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?

  1. 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:

  2. 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

  3. 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/

 

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

 

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

 

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 

 

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 

 

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

 

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

 

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

 

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.

 

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

https://www.psychologytoday.com/us/blog/braintalk/201412/mental-illness-advocate-vs-mental-health-advocate

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