Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Decouple Gun Violence and Mental Health Conversations (Democratic Debate Edition)

Disability continues to be a largely ignored issue in the presidential primaries except for when it comes to gun violence, when the candidates get things entirely wrong. Here's 100% of what Sanders or Clinton (the only candidates that actually might get nominated) said about disability last night.
SANDERS: Let's begin, Anderson, by understanding that Bernie Sanders has a D-minus voting rating from the NRA. Let's also understand that back in 1988 when I first ran for the United States Congress, way back then, I told the gun owners of the state of Vermont and I told the people of the state of Vermont, a state which has virtually no gun control, that I supported a ban on assault weapons. And over the years, I have strongly avoided instant background checks, doing away with this terrible gun show loophole. And I think we've got to move aggressively at the federal level in dealing with the straw man purchasers.
Also I believe, and I've fought for, to understand that there are thousands of people in this country today who are suicidal, who are homicidal, but can't get the healthcare that they need, the mental healthcare, because they don't have insurance or they're too poor. I believe that everybody in this country who has a mental crisis has got to get mental health counseling immediately. 
COOPER: Do you want to shield gun companies from lawsuits?
SANDERS: Of course not. This was a large and complicated bill. There were provisions in it that I think made sense. For example, do I think that a gun shop in the state of Vermont that sells legally a gun to somebody, and that somebody goes out and does something crazy, that that gun shop owner should be held responsible? I don't.
On the other hand, where you have manufacturers and where you have gun shops knowingly giving guns to criminals or aiding and abetting that, of course we should take action.
Sanders needs to stop stigmatizing mental health. He's learned to speak much better about racial injustice (good job activists. And all my white liberal friends who were complaining that BLM activists were unfairly pressuring him, that's why. So he learns). But this stigmatizing of mental health crisis as causally linked to our gun violence, rather than easy access to firearms, when people with mental health issues are vastly  more likely to be victims, has to stop.

I'm delighted to have a candidate advocating for better mental health care - so long as it doesn't involve forced institutionalization or forced medication. But we have to decouple the conversation about mental health from the conversation about gun violence. 

Whatever Sanders' intention, his comments reinforce the notion that gun violence is due to mental illness. We've got to push back hard against that. And Sanders supporters, if they want my vote for their candidate, will need to lead the way. Teach your candidate.

#CultOfCompliance - Oregon Prisons and Mental Disabilities

Prisons are the asylums of our age. We just don't call them that. Then, when people with mental disabilities end up incarcerated, they are horrifically vulnerable to abuse from both prison employees and other prisoners. Moreover, prison staff even when not intentionally abusive, are not well-trained in responding to the needs of people with disabilities, so they use the tools with which they are familiar - enforced compliance, pain and isolation.

From Oregon Public Radio:

Prisoners with severe mental illness are routinely tasered, pepper-sprayed, isolated, and denied access to adequate mental health care - according to a new report by Disability Rights Oregon.
Disability Rights looked at the Behavioral Health Unit at the Oregon State Penitentiary.
That’s where prisoners with severe mental illness, who’ve committed violent crimes, are often placed.
Sarah Radcliffe, an attorney with Disability Rights, says they found prisoners being held in solitary confinement for 23 hours a day; and an imbalance of power between security and medical staff, which led to inadequate mental health care. “And we also found that prisoners in this unit are subjected to frequent unnecessary use of force, by staff, often in response to behaviors that are related to their mental illnesses,” she said.
The whole report from DRO is here in pdf.

We have to rebuild our whole mental system from the ground up with massive community-based supports, as part of the path of ending mass incarceration.

No Consensus on Mental Health and Policing

Yesterday, I wrote about the death of Anthony Hill, a man with bipolar disorder, who, while naked and unarmed, was killed by police in the Atlanta area. Here are three stories on how police should respond to these sorts of situations (I'm guessing there are 500+ related deaths a year nationally, but numbers are hard to locate).

New Jersey - Crisis Intervention Training Pays Off.
Police officers in 11 New Jersey counties have received crisis-intervention training to interact more effectively with people who have mental illnesses, and research shows that the program is changing cops' attitudes.
During the weeklong, 40-hour training, officers learn about symptoms, meet with people who have a mental illness, and study techniques to de-escalate difficult situations.
"Trainers educate the officer that a person's behavior is often out of their control," explained Mary Lynne Reynolds, executive director of the Mental Health Association in Southwestern New Jersey. "For example, if someone is in a state of mania, they cannot stand still. So if a police officer says, 'stand still,' the individual can't do that."
I like that last line a lot, as it directly works against the cult of compliance. But there are other models, instead of training each officer to handle these situations. In Baltimore, the idea is to create special mental health cops.
State Sen. Shirley Nathan-Pulliam (District 44) and Del. Charles Sydnor (District 44B) have sponsored legislation that would create separate mental health units for the Baltimore City police department and establish an evaluation system for the unit that already exists in Baltimore County.
The legislation would establish a pilot program requiring both police departments to have units made up of officers trained to understand the needs of those with mental illness.
Meanwhile, in Montreal - training seems of limited use.
Paulin Bureau, director of training at École nationale de police du Québec, detailed how many hours of training are dedicated to dealing with people who suffer from mental health issues and with the homeless.
He said the college offers continuing training to police forces across the province.
But Bureau stressed training isn't an easy fix for police dealing with people who have mental health issues.
Bureau told the inquest cadets might not have to put that training into use in the field for a few years, and by then it would be difficult to recall what they had learned about dealing with someone in crisis.

After 15 weeks of training at the provincial police college, officers don't come out as mental health specialists with the ability to diagnose someone in a short time period, Bureau said.
He said a police officer could get additional training for dealing with mental health issues one year and might not have to use that training for months or even years.
I'm more a fan of the Baltimore model (which is itself the San Antonio model), but even that I think has limited impact. There are medical issues related to mental health and cops need to know them and/or have instant and reliable access to experts. But that's secondary to changing attitudes and approaches to potentially violent encounters.

For me, I've been persuaded that the focus should be on strategic thinking generally, not mental-health specific training. Much more on this to come over the months ahead.

Lavall Hall - The Cult of Compliance Claims a New Victim

It started, as it so often does, with a family member calling 911 for help for a loved one in mental

health crisis. Lavall Hall was outside, in Miami Gardens, when police arrived. He had a broomstick.
Miami Gardens police officers Peter Ehrlich and Eddo Trimino fired their Tasers at Lavall Hall after he struck them with the metal end of a broomstick. The Tasers had no effect. Then they chased Hall for about half a block before he turned and charged at them. As Hall neared, Trimino fired his gun five times, striking Hall twice, once in the arm, and the kill shot to his chest. Hall was still alive and “struggling” when the officers handcuffed him and placed him faced down on the street. He died moments later.

Note - He was running away and the police chased. Then when he turned, they were too close to maintain space. As I wrote about for the death of Kristiana Coignard and Kajieme Powell, the minute we enter a situation where the police have decided that the suspect must obey commands or be shot, shooting is inevitable. Here's Hall's death as described by the chief [my emphasis]:
That version of Sunday morning’s violent encounter between Lavall Hall, 25, and the two Miami Gardens cops came from Miami Gardens Police Chief Stephen Johnson, as he addressed the media at police headquarters Tuesday night.
Tremino encountered the subject and gave him several commands. He continued to be combative,” said Johnson. “They did the best they could.”
They may well have done the best they could. But they didn't do enough. 
As Hall headed east on Northwest 191st Street, Tremino gave chase. “Mr. Hall at that time began to physically attack the officer,” Johnson said.
After hitting Tremino in the head with the broomstick, Johnson said Tremino fired his Taser. It had no effect. Hall headed south on Northwest Second Court, about half a block from his home. Tremino continued to chase. As Hall turned and charged toward the officer, Johnson said Tremino fired his weapon five times.

“He gave him several commands,” said Johnson.

Ehrlich was treated at the scene. Tremino went to the hosptial and received stitches. Both officers are on paid administrative leave. Johnson said both officers are veterans who have received crisis intervention training.
CIT is useful, but it's not a panacea. Maintain distance, call backup, be ready to gang tackle even if it means being hit with a broom handle.

These officers will be found innocent of any wrong doing (let alone criminal charges), but once it became a comply-or-die situation, that's a death sentence for people with psychiatric disabilities who cannot comply.

And so Lavall Hall is dead. Last week it was a man throwing rocks in Pasco. The week before, Coignard.

Who will die next week because police insist that people in mental health crisis be normal or be killed?


What do you do when someone tells you they are thinking about suicide?

When someone brings up thoughts of suicide to you, you have already done something right. 

This is a repost with permission. Amy McNally is a musician in Madison and a friend. Please share this. There is someone in your social circle who needs to read this. 

Originally posted by sweetmusic_27 at International Survivors of Suicide Loss Day 2014
November 22 is International Survivors of Suicide Loss Day.


Four years ago, my mother committed suicide. I still struggle coming to terms not only with her death, but with my family's wider history of suicide. My maternal grandfather and great-uncle died by suicide, my sister made an attempt, and I have struggled with depression and suicidal thoughts since puberty.

When I talk about these things, people shy away. It's a frightening subject, but if we want to help people who are suicidal, we need to understand what suicide really means, how it works, and how to respond to people contemplating it. Remember, talking about suicide does not cause someone to be suicidal. If you're worried about someone, it is safe to bring up the topic of suicide.

Suicide is the act of taking one's own life, and suicidality - the tendency toward or risk of suicide - is an illness like any other. Some people have this sickness temporarily, others fight it their whole lives. In my family, it's hereditary. All too often, it's fatal. It takes over your mind and body and you die from it. When that happens, as a society, we tend not to talk about it too much. It’s a very quiet killer, rendered quieter by stigma, taboo, awkwardness, and misconceptions.

Suicide is not selfish. Imagine that your thoughts and emotions make up a house. My mother's mental house faded around the edges. Room by room, the space available to her shrank until she was left a hallway, trapped in a narrow place. It's not that she was thinking of herself; it's that she couldn't think of anyone, anything.

It’s nobody’s fault when this medical condition takes hold. As many as one in six people become seriously suicidal at some point in their lives. While it is not directly caused by depression, anxiety, drug use, or other risk factors, about 90% of suicidal people have mental issues that involve or worsen seriously suicidal thoughts. These issues can be treated.

If someone brings up the topic of suicide with you, don't panic. Don’t lecture, and don’t make demands. Start by listening. Someone reaching out to you is a very good sign. First of all, it means they trust you. Second, if an individual is sharing these thoughts with you, there is something stopping or delaying them from completing suicide. It is safe to ask, "What's stopping you, and how can we focus on that?"

Here are some other “do’s” and “don’ts” for such a conversation. We all need to be ready to support our friends and family.

Do try to have the conversation in private. Don't promise to keep the contents of the conversation private, though. It's important that you be willing to get help if someone you know is in crisis.

Do try to say something, even if it's "wow, I'm sorry," or "well, crap." You don’t have to instantly become a perfect therapist. A friend of mine reached out to some of her friends, and they reacted with silence. "You could have heard a pin drop," she told me. "Nobody said a thing." It made her feel distanced, alone.

If the person you're talking to mentions a certain means of committing suicide, it's safe to bring up ways to remove or limit that means. "Do you want me to keep your gun for a while? Do you keep ammo in the house?" "When you say you're thinking about swallowing pills, are they pills you have? Can you get someone to dose out a week at a time instead of having the whole bottle around?" "You mentioned slitting your wrists. Is looking at knives or razors hard for you? I can come over and help you get those things out of the house for a while. Want to go shopping for an electric shaver together?" Bringing this up is not harmful and will not give anyone ideas. Don't press for action, just let them know there are options.

Later, check back in. Be ready for things not to suddenly be better. The mental issues surrounding suicidality don't go away quickly. If you can, try to communicate that it's okay to still be struggling.

There are many resources for those who are suicidal or talking to people who are considering suicide. America's Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (8255) and anyone in crisis can use their online chat to talk to a counselor. Similarly, IMAlive is an online chat-based Hopeline staffed by trained volunteers, and the Kristin Brooks Hope Center's Hopeline phone number is 1-800-442-HOPE (4673).

If you're suicidal, there are people who can help. If you are not, the odds are that somebody in your life will be or has been before, and you can still help by being willing to educate yourself and others, and being willing to say the word "suicide."

When someone brings up thoughts of suicide to you, you have already done something right. You’re the one they trust, you’re the one who feels safe. "Suicide" is a scary word, but talking about it doesn't kill you, and being ready to listen might help someone live.

Every time you share this post or other information on suicide, you help to fight the stigma, break the taboo, and dispel the myths. Feel free to link back to this. Feel free to comment here with other links and resources and stories. Feel free to talk to me about suicide.