The Keys to Preventing Relapse, Rehospitalization, and Reincarceration

Last Friday morning a small group of NAMI-Montana members had an opportunity to participate in the NAMI Adult Issues Conference Call with NAMI's Medical Director, Dr. Ken Duckworth. The guest was Dr. Peter Buckley, Dean of Georgia Health Sciences University and one of this country's leading researchers on schizophrenia

Dr. Buckley shared the most important aspect of treating schizophrenia, and where the current emphasis is placed, is on the early detection and treatment of the illness. On average it takes one year after the onset of the illness to initiate treatment. We know that schizophrenia is not preventable. But, with early detected and intervention, cognitive deficits can be prevented and long term disability can be minimized. The goal is secondary prevention to prevent relapse and promote recovery.

Many think that schizophrenia is the most debilitating of the serious mental illnesses. Our treatment dollars are spent on crisis management and hospitalization. If we could save treatment dollars for recovery services instead of crisis services it would be a better world.

I asked Dr. Buckley what he thought would be the best policies to prevent relapse, rehospitalization and reincarceration. Without hesitating he said, "PSYCHIATRIC ADVANCED DIRECTIVES and ASSISTED OUTPATIENT TREATMENT (AOT). The wonderful thing is that these two policies have already been legislated in Montana.

PSYCHIATRIC ADVANCED DIRECTIVES: Legislation just passed the 2011 Montana Legislature which would promote Psychiatric Advanced Directives. This legislation was developed by those people who live with serious mental illnesses to be a part of their treatment for their illnesses. Nobody knows better what medications and therapies work best for the treatment of their individual mental illnesses than the people receiving treatment. For too long their input and wishes have been ignored. Now, the real test will come. Can Psychiatric Advanced Directive be implemented in such a way that they are useful, helpful and meet the needs of those individuals who so desparately wish to participate effectively in their treatment?

ASSISTED OUTPATIENT TREATMENT: Assisted Outpatient Treatment, or Community Commitment has been a part of Montana law since at least 1999. The problem is that mental health professionals and county attorneys rarely use it. For fear of laws suites from civil rights lawyers this effective treatment is underused. Studies in New York and North Carolina, which have AOT, have shown that it reduces relapse and recidivism at state hospitals, jails and prisons. This is the treatment families desperately need when their loved one suffer from anosognosia, are not compliant with their treatment and become "frequent flyers" in the revolving doors on the mental illness treatment system.

So, if one of our country's leading researchers feel that PSYCHIATRIC ADVANCED DIRECTIVES and ASSISTED OUTPATIENT TREATMENT of the most effective programs to reduce relapse,recidivism and disability, why can't they be implemented in Montana to improve our mental illness treatment system?

Individuals living with serious mental illnesses want effective Psychiatric Advanced Directives.

Families of individuals who deny their illnesses need Assisted Outpatient Treatment for non-compliant family members.

Who is going to be our champion!


Dr. Gary Mihelish, President
NAMI-Helena

Thoughts on Mothers Day

Since 1997 Sandra and I have taught the NAMI Family-to-Family Education Program to over 500 Montanans. During those classes I have come to the conclusion that having a serious mental illness in the family is an extreme burden to families, especially mother's. "In mental illness, our grown children regress to an earlier, desperately frightening stage of need. Mothers hastily adopt the old mode of mothering; all the care taking alarms go off when their child fails to thrive. This is why mothers have a hard time pulling out of the care-taking role. Because they have to keep themselves together and protect, they cannot risk letting down into grief: and to mothers, letting go of grief often fells like they are abandoning their own flesh and blood."

Several days ago I received a message from a Montana NAMI Mommy. We all may realize how difficult and traumatic it must be to live with a serious mental illness. The effects of serious mental illness are devastating and traumatic to the individual living with a mental illness. The stigma, discrimination and the isolation of being treated as a second class citizen is life altering. Many "normals" do not understand this same stigma and discrimination extends to the families of the mentally ill.

I've attached this NAMI Mommy's message to heighten that understanding:

Sandy, I have been thinking of you & Gary earlier tonight...our daughter stopped over and though she is feeling somewhat better on her new meds , after being recently hospitalized for about a week. and is now SLEEPING at night.

She struggles with portioning her day, & sometimes is looking groggy. I'm glad she doesn't drink, because it looks like it! Earlier this evening, she went for a coke with a girl friend, & sometimes it's REALLY hard not to compare her life, with her friend's, who is successful, makes $80K or more a year at her regular job. Lost 80# so far, is training for a marathon, & says life is so good.

I know my daughter and her husband have a very thin financial thread. To try to make ends meet until the end of the month, especially since both of them are on SSI. She's having a heck of a time losing any weight at all, & it's all she can do to stay ALIVE. And stay WELL, & be somewhat optimistic...I guess regular people have no idea what persons with "mental problems" endure, unless they have had it in their own family. WE family members also suffer right along with our "person."

I'm reading "Stop Walking On Eggshells" now, book and workbook which has been recommended to me. What a MAJOR task for me to try to Mind my Own business, and not obsess over her. Or even buy them all their groceries, and CLOTHES. It's hard to find clothes to FIT her now as she's 5X...

Anyway, thanks again to you & Gary for ALL YOUR NAMI WORK, and that I was blessed to be in your classes. Little did I know that I'd have to learn and RE-learn those lessons, that would be coming up, & re-occurring again and again...

So, on Mother's Day, to all of you NAMI Mommies: Never give up and NEVER, NEVER, EVER give up HOPE!

HAPPY MOTHER'S DAY!!!! YOU ARE ALL THE BEST!!!!!!!!!!!

Gary Mihelish