focuses on metrics like improving “mental wellness” in the masses and running useless pop-psychology webinars, rather than reducing homelessness, arrest, incarceration, and needless hospitalization of people with serious mental illness.
CMHS claims to want to change and invited me to a “stakeholder” meeting. But the CMHS organizer wouldn’t tell me who was attending or what the agenda was, so naturally, I turned down the invite. After further discussions, I discovered that no corrections officials, police chiefs, sheriffs, district attorneys, or judges were being invited. 400,000 seriously mentally ill are behind bars. How can corrections not be a stakeholder? NY Police alone went on 165,000 calls for emotionally disturbed persons last year. How can the police not be a stakeholder? Criminal Justice knows a lot about serious mental illness because the mental health system offloads so many seriously ill on them. They would be able to tell a CMHS stakeholder meeting how more hospital beds, easier to meet civil commitment criteria, greater use of AOT, group homes, long-acting injectables, and other interventions could help stop the mental illness to jail pipeline. Without them there, the meeting would likely focus on things that have nothing to do with helping the seriously ill, such as educating the public and using person-first language, worthy endeavors, but largely irrelevant to solving the biggest problems.
DJ Jaffe’s Quote for March 27th, 2021
From an interview with Pete Earley in 2018
- What got you interested in mental health, or as you would prefer, mental illness?
In the 1980s, my wife and I became guardians for my sister-in-law, and the day treatment program that she was attending wanted to kick her out because she refused to attend group therapy. I asked her why. She said everyone talked about suicide, which she found depressing and against her Catholic faith. It seemed to me that she had two really good reasons for not wanting to attend and because of that they were going to kick her out. That made me realize how messed up the mental health system is so I started volunteering with a local NAMI chapter, which at that time was focused on the seriously mentally ill (SMI).
DJ Jaffe’s Quote for March 20th, 2021
D.J. had non-stop advocacy to emphasize programs for the seriously mentally ill and its parent members rather than expanding its “tent” to include all mental illnesses and consumers.
DJ Jaffe’s Quote for March 14th, 2021
In an email, Ron Honberg, a retired legal policy expert at the National Alliance on Mental Illness, wrote: “D.J. was one of a kind, firm and resolute in his advocacy passion and not afraid to be the skunk at the garden party, in fact, he relished it. He will be missed.”
DJ Jaffe’s Quote for March 7th, 2021
Everyone Recovers. Some people do not. To improve care for adults with the most serious mental illnesses, we have to fund science, not mythology. The “Helping Families in Mental Health Crisis Act“ (HR3717) introduced by Rep. Tim Murphy along with 73 co-sponsors in both parties does that.
DJ Jaffe’s Quote for February 20th, 2021
We particularly like this DJ Jaffe’s quote: Clinical evidence has now indicated that allowing schizophrenia to progress to a psychotic break lowers the possible level of future recovery, and subsequent psychotic breaks lower that level further – in other words, the cost of withholding treatment is permanent damage. Meanwhile, bureaucratic road-blocks, such as time-consuming judicial hearings, are passed off under the cloak of “due process” – as if the illness were a crime with which one is being charged and hospitalization for treatment is punishment. Such cumbersome restraints ignore the existing adequate safeguards – the requirement for two independent assessments and a review panel to check against over-long stays.
Read more at: https://mentalillnesspolicy.org/media/bestmedia/uncivilliberties.html
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for February 14th, 2021
The anti-treatment advocates say: “If that’s how people want to live (babbling on a street corner, in rags), or if they wish to take their own lives, they should be allowed to exercise their free will. To interfere — with involuntary committal — is to deny them their civil liberties.” Whether or not anti-treatment advocates actually voice such opinions, they seem content to sacrifice a few lives here and there to uphold an abstract doctrine.
Read more at: https://mentalillnesspolicy.org/media/bestmedia/uncivilliberties.html
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for February 7th, 2021
Anti-treatment advocates insist that involuntary committal should be limited to cases of imminent physical danger — instances where a person is going to do bodily harm to himself or to somebody else. But the establishment of such “dangerousness” usually comes too late — a psychotic break or loss of control, leading to violence, happens suddenly. And all the while, the victim suffers the ravages of the illness itself, the degradation of life, the tragic loss of individual potential.
Read more at: https://mentalillnesspolicy.org/media/bestmedia/uncivilliberties.html
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for January 31st, 2021
Community services for the most severely ill have been badly shortchanged because the states and the federal government never developed a rational way of sharing costs for running them. Lack of overall planning and fragmented budgets led to attempts at cost-shifting that left the severely ill out in the cold.
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for January 24th, 2021
Untreated patients with severe illness are a terrific burden on themselves, their families, and the community. Their psychotic symptoms and inability to care for themselves attract police attention. And because treatment facilities are almost non-existent, cops have no alternative but to bring them to jail, where they are vulnerable to attack, subject to solitary, and likely to de-compensate further. Untreated patients with severe illness are a terrific burden on themselves, their families, and the community. Their psychotic symptoms and inability to care for themselves attract police attention. And because treatment facilities are almost non-existent, cops have no alternative but to bring them to jail, where they are vulnerable to attack, subject to solitary, and likely to de-compensate further.
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for January 17th, 2021
His Insane Consequences traces in intricate and fascinating detail how state governments de-institutionalized the severely ill by closing snake pit mental hospitals, only to re-institutionalize them again in completely inappropriate, even more degrading, and more expensive prison dungeons.
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for January 10th, 2021
His Insane Consequences traces in intricate and fascinating detail how state governments de-institutionalized the severely ill by closing snake pit mental hospitals, only to re-institutionalize them again in completely inappropriate, even more degrading, and more expensive prison dungeons.
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for January 3rd, 2021
The crucial mistake was to discharge severely ill patients without providing anything approaching adequate community treatment and housing. Instead, community investments went to serve less severely ill people who never would have been hospitalized. The same is true today: hospitals are being closed and the most seriously ill are neglected while people with mild problems are often over-treated with medicines, they don’t need that may make them worse.
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for December 27th, 2020
US patients are currently prisoners; twice that number have previously been in jail and stand a good chance of rotating back; and about 200,000 are homeless.
Prison conditions for the severely ill in the US are dangerous and disgusting beyond your imagination. And being homeless, always a severe challenge to human ingenuity poses a daily threat of violence to those who are made most vulnerable by mental illness.
Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for December 20th, 2020
If I suffered from a severe mental illness, Trieste would be my first-choice place to live. Patients in Trieste are regarded as valued citizens of the city who need and deserve adequate services. They are treated in attractive and accessible, club-like community settings; with easy access to both psychosocial and medical care; with respect for their dignity and autonomy; and usually have paid jobs working for a large gardening coop run by the mental health system. There are no homeless and the thought of imprisoning people with mental illness would be shocking.
The United States would be my last choice. We have criminalized mental health problems with a barbaric throwback to the dismal conditions before the Enlightenment. Among peer countries, we have become the very worst place to have a severe mental illness. As D. J. Jaffe has documented in his wonderful new book, Insane Consequences: How the Mental Health Industry Fails the Mentally Ill,
DJ Jaffe, Mental Illness Policy Organization
DJ Jaffe’s Quote for December 13th, 2020
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Spend smarter: Spend on mental “illness”, not mental “health.”
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Use Assisted Outpatient Treatment (court-ordered outpatient treatment) for those with a history of violence dangerousness or multiple rehospitalizations due to noncompliance.
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Reform involuntary commitment laws so they prevent violence, rather than require it.
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Reform Medicaid law to preserve psychiatric hospitals (eliminate the IMD Exclusion)
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Reform HIPAA so parents of mentally ill can help loved ones.
DJ Jaffe, Mental Illness Policy Organization
https://mentalillnesspolicy.org/#consequences-status-quo
DJ Jaffe’s Quote for December 7th, 2020
Excerpts from Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
People with severe mental illness die, on average, 20 years earlier in large part because they are denied treatment, neglected, and extruded from our society.
The abuse and neglect of the mentally ill is a shameful stain on our nation. How did we get here? And how can we emulate Italy and the Nordic countries that provide humane care at a lower cost?
DJ Jaffe’s Quote for December 1st, 2020
Excerpts from Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
We have criminalized mental health problems- as a barbaric throwback to the dismal conditions before the Enlightenment.
DJ Jaffe’s Quote for November 24th, 2020
Excerpts from White Paper on Thrive NYC
https://mentalillnesspolicy.org/wp-content/uploads/thrivenyc_white-paper.pdf
March 26, 2019
The needs of the seriously mentally ill are being ignored while dollars and attention flow to “mental illness lite” and social problems masquerading as mental illnesses. The ability to get care has become inversely related to need. The least seriously ill go to the head of the line and the seriously ill to jails shelters prisons and morgues. Riker’s is New York’s largest facility to treat the mentally ill. We don’t need a ‘new paradigm’ a ‘shift in culture.’ We need a return to the old culture where the primary responsibility of the mental health system was to treat the seriously mentally ill. New York has moved from a hospital-based system which by definition served the seriously ill to a community-based system that refuses to serve those so seriously ill they would otherwise need hospitalization. Under the First Lady’s leadership, community programs are now getting more of what they want: mental health dollars absent an obligation to serve the seriously ill. Former NYPD Police Commissioner Bill Bratton told a forum that to reduce the problems the police face, he needs easier civil commitment standards, city hospitals to take in those they bring in, keep them long enough to be stabilized, give them treatment and housing after release, and enroll in Kendra’s Law if warranted. That is still the best plan for the seriously mentally ill in NY. What the City Council can do. The City Council should cut the 54 initiatives down to a few that help the most seriously mentally ill and require the administration to focus on those. It should exercise its oversight and budget responsibilities and ensure mental health funds are being used where they are most effective. They should hold officials responsible for, and require them to report on rates of homelessness, arrest, incarceration, violence, EDP calls, and needless hospitalization of the seriously mentally ill. The council should ramp up funding for Kendra’s Law.
DJ Jaffe, Executive Director, Mental Illness Policy Org.
DJ Jaffe’s Quote for November 17th, 2020
DJ JAFFE ON HOW NATIONAL MENTAL HEALTH ORGANIZATIONS ABANDONED THE SERIOUSLY MENTALLY ILL AND WHY HE STARTED MENTAL HEALTH POLICY ORG
Excerpted from Pete Early, “Q & A With Controversial Mental Health Advocate D. J. Jaffe: A Self-Made Influential Player In Washington.” http://www.peteearley.com/2018/09/13/q-a-with-controversial-mental-health-advocate-d-j-jaffe-a-self-made-influential-player-in-washington/
Pete Early Question: You have served on the NAMI and TAC boards. Why did you feel it necessary to start your own website and group?
DJ Jaffe Response: The Group I started, Mental Health Policy Org, focuses on the group NAMI National no longer does: the 4% who are the most seriously ill. Disaffected and disaffiliated NAMI are the core of Mental Illness Policy Org’s support.
Here’s the problem, to get more members NAMI felt it had to expand beyond families of the most seriously ill, which used to be their core constituency. Today, the NAMI national office, like MHA, CMHS, and others look at the existence of the seriously mentally ill as a public relations disaster. So they sweep them under the rug. For example, bringing attention to the fact that when the most seriously ill go untreated, they are more violent than others and how to reduce that violence, would make it harder for NAMI to convince the public of the platitude that the mentally ill are no more violent than others.
Bringing attention to the fact that some SMI needs hospitals and not everyone recovers is counter to their goal of convincing the public that everyone recovers and if we had more community services we wouldn’t need hospitals.
Focusing on the fact that the biggest barriers to care for the seriously are the lack of services, doctors, clubhouses, group homes, transportation options, etc., is counter to their goal of convincing the public that the biggest barrier to care is stigma.
Focusing on the fact that anosognosia, being unaware you are ill, is a real problem facing 40% of the seriously ill is counter to their goal of convincing the public that everyone should be empowered to self-direct their own care.
So the seriously ill are shunned, marginalized, and ostracized by NAMI, MHA, and others. They are not the poster children for the recovery they want to associate with. Now having said that some state organizations and the local affiliates still focus on the seriously ill and the Family to Family program offered by locals is excellent.
DJ Jaffe’s Quote for November 8th, 2020
D.J. JAFFE ON WHY WE NEED TO PRIORITIZE MENTAL HEALTH SPENDING
Pete Early Question: You have a reputation for being a policy geek. Your book contains numerous recommendations, but what do you think are the two biggest changes that need to be made on the federal level to improve the lives of individuals with mental illnesses?
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DJ Jaffe Response: Globally we have to focus on existing mental health funds on those who need help the most, not the least. We have to send the most seriously ill to the head of the line, rather than jails shelters prisons, and morgues. We have to prioritize, not marginalize the seriously ill. We need to support programs, like Clubhouses, that have proven track records of improving the most meaningful metrics which are rates of homelessness, arrest, incarceration, violence, suicide, and needless hospitalization of the seriously ill. Two specific policies on the federal level to help accomplish that are:
-
Eliminate the IMD Exclusion. It prevents Medicaid from reimbursing states for seriously mentally ill adults who need long-term hospital care. It applies to no other population than the mentally ill. It’s a blatant form of government discrimination and created the hospital bed shortage. Rep. Eddie Bernice Johnson (D., TX) has been the leader on this and worked with Rep Tim Murphy to chip away at this in the Helping Families in Mental Health Crisis Act but the most important IMD ameliorating provisions were removed from the final bill
-
Robustly Fund Assisted Outpatient Treatment (AOT). AOT allows judges to order a tiny group of the most seriously ill to comply with treatment if they have a history of multiple arrests, incarcerations, or hospitalizations as a result of not complying. It reduces homelessness, arrest, incarceration in the 70% range, an extraordinary result given that it is only for the most seriously ill. It would be great if the Centers for Medicaid and Medicare Services (CMS) made the $2,000-$5,000 court costs of AOT Medicaid reimbursable. They are essentially case management services. And because you asked for two, I won’t mention housing, which I know you’ve been working on through the Corporation for Supportive Housing.
Excerpted from Pete Early, “Q & A With Controversial Mental Health Advocate D. J. Jaffe: A Self-Made Influential Player In Washington.” http://www.peteearley.com/2018/09/13/q-a-with-controversial-mental-health-advocate-d-j-jaffe-a-self-made-influential-player-in-washington/
DJ Jaffe’s Quote for November 2nd, 2020
PRIORITIZING THE NEEDS AND FUNDING FOR THE SERIOUSLY MENTALLY ILL
100% of the population can have their mental wellness improved, 20% have something in the Diagnostic and Statistical Manual (DSM) often mild illnesses like anxiety, mild depression, and ADHD. But 4% of adults have a serious mental illness meaning they have a functional impairment which substantially interferes with or limits one or more major life activities.
The untreated seriously mentally ill need help the most and are most likely to become homeless, arrested, incarcerated, victimized, violent, suicidal, or hospitalized without treatment. They need hospital beds, medications, case managers, supported housing, clubhouses, civil commitment, Kendra’s Law, and other treatments not needed by the higher functioning. This is the group ThriveNYC and DOHMH fail to prioritize
The needs of the seriously mentally ill are being ignored while dollars and attention flow to “mental illness lite” and social problems masquerading as mental illnesses. The ability to get care has become inversely related to need. The least seriously ill go to the head of the line and the seriously ill to jails shelters prisons and morgues. Riker’s is New York’s largest facility to treat the mentally ill. We don’t need a ‘new paradigm’ a ‘shift in culture.’ We need a return to the old culture where the primary responsibility of the mental health system was to treat the seriously mentally ill. New York has moved from a hospital-based system which by definition served the seriously ill to a community-based system which refuses to serve those so seriously ill they would otherwise need hospitalization. Under the First Lady’s leadership, community programs are now getting more of what they want: mental health dollars absent an obligation to serve the seriously ill.
Excerpts from White Paper on Thrive NYC
DJ Jaffe, Executive Director, Mental Illness Policy Org.
https://mentalillnesspolicy.org/wp-content/uploads/thrivenyc_white-paper.pdf
March 26, 2019
DJ Jaffe’s Quote for October 26th, 2020
VIOLENCE AND PEOPLE WITH MENTAL ILLNESS
Violence is almost always associated with going off treatment and becoming delusional or psychotic. There are many reasons people with serious mental illness go off treatment. Some reasons are not unique to mental illness while others are.
The ability to regulate behavior is compromised because the brain is the organ affected.
Anosognosia: Up to 50% of people with schizophrenia and many with bipolar lack insight: they are so sick they don’t know they are sick (anosognosia).
Costs/Side Effects: Some refuse treatment because of costs, side effects, lack of support, etc.
Civil Liberties: A misunderstanding of civil liberties, the nature of mental illness, combined with misinformation leads us to protect the right of the psychotic to ‘die with their rights on’ rather than mandating violence preventing treatments that can restore free will.
Reaction to hallucinations and delusions: When people with serious mental illness act out, they are often doing so as a logical reaction to their delusions, hallucinations, and paranoia. If you think someone is the Devil and trying to kill you, you will try to hurt them first.
Misplaced Funding: Most money spent goes to improving mental ‘health’ not treating mental “illness”. People with serious mental illness are usually sent to the end of the line, rather than the front. The ability to get services is inversely related to need, therefore people with serious mental illness find it difficult to get services. Mental health providers often discriminate against highly symptomatic people with serious mental illnesses
DJ Jaffe, Mental Illness Policy Organization
https://mentalillnesspolicy.org/#consequences-status-quo
DJ Jaffe’s Quote for October 17th, 2020
VIOLENCE AND PEOPLE WITH MENTAL ILLNESS
If you are talking about the 40-50% of Americans who may have a “diagnosable mental disorder” during their lifetime (18% annually), then ‘no’, the mentally ill are not more violent than others.
If you are talking about the 4% of Americans with the most serious mental illnesses that affect daily functioning–primarily schizophrenia and treatment-resistant bipolar disorder, then ‘no’, the mentally ill are not more violent than others.
If you are talking about the subset of the 4% group who go off treatment that has previously prevented them from being psychotic, hospitalized, or violent, then ‘yes’ the mentally ill are more violent than others. This higher than normal rate of violence increases, even more, when these groups abuse substances. When people ask, “Are the mentally ill more violent“, they are usually asking about this group, the most seriously mentally ill who are not in treatment.
DJ Jaffe, Mental Illness Policy Organization
https://mentalillnesspolicy.org/#consequences-status-quo
https://mentalillnesspolicy.org/consequences/violence-statistics.html
DJ Jaffe’s Quote for October 12th, 2020
VIOLENCE AND PEOPLE WITH MENTAL ILLNESS
Recent studies have established that being severely mentally ill and not taking medication is one of the major clinical predictors of violent behavior. Two other major clinical predictors of violent behavior are past history of violence and substance abuse (alcohol and/or drug) which are also disproportionately found in people with untreated serious mental illness. People with milder mental illnesses or serious mental illness that is treated are not more violent than others.
Severely mentally ill individuals who ARE taking their medication are NOT more dangerous than the general population.
DJ Jaffe, Mental Illness Policy Organization
https://mentalillnesspolicy.org/#consequences-status-quo
https://mentalillnesspolicy.org/consequences/violence-statistics.html
DJ Jaffe’s Quote for October 6th, 2020
VIOLENCE AND PEOPLE WITH MENTAL ILLNESS
After every mass tragedy, mental health advocates fire off “mentally ill are no more violent than others” press-releases because 20% of adults with a mental health condition that they represent are no more violent than others. But as an advocate for the 4% who are seriously ill, I highlight that the seriously mentally ill who go untreated are often more violent than others. I do that so we can take steps to reduce the violence. People in the mental health industry know the connection to violence I’m talking about is there, but they want it to be our little secret. They know psychiatric units are locked and cardiac units aren’t. They know nurses in psych units wear panic buttons and those in liver care units don’t. They know we train police to deal with the mentally ill not those with psoriasis. And they know our outreach workers go out in pairs for their own safety. It may be provocative and disruptive to acknowledge the connection to violence but it’s also true and it’s necessary if we want to reduce the violence.
DJ Jaffe, Mental Illness Policy Organization
https://mentalillnesspolicy.org/#consequences-status-quo
DJ Jaffe’s Quote for September 26th, 2020
Schizophrenia interferes with a person’s ability to think clearly, manage emotions, make decisions, and relate to others.
The Mindstorm March 19, 2013
https://www.manhattan-institute.org/html/restore-sanity-mental-health-spending
DJ Jaffe’s Quote for September 21st, 2020
Meanwhile, the seriously mentally ill are allowed to decompensate on the streets until they are ready for jail. Ten times as many mentally ill people are now incarcerated as hospitalized.
Washington Examiner March 25, 2019
Health PolicyMental Illness
https://www.manhattan-institute.org/html/restore-sanity-mental-health-spending
DJ Jaffe’s Quote for September 13th, 2020
The only kinds of fights worth fighting are those that you are going to lose. Because somebody has to fight them and lose and lose and lose until someday someone who believes as you do, wins.
DJ Jaffe’s Quote for September 7th, 2020
To improve care for people with serious mental illness money is not missing, leadership is. We have to stop listening to mental health advocates and start listening to mental illness advocates. We need to replace mission creep with mission control. As Police Chief Biasotti, testified to Congress,
We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. …(M)ental health officials seem unwilling to recognize or take responsibility for this second more symptomatic group.”
We have to stop ignoring the seriously ill.
DJ Jaffe
Mental Illness Advocate vs Mental Health Advocate
Excerpts from Speech to NAMI/NYS Convention
Exec. Dir. Mental Illness Policy Org.
November 15, 2013