NAMI Montana

Two Posts from NIMH's Blog

2012-01-25T13:32:00.000-08:00

I wanted to point out these two great blog posts from Dr. Insel on research advances and the direction of research. I hope you like them.

matt

Treatment Development: Where Do We Go From Here
by Dr. Thomas Insel

NIMH's Top 10 Research Advances of 2011
by Dr. Thomas Insel

The Wrong Diagnosis

2011-07-01T09:16:00.000-07:00

I applaud the New York Review of Books for publishing Dr. Marcia Angell’s articles on “The Illusions of Psychiatry.” Three years ago, I responded to my step-brother’s suicide by giving up my practice as a corporate attorney to become the Executive Director of the National Alliance on Mental Illness for Montana (NAMI Montana). Shortly after that, another one of my loved ones was struck by serious mental illness. I have been personally and professionally immersed in the stark realities of serious mental illnesses and the haphazard treatment system that has evolved to treat those conditions.

While I disagree with many of Dr. Angell’s conclusions, I could not agree more that the method of diagnosing mental illnesses needs serious improvement. This ineffective diagnostic methodology has led to too many people taking medications that they do not need and too many people that do need medications taking the wrong types or dosages. As Dr. Angell described, some of the most heart-breaking examples of this systemic failure involve the improper medication of children. The financial impacts of these misdiagnoses on the public and private healthcare system are staggering. The pharmaceutical industry’s marketing efforts deserve some of the blame for this state of affairs, but it is not the main culprit.

The real problem is that medical providers are trying to diagnose biologically-based conditions without biologically-based screening tests. Doctors do not have effective brain scans, blood tests, or other tangible biological screening tool to identify which patients are affected by biologically-based mental illnesses. Instead, they try to use patients’ perceptions and behaviors to discern the presence or absence of a biological condition. It is the equivalent of trying to determine whether a patient has a broken leg by asking them if they can walk or if they are in pain. If we were forced to apply that method of diagnosing broken legs, one would expect to find a number of books decrying the number of casts on people that did not need them and the number of people in need of casts that are forced to go without.

We must find a way to foster the development of biologically-based mental illness diagnostic tools. There are many ways of going about this task and many of them would likely succeed. Personally, I recommend establishing a Mental Illness Screening X Prize, similar to the multi-million dollar prizes that have been used to stimulate innovation in commercial space flight and fuel efficient vehicles. The winner of the Mental Illness Screening X Prize would be able to use a biological test to determine whether a person has either schizophrenia or bipolar disorder.

That biological test would be a major step toward revamping our broken mental illness treatment system to address many of the legitimate issues that Dr. Angell described in her article. With the billions of dollars that our nation spends on treating these conditions each year, it is time to make the development of that screening tool a priority.

Matt Kuntz, JD
Executive Director
NAMI Montana

On Mental Illness: Delusion

2011-06-14T13:21:00.000-07:00

This is our first blog post by Kathie Harrison, a Bozeman writer who lives with serious mental illness. NAMI Montana is honored to count Kathie as a supporter and we're happy to share her views with the world.

On Mental Illness: Delusion

I saw A Beautiful Mind and began to compare experiences. He was living as a spy in the cold war and acting on information from television and news reels. I had believed the world is a criminal delusion and I have not, to my knowledge, broken the law and as of this writing have not been arrested. I am a consumer.
I had two perceptions at once. I observed typing errors in paperwork, credentials, and mailings that looked like I was being framed so my identity would be stolen or I could be replaced. The facts were convincing me I might be in a criminal system. My cousin, a sheriff deputy, once asked me “How do I approach people like you?” I told him to remember we are reacting to something in our brain.

As with most of the mentally ill I hear voices. I was untreated for three years. In that time I was homeless a month; I was being told to steal an infant and hide. Voices urged me to kill others. I got help even though I never spoke of my experiences. My voices had me in fight; flight, or freeze mode as a counselor told me. Talk, you die! And so I was silent many years. The three F’s ran me. On rare occasions voices comfort compliment and are supportive.

I lived delusional for twenty-five years. Stigma keeps a lot of people silent and I thing also the fear of being laughed at and disbelieved. Paranoid Schizophrenic was my first diagnosis. Paranoia meaning living in fear, schizophrenia meaning one works well alone or likes to be solitary. The first thirteen work years I had I changed jobs may times; my last job lasted six to ten years, You can train people to be more social in the clubhouse setting, and in a job with the public. I am now diagnosed a schizoaffective bi-polar disorder.

Ridiculous is what the mentally ill face when they expose their story. We had a saying in the sixties, “Let all hang out!” Most of what our voices tell us never happens. Mean teasing could follow. I have sixty years of experiences to talk about. I am going to write more often and make a book of collective writings. Perhaps they’ll be in print and read. Life can turn on a dime as a friend said once. Another friend died and the lesson is; do it now; no one knows their future the paranoia is completely gone.

Kathie Harrison

Thoughts for a Rainy Day

2011-06-13T08:58:00.000-07:00

It's flooding two blocks from my front door and the rain is coming down. I can't think of a better thing to do than share my thoughts on serious mental illness and advocacy.

COMMENT: Treating serious, disabling mental illness is difficult. Having a family member living with serious, disabling mental illness is more difficult. Living with a serious, disabling mental illness is most difficult.

QUOTE FROM THE NAMI FAMILY-TO-FAMILY EDUCATION CLASS: Perhaps the best definition of advocacy was voiced by Eleanor Roosevelt (quote): "You must do things you think you cannot do." In facing the stigma and shame that still surrounds mental illness, we are tested by many challenges Each of us has to break through boundaries of fear and convention to help our family members; each of us has felt the discrimination that exists against people who have brain disorders. In our struggle to "stand with" and "stand up for" our loved ones, we are all advocates.

FRIDAY, JUNE 10, 2011: I received a call from a women in Colorado whose brother-in-law is receiving mental health services at the Center for Mental Health in Helena. He has been diagnosed as suffering from schizophrenia and/or bipolar disorder. He has received services at the Montana State Hospital and the Montana State Prison. He was a part of the ACT Team in Helena, but was released from the ACT Team because he was probably non-compliant and the ACT has recently undergone structural changes. Several days after being released from the ACT Team he attempted suicide and was committed to the Montana State Hospital. After six days in the MSH he was scheduled for release. With the help of NAMI National she was able to compose a letter and he was kept in the hospital for sixty days. He has been released, but not returned to the ACT Team. He tried independent living, but was unsuccessful. "He was living in deplorable conditions." He has since been living in a foster care facility and doing relatively well. She would like to find a private therapist because she does not think one hour a month is adequate for therapy and has asked me to help her find a private therapist.

SATURDAY, JUNE 11, 2011: I received a call from a mother in California whose son has been receiving services at the Western Montana Mental Health Center in Bozeman. he has been diagnosed with schizophrenia and substance abuse disorders. He has been non-compliant and was sentenced to the WATCH Program at Warm Springs after his 4th DUI. He also was in the prerelease program, but was non-compliant because he was not responsible and accountable. He has been transferred to the Montana State Prison because he has failed to comply with the goals of the program. He has not contacted his mother and his mother has been told she may not visit him for 45 to 120 days until he is processed. If the underlying mental illness is not treated appropriately, prerelease and substance abuse treatment will never be successful.

DISCLAIMER: I have been in the Montana mental Illness treatment system for almost 27 years and realize emotional family members do not always relate events as they actually occur. However, this is their perception of events as they unfolded.

The treatment of serious, disabling mental illnesses is very difficult. But, a definition of insanity is: "Doing the same things over and over again and expecting different results." Last Thursday the census at the Montana State Hospital was 156. This is the lowest census in years. Those with an optimistic view would say this is due to improved community services and transition services out of the hospital. Some of us with a skeptical point of view would point to the fact that it has been more and more difficult to commit individuals with mental illnesses, who are in psychiatric crisis, to the Montana State Hospital. Commitment laws make it more and more difficult to accomplish early intervention and treatment. It may also be that more people at the Montana State Hospital are being transferred to the Montana State Prison and thereby lowering the census. The questions is? Does the Montana State Prison have the resources to adequately treat and care for those mentally ill individuals who are being transferred to their care. The Department of Corrections has the obligation to protect our society from those who might harm us. But, do they have the resources and training to treat the increased numbers of mentally ill they are receiving?

We are approaching a time of limited resources and funding to treat those who live with serious mental illnesses. We are rationing treatment and medication although it is not called that. Maybe we should spend our resources on those who suffer from mental illnesses in their teens and twenties when recovery is more possible. Then we would spend our funds to just maintain individuals in their 30's, 40's 50's and 60's who are so much a part of the "revolving door" that is characteristic nature of these illnesses. Just a provocative thought!

NAMI family members need to advocate for their mentally ill family members who live with serious, disabling mental illnesses because there are very few out there who are capable of understanding our lived experiences.
Dr. Gary Mihelish, President
NAMI-Helena

The Keys to Preventing Relapse, Rehospitalization, and Reincarceration

2011-05-31T11:04:00.000-07:00

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

2011-05-09T09:19:00.000-07:00

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

Frustration, Anger, and Hopelessness

2011-04-27T08:19:00.000-07:00

Many people cannot understand why NAMI people are frustrated and angry so much of the time. Almost every day, or at least several times a week, we receive phone calls and e-mails from NAMI members totally frustrated by the "mental illness treatment system." With permission I would like to share an e-mail we received last Friday.

Hello Gary & Sandy,

My daughter who is 30 years old was committed to the state hospital in nearby state. While waiting for a bed she broke out of the private hospital they were holding her in until a bed was ready. She was caught and booked into jail and the next morning she was released on her own; homeless with no meds. Two days after getting out of jail she was again arrested with 4 felonies that carry life sentences. i was down there in January with my wife and helped her get into a hospital for treatment. She had an assessment done by the county mental health folks there back then and I talked to them and told them she was a danger to herself and others, but they let her go and that's when she went on a crime spree. She has lost her home and her three children now and the mental health professionals agree they made a mistake in not committing her back in January.

I am so tired of the broken mental HELL system. She has catastrophic PTSD, severe depression, poly substance abuse issues and Bi-Polar,..right now she is in the county jail with no meds. Oh, she tried to kill herself in jail a few weeks ago and was flat lined and taken to the hospital, then put back into treatment and then committed to the State Hospital when she broke out.

There is no cure for mental illness at this time. Successful treatment is extremely difficult, but it is possible. I have been in Montana's mental illness treatment system for over 26 years. After our family's 7 years of Hell we were able to get a diagnosis and develop a relationship with caring, compassionate, competent mental health professionals. Things have only gotten better, but we are not the average family who gets involved in this system. We were fortunate to have mental health professionals who believed in the collaborative treatment model which involved the individual with the illness and the family in developing a plan to manage serious mental illness.

When will ALL mental health professionals embrace the collaborative model? When will individuals with mental illness and their families be recognized as part of the solution and not the problem? Montana's Olmstead Report (Which is gathering dust on a shelf somewhere) concluded what is really needed to improve and change Montana's mental illness treatment system is a change in attitude.

And, until we see that change in attitude, Montana's individuals living with serious mental illness and their families will continue to be frustrated, angry and feel hopeless.

Dr. Gary Mihelish
NAMI Montana's Director of Government Affairs

Thoughts on Suicide

2010-12-21T15:23:00.000-08:00

The tragic suicide yesterday of Mark Madoff gives me cause to reflect and advocate. This was once again a terrible and unnecessary tragedy. I have also just completed, "Myths about Suicide" written by Dr. Thomas Joiner from Florida State University. It is a must read for anybody wanting to understand suicide.

Every year over a million people worldwide commit suicide. The most recent statistics in the U.S. indicate over 34,000 suicides occurred in that year. The most recent statistics from Montana in 2008 indicate 202 Montanans took their own lives. Montana annually has, if not the highest, one of the highest suicides rates in the nation. A suicide attempt occurs every minute of each day and a person dies from taking their life every 16-18 minutes in the U.S.

Dr. Thomas Joiner: "We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, or rash; that is not caused by breast augmentation, medicines, "slow" methods like smoking, or anorexia, or, as some psychoanalysts thought, things like masturbation; that it is partly genetic and influenced by mental disorders, themselves often agonizing; and that it is preventable and treatable. And once we get that into our heads at last, we need to let it lead our hearts."

" And so I am prepared to defend the view that 100 percent of suicides are characterized by the combination of learned fearlessness, perceived burdensomeness, and profound alienation from others, and that these factors, in turn, arise from underlying mental disorders, mostly of the full-blown type, but sometimes of the partial syndrome variety. As discussed in other sections of the book, people can have these conditions, especially depression, and not be psychotic or deluded, and certainly in the case of people with terminal illnesses, people can have subsyndromal depression that most of us can readily understand, sympathize, and even identify with. But none of this changes the fact, in my view, that mental disorders represent the matrix from which serious suicidal behavior emerges."

It is simple, but yet so difficult to reduce suicide. If 10-15% of individuals living with serious mental illness (mental disorders) end their lives by committing suicide, we must better treat mental illnesses. We must end the discrimination and stigma individuals living with serious mental illnesses and their families endure. Its all about EDUCATION, EDUCATION, EDUCATION! We all must develop an understanding of serious mental illness and also develop caring, compassion for those who live with these illnesses.

As we say in NAMI, it is the responsibly of families, friends and mental health professionals to keep our family member alive until they can obtain effective, evidenced-based treatment.

Dr. Gary Mihelish, President
NAMI-Helena

Tips for Coping with the Holidays

2010-12-08T08:34:00.000-08:00

TIPS FOR COPING WITH THE HOLIDAYS

from NAMI Connections

Stay close to family and friends who understand your illness.
Take your medications as prescribed. Be sure to get the sleep you need.
Celebrate the holidays in ways that are comfortable for you.
The holiday season does not stop feelings of sadness and loneliness. Give yourself permission to work through these feelings.
Don’t compare this season with previous ones. Enjoy all the little things you have now.
Talk about the stress you feel with family and friends.
Keep expectations manageable. Plan your work and work your plan.
Set a budget and stick with it. Many items that you can give do not cost money – a phone call to a friend may mean more.
Do something nice for someone else. Do something nice for yourself.
Stay out of department stores.
Play your favorite non-holiday music.

Happy holidays from NAMI Montana

A Simple Way to Save Lives

2010-09-16T10:29:00.000-07:00

NAMI Montana supports, educates, and advocates for Montanans who live with serious mental illnesses and their families. The most basic part of our mission is teaching that these illnesses are medical conditions of the brain that require treatment by both a psychiatrist and a therapist. I’d like to share the words of one young mother that followed this lesson.

Matt, I have been on medication since January, and my life has changed entirely! I am experiencing only happiness and genuine excitement about waking up each day! No more panic attacks, no more anxiety, just a whole lot of me being honest about my condition and really trying to do something about it! Had I taken your advice sooner, I would have probably healed much more quickly. Cognitive therapy works so much better (I speak only for myself here) with medication. Thank God we live in this day and age where it is easily accessible.

I passed this hopeful message on to an email list. Someone used it to convince another young mother who was nearly suicidal due to depression why she needed to see a therapist. The message worked again. It’s what NAMI is all about.

Thoughts from NAMI 2010 Convention

2010-07-12T09:00:00.000-07:00

Six members of NAMI-Montana were among the 1300 NAMI members who participated in the annual NAMI Convention in Washington, D.C., June 30th thru July 3rd. Of course the highlight of the convention was NAMI-Montana's own Quentin Schroeter was presented the Lionel Aldridge Award, which recognizes and individual with mental illness who has exhibited courage, leadership and service on behalf of all people living with mental illness. CONGRATULATIONS QUENTIN

We also participated in an awards ceremony in the Russell Senate Building where NAMI presented Senator Max Baucus and award for his role in healthcare reform and his continued advocacy on behalf of individuals and families who live with serious mental illness. Thursday was Advocacy when we met with our Congressional Representative on Capitol Hill. We were able to meet personally with Senator Baucus and his staff, Representative Denny Rehburg and his staff and the staff of Senator John Tester.

There are always so many presentations and workshops that educate and inspire. I would like to mention three.

The research plenary discussed the NIMH RAISE Study: Altering the Course of Schizophrenia. The presenters were Tom Insel, M.D.. Director of the National Institute of Mental Health and the lead researchers, Dr. Jeff Lieberman Chairman, Department of Psychiatry, Columbia University and Dr. John Kane, Chair Schizophrenia Research, Zucker Hillside Hospital, Glen Oaks, N.Y. RAISE is a large scale research project to explore the effectiveness on early and aggressive treatment in reducing the symptoms of schizophrenia and preventing the gradual deterioration of functioning that is characteristic of chronic schizophrenia. In other words, early intervention and treatment can prevent cognitive deficits and promote a higher level of recovery. We hope to have a leading researcher at the Montana State Conference on Mental Illness in October in Billings.

The panel of Dr. Xavier Amador, Jonathan Stanley, J.D. and Delaney Ruston. M.D., presented a overcrowded presentation on "Confronting Anosognosia: How to Get Help to Those Who Don't Know They're Sick." It was interesting and provocative. Remember: TREATMENT WORKS IF YOU CAN GET IT!" Hopefully. Dr. Ruston will be a presenter at the Montana State Conference in October. She will screen her documentary film, "UNLISTED" which will premiere on PBS in October. It is a film about her relationship with her father who lived with schizophrenia. She will also present a workshop" Psychiatric Advanced Directives: Giving a Voice to Consumers."

But the "Ask the Doctor" session are always great. My favorite was "Recovery and Neuroscience by Jill Bolte-Taylor Ph.D., author of My Stroke of Insight (For $15.00 a must read), and spokesperson, Harvard Brain Tissue Resource Center. Dr. Jill is a Harvard trained brain scientist, a NAMI members and former National Board member whose brother lives with schizophrenia. Her book was on the New York Times best seller list, she has appeared on the Oprah Winfrey Show and at a reception last Saturday we learned they will be making a movie of her life. The movie will star Jodie Foster and the only problem is that Jodi Foster is not as good looking and Dr. Jill. Dr. Jill currently teaches at the University of Indiana Medical School. She has been a featured presenter at two Montana State Conference on Mental Illness and she is a friend. On December 10, 1996, she suffered a massive stroke in the left hemisphere of her brain. Complete recovery took eight years. Her presentation stressed the similarities of recovery from a brain injury (stroke) and mental illness. The most memorable quote from the convention for me was:

'SLEEPING TIME IS HEALING TIME!"

TEN PRINCIPLES FOR RECOVERY; For Individuals who live with mental illness and their families. Maybe even for mental health professionals.

1. Honor the healing power of sleep.
2. Treat me like I will recover completely.
3. Challenge my brain systems immediately.
4 Love me for who I am now.
5. Help me define my priorities for energy use.
6. Focus on my abilities.
7. Give my brain years to recover.
8. Divide every task into small action steps.
9. I am not stupid, I am wounded. Repeat for me!
10. Come close. Do not be afraid of me.

Lastly, I am not deaf. I am wounded. Raising your voice will wound me.

2011 NAMI Convention, Chicago, Illinois
2012 NAMI Convention, Seattle, Washington CLOSER!!!!!!!

Dr. Gary Mihelish
NAMI Montana

Goodbye to a Friend and Advocate

2010-06-01T13:04:00.000-07:00

NAMI Montana friends and family. I am sorry to announce the death of our dear friend and fellow advocate Carol Waller. Carol lived with Bipolar Disorder and was a strong advocate for effective treatment for mental illness. It's an honor to have worked with her as NAMI Montana's volunteer Senior Specialist.

I'd like to share with you an article that Carol wrote about this time last year so her wisdom will continue to live on.

Thank you for all of your work Carol. Rest in peace, but please keep praying for us. It's a tough fight and we can still use your help.

matt

Dear Readers:

My name is Carol Waller. I fall into the Senior Citizen category according to the census figures. I live independently and drive my own car. I live a fairly active life and get along pretty well. But the most important thing I can tell you about myself is that I have a mental illness; depression and anxiety, and I am concerned over other people who might be in the same age range. And possibly they have mental illness, such as depression, and may not even be aware of it!

First let me give you some statistics. Montana has the highest rate of suicide in our nation! From the Census 2000, senior citizens, 65 years of age and older account for over 10% of the total population, with the numbers rising each year as the “Baby Boomers” come into their golden years. Now consider the fact that about one out of ten people in this age group suffers from some sort of mental illness, most of which is some type of depression. Of this number, two will make a suicide attempt, half of which succeed. When you consider all of this data, it seems that depression and the elderly are not taken as seriously as it might need to be.

Why do so many seniors with depression go untreated? I have often wondered that as I have been treating my own depression since my early 20’s. One reason is very obvious to me and that is the stigma that still hangs over mental illness. I grew up in a time when a person with a mental illness was classified as “crazy” and often shunned and rarely understood. Today it is not quite as bad, but still the stigma exists and can be the cause of denial in order to appear to be “normal”. Today it is also viewed as a disease by most educated people and it can be treated and you can live a fairly normal life. But still there is a stigma attached that can keep people from getting the help that they need.

So how can you tell if a person is suffering from depression? Most people have periods of sadness in their lives which is normal and different from depression. I have listed some of the signs which seem to indicate some degree of depression is present.

Of course the obvious sign is sadness: like after a death or loss of a loved one, but one that does not go away in a reasonable length of time. Usually a person suffers mild forms of depression at times like this about two times in their lifetime. A more serious depression can develop from this with other signs present.

One of the obvious signs of depression is disruption of sleep patterns. Either there is excessive sleep, not wanting to get up and start their days. The other is insomnia, where the person has trouble falling asleep and staying asleep. Personally, I had trouble with both, wanting to sleep during the daytime and then not being able to fall asleep or stay asleep. Either way usually there is no feeling of being rested.

Appetite is another thing that is affected. Either there is over eating or no appetite. I fall into the no appetite group. But in either case there is very little enjoyment of the food.

Decision making becomes very hard and at time impossible. This causes frustration and the feeling of not being up to “snuff”.

There is a loss of energy and movements may become slower and harder to make. Another loss is that of interest. Things that have excited or pleased the person in the past loose their attraction.

Low self esteem is a common problem with depression. There are memories of losses or failures and the depressed person takes the blame and feels as though they are not “good enough” or guilty of something.

As the depression episode continues there is a feeling of hopelessness; that no matter how temporary a situation may be in reality, the feeling that it will never get better hangs on. This leaves the person with no incentive for living or motivation for changing the things that depress the person.

People who observed the depressed individual apply labels which are untrue but appear to be valid, like being lazy or stupid or changed to the point that they are so ill they are useless.
This is usually followed by the thoughts of suicide. If you are thinking in these terms or have friends or family talking or thinking in terms of this being the end, do not take it lightly! This is a serious situation and needs medical attention as soon as possible. This is a case for medical attention such as a personal physician, psychiatrist or even the emergency room.

I can tell you that the road back from the brink is a hard one! Many times it is one step forward and two steps back. But this road of ups and downs is well worth the trouble. Remember, suicide is a permanent solution to a temporary situation. Recovery is an arduous journey but it is possible.

This journey usually involves medication which may alleviate some of the symptoms, psychotherapy of some sort, group activities, the love of family and friends and understanding. For more information on this topic, I suggest you contact the NAMI, MT at 443-7871, and Center for Mental Health at 443-7151, the Crisis Line at 443-5353, Warm Line at 1-877-688-3377, or your personal physicians. If it is a case of emergency, you will probably get the quickest results with 911.

It is my hope that I have provided my senior friends with some understanding of this disease, this mental illness, called depression and that the statistics do not continue to grow at such an alarming rate. This does not have to be the end, but rather a beginning of recovery.

Thank you for your interest and time.

Sincerely,
Carol Waller

Mental Illness and Justice: The Need for a New Paradigm

2010-03-29T10:25:00.000-07:00

Last fall, I received a call from a distressed father asking me to review his son’s case. His son had been diagnosed with bipolar disorder (manic depression). The son was on parole for a crime that he had committed when he was in a manic stage. He quit taking his medication again, went manic, and committed another series of crimes. The son was eventually sentenced to seventy years in prison with twenty suspended.

I talked with the son’s attorney before sentencing and expressed my sorrow that the parole officer, family, or someone else hadn’t been able to force the son into treatment when it became clear that he was off his medication and headed for serious trouble. In many cases, a couple of days or a few weeks with the proper medical care would be all that it takes to stabilize a patient’s brain chemistry so they can return to their normal life.

The attorney looked at me in disgust and responded “but that would have violated his civil rights.”

I can’t think of a clearer depiction of our profession’s inability to grasp the realities of mental illness. The system that we’ve established and operate helped this young man avoid a short involuntary stay in favor of a lifetime in prison. It’s not surprising that under this system our State Prison houses several times more people with serious mental illness than the State Hospital.

Last month, our office worked with the family of a Helena man who suffered from a mental illness-induced psychosis that involved a major battle between angels and demons. According to his delusions, the battle would end on a specific day in early March when the man must kill the Antichrist. The family was terrified that the delusion of the Antichrist would be projected on an innocent victim on the street. The legal and medical communities felt legally blocked from averting potential tragedy.

While I understand that there is a real need to revise some of Montana’s laws pertaining to mental illnesses, I can’t help but think that part of the problem is our profession’s failure to understand the role of brain chemistry in mental illnesses and crises. Would we be this paralyzed if the dangerous delusions had been caused by someone slipping him LSD? I have to believe that we would have done more to keep this poor man’s path from intersecting with the SWAT Team or the coroner.

The man was arrested before the delusional apocalypse and sent into treatment. While we can all be happy that broad tragedy has been averted, it is shameful that he had to become a criminal in order to be freed from his debilitating hallucinations.

We can and must do better than that.

The legal system flounders when faced with someone whose biological brain disorder affects how they think, feel, and act. People who live with serious mental illnesses and their families expect us to do better than seizing someone who acts irrationally because of a medical condition and punishing them for acting irrationally. Our profession must update our conception of mental illness to reflect society’s new understanding of the effects of mental illnesses on the functioning of the brain.

The realities of the challenges presented by mental illness mirror the plight of a person who is “involuntarily intoxicated.” For instance, bipolar disorder drastically alters the release of the brain chemicals dopamine, serotonin and norepinephrine. The different levels and timing of these chemicals affect mood regulation, stress responses, pleasure, reward, and cognitive functions to cause mania, depression, or even a mix of both. A man or woman in the grips of a manic or depressive episode has effectively been drugged by their illness.

While not a silver bullet, the involuntary intoxication paradigm can be can be a valuable tool to help attorneys navigate through the complex civil rights, neglect, and public safety issues presented by someone in a mental illness crisis. It offers a major step forward in adapting our legal system to reflect the medical realities presented by these devastating illnesses.

Mental Illness, Football, and Dangerousness

2010-03-09T09:29:00.000-08:00

"BOTTOM LINE: MENTAL ILLNESS IS A TRAGIC THING THAT CHANGES LIVES AND FAMILIES FOREVER." Family Quote.

Please be patient for me. but it has been a bad week for individuals who live with serious mental illnesses and their families. On this beautiful Montana Winter day I would like to be a little philosophical.

Long before I was a passionate advocate for those individuals who live with serious mental illness and their families, I was just as passionate about the game of football. That is why I have attached the following story which was printed in the "Helena Independent Record" this past Wednesday. Because of my passion for mental illness and football, I have followed this story closely. Until I was old enough to play high school football, my father took me to every Grizzly home game. I enjoyed a 25 year career as a high school and college football official until mental illness entered my family. My youngest son played college football and has been a successful college and high school coach since 1996. Sandra and I have had season tickets for Bobcat football since we returned to the state in 1971. Every Friday night and Saturday afternoon in the Fall we can usually be found at a high school or college football game.

This last week has again shown how the mental illness treatment has failed those individuals who live with serious mental illnesses and their families again. The Pentagon shooting involved a young man suffering from mental illness, The suicide in Helena probably involved mental illness and the attempted suicide in Butte involved mental illness. And it is all topped of by the attached story.

I do not know how much longer we can rely on the current commitment laws to meet the needs of the mentally ill. For almost 40 years we have used the criteria of "imminent danger to self or others" to commit individuals for treatment. One definition of insanity is to keep doing the same thing over and over again and expect different results. People! The system is not working. The present laws allow people to become so sick some of them lose their lives and sometime harm others. We need to change the commitment laws so to allow the mentally ill to access early intervention and experience the hope of recovery. We can no longer afford business as usual!

Helena Independent Record, Sports, Wednesday, March 3, 2010

"Iowa jury convicts man in football coach killing." by Nigel Duara, Associated Press.

Allison, Iowa -- Mark Becker stood passively Tuesday as a jury found him guilty in the shooting of a nationally known high school football coach. He seemed far removed from the man whose mind was filled with images of angels and horned demons who lurked in the shadows of every room, telling him that the community was plotting against him and that Aplington-Parkersburg coach Ed Thomas-known for his winning record and town leadership-was Satan.

Becker, 24, had explained to psychiatrists that after months of torment, he short Thomas at least six times in the high school weight room, then kicked his body before walking away.

Jurors deliberated 24 hours over four days before convicting Becker of first-degree murder, rejecting his plea of not guilty by reason of insanity. The guilty verdict carries a mandatory life-in-prison sentence. Minutes after the verdict was read, Becker's mother, Joan comforted a crying relative sitting behind her. "It's OK," Joan Becker said. "Just pray he gets the right medication." Details of Becker's mental state emerged during the 14-day trial healed in tiny Allison, about 150 miles northeast of Des Moines. Jurors heard from defense attorneys that Becker's delusions were so severe that he didn't know right from wrong.when he shot Thomas. Psychiatrists testified Becker believed invisible forces were pushing down on his eyes. Police interrogation videos showed him sitting alone, speaking to no one, swatting the air.

Prosecutors acknowledged that Becker suffered from a mental illness, but said that he also coldly calculated the killing, taking practice shots with his .22 caliber pistol he used to kill Thomas and lying to people in search for the coach.

After the verdict, the Thomas and Becker families-who attend the same Parkersburg church-said they would pray for each other. But they took away different lessons from a system that couldn't help Becker but ultimately succeeded in convicting Thomas's killer.

Joan Becker said the mental health support system in Parkersburg and Butler County failed her son. A psychiatrist in a Waterloo hospital agreed to his release just days after he was hospitalized following a violent incident and arrest. Police weren't notified when he was let out of the psychiatric unit. "Ed Thomas was a victim of a victim," she said. "Although Mark and we as his parents attempted to go through proper channels to get Mark the proper mental health treatment he desperately needed, the system failed miserably."

Thomas's son, Aaron, said both families have only begun to grieve, and the conviction wouldn't change that. But he said the justice system did what was necessary. "We do want to recognize that there truly are no winners in this case, but the system worked," he said.

The question of why Becker's delusions focused on Thomas remains unanswered. Thomas last coached Becker six years before the shooting and Becker had spent significant time away from Parkersburg.

Thomas amassed a 292-84 record and two state titles in 37 season as a head coach-34 of them at Aplington-Parkersburg High School- and coached four players in the NFL. He also was a leader in rebuilding Parkersburg after nearly one-third of the 1800-person town was wiped out in May, 2008, by a tornado that killed six people.

TRAGICALLY ONE MAN HAS BEEN KILLED, ONE YOUNG MAN IMPRISONED FOR LIFE AND TWO FAMILIES DEVASTATED FOREVER. THINGS MUST CHANGE!

Dr. Gary Mihelish
Former President of NAMI Montana

More Specifics on Cuts to MI Treatment System

2010-02-10T15:30:00.000-08:00

Lou Thompson, the Director of AMDD, sent out this message today. I'm going to post it in its entirety to ensure that I don't inadvertently misconstrue anything.

matt

I’m sure everyone is well aware of the Governor’s request that all state agencies seek to identify operational efficiencies and to develop a plan for an overall budget reduction of 5% in general fund expenditures. I very much appreciate the time and effort of Jerry, Jeff, and Mary Ann as well as Glenda and Joanie in helping us put together our proposal. I want to emphasize that it is only a proposal and that it will be reviewed by Governor Schweitzer along with proposals from across state government. I expect a final decision on budget changes to come from the Governor’s office around March 5.

I think that AMDD was very fortunate to be able to achieve its savings by not implementing some new programs, putting us in a position of not cutting any services to our constituent population. In order to achieve some of the savings identified below, however, it will be necessary that each of us become more aware of how we conduct our business including the use of cell phones and travel, and conserve as much as feasible during these challenging times. I ask that everyone take whatever steps are possible to reduce daily expenses and develop more efficient and alternative ways of meeting the needs of those we serve. Bureau Chiefs may have specific guidelines for their bureau.

Here are the numbers that were developed by AMDD and submitted for consideration:

Elimination of the 2% provider rate increase for FY2011 ($660,757)
General operating expenses including travel, meetings, office supplies, cell phones, etc. ($57,407)
MMHNCC savings in worker’s comp, vacancy savings, overtime ($300,000)
MSH savings in worker’s comp, vacancy savings, overtime ($967,731)
Eliminate expansion of HCBS Waiver in FY2011 ($356,208)
Eliminate OTO funding for HB130-131-132 ($458,228)
Reduce funding for crisis diversion programs HB130-131-132 ($619,468)

Thanks to each of you for all that you do. If you have any questions, give me a call.

Lou

Checking the Foundation

2010-02-10T14:35:00.000-08:00

I spent yesterday at the Montana Legislature's Law and Justice Interim Committee. The Committee was focusing on improving Montana's DUI law and NAMI has a role in the process since many people who have serious mental illness also have co-occurring alcohol and substance abuse disorders. The legislators have spent a lot of time analyzing the issues and have come to some really strong conclusions. From NAMI's perspective, we really liked their focus on treating the underlying causes for the behavior rather than just focusing on stacking up the punishment.

However, treatment and education cost money. While they may save us money in the end due to lower rates of incarceration, etc.; they do carry a price tag. The challenges in paying for that price tag became very clear when DPHHS Director Anna Whiting Sorrell had to tell the interim committee that the budget for two of the three crisis bills that came out of the last interim committee had been cut. DPHHS cut HB 131 and HB 132, but left HB 130's grant program for jail diversion and crisis intervention.

To their credit, none of the legislators tried to make hay out of these cuts. They thanked Director Whiting Sorrell for her service in these challenging times and asked her to try and protect the critical crisis services paid for in HB 130 from further cuts. NAMI couldn't agree more.

At the end of the day, it was really hard not to think that it may be time for Montana to find another way to help pay for the mental illness treatment system that one-in-five Montana families so desperately need. How deeply can we cut this treatment system, before our leaders find a way to supplement the declining revenue with another funding stream, such as additional taxes on alcohol and tobacco?

No one likes to talk about raising taxes, but no one likes to talk about the dangers of untreated mental illness and co-occurring disorders either. Eventually we'll have to talk about one or the other. From my desk, it's pretty clear which is the lesser of two evils.

Sincerely,

Matt Kuntz
Executive Director
NAMI Montana

A CLIMATE OF ANXIETY, FEAR AND HOPELESSNESS

2010-02-04T13:46:00.001-08:00

According to many, the United States is experiencing its worst recession since the Great Depression. Nationwide, cuts to mental illness treatment services are the most extensive they have been in the last 30 years. Montana is also beginning to experience budget deficits. While politicians and public officials publicly assure us there has not been budget cuts to mental health services, mental illness providers tell their clients cuts to mental illness treatment are imminent. I have received calls from individuals suffering from severe mental illness who are extremely anxious about their future.

In my experience, individuals suffering from a severe mental illness almost always suffer from extreme anxieties. They are in fact sometimes paralyzed by fear and find it difficult to function. A diagnosis of severe mental illness is the quickest ticket to poverty I know. Hopes and dreams for a fulfilling, comfortable and rewarding life are blown out of the water. Because our culture does not readily accept people who live with serious mental illness, they are in most cases marginalized. They live on the fringe of everyday society.. Mental illness means that you usually live in substandard housing, rarely are able they to find meaningful employment, rely on the meager funding of Social Security benefits in order to live, access Medicaid for health care and medication, food stamps for food with very little hope of a rewarding future.

Individuals living with mental illness are extremely concerned about their future. Reductions in treatment programs frighten them. Losing access to life saving medications is terrifying. Many of them worry that they will not have any future. Reductions to mental health services will lead to increased hospitalizations at the Montana State Hospital, place a burden on law enforcement and our criminal justice system, some say suicides will increase. A number of years ago, one of my favorite legislators told me not so play the suicide care. So, I sent him a newspaper clipping monthly of obituaries of individuals I have known who lost their lives to mental illness and suicide.

I know mental illness treatment services will never be funded at the level I would like to see. I know that if people living with serious mental illness receive appropriate evidenced-based services, recovery from severe mental illness is possible. So what can we do in these difficult financial time. Several years ago the final paragraphs of Montana's Olmstead concluded there would probably never be the needed funding for mental illness treatment programs. However, what was needed was a change of attitude. Society must accept the fact that mental illnesses are real and treatable. They are no-fault brain disorders. We need to be more caring and compassionate to people suffering from these overwhelming disorders. And, we must not extinguish hope for the mentally ill. Because right now that is all many of the have. Compassionate mental illness providers and caring families must provide this hope.

If a society is judged by the manner in which we care for our most vulnerable citizens, we are not doing very well right now.

Dr, Gary Mihelish, Past-President
National Alliance on Mental Illness of Montana

Reductions in Montana's Mental Illness Treatment Services

2010-01-13T11:02:00.001-08:00

Dear NAMI Montana Members and Friends,

I know that a lot of you have read the articles about cuts to mental health services and you're worried. Those fears are justified. The State of Montana's budget is in tough shape and the weak economy has led to a sky rocketing demand for state-funded mental illness treatment. The reality is that it will be harder to access that care.

What We're Facing

Here is a breakdown of the cuts and service reductions as I see them based upon conversations with state personnel and an analysis of the available articles on the subject. (These articles are available at the News section of our website).

The most glaring reductions of services stem from the high demand on the Mental Health Service Plan (MHSP). The State is sharply reducing services, such as case management, and eliminating others, such as day treatment, to prevent MHSP from running out of money. On a personal level, these service reductions will really hurt many Montana families. On the state level, these service reductions risk funneling sick people from cost-effective outpatient care to more expensive placement at the Montana State Hospital or Department of Corrections.

The Governor canceled a $4.5 million renovation of the receiving hospital at the Montana State Hospital at Warm Springs. On top of that $4.5 million, it looks like the Department of Public Health and Human Services is facing a 5% reduction in its budget. It would be a good bet to expect later cuts beyond that 5%.

NAMI Montana has asked the Governor's office to please consider all of the reductions in the mental illness treatment system, including the cancelled renovation at the State Hospital, to ensure that Montanans with serious mental illnesses and their families don't bear more than our share of the burden of the budget cuts.

How You Can Get Involved

The most effective method of getting your voice heard on this issue is to contact Governor Schwietzer's office directly. His phone number is (406) 444-3111. You can write to him through the Governor's website, http://governor.mt.gov/contact/commentsform.asp. You can also send him a letter at this address:

Governor Brian D. Schweitzer
Office of the Governor
Montana State Capitol Bldg.
P.O. Box 200801
Helena MT 59620-0801

It's your state and your mental illness treatment system. Don't be afraid to express your views on how that system should be affected by the upcoming budget cuts.

Sincerely,
Matt Kuntz
NAMI Montana

No Good Deed Goes Unpunished

2010-01-11T14:51:00.000-08:00

The National Alliance on Mental Illness for Montana (NAMI Montana) works with and against politicians all of the time. We don’t care whether someone is a Democrat or a Republican. The real issue for our organization is whether the politician is trying to help the one-in-five Montana families affected by serious mental illnesses. In many instances, we’ll support a politician on one issue and then fight them on another. With Montana’s suicide rate repeatedly among the highest in the country, we can’t afford to be ideologues. There’s just too much at stake.

In August of 2008, I met with Senator Baucus’s staff to provide input to their efforts to improve the healthcare system. NAMI’s position is simple. We’d like to get as many people access to medical care as possible. We also think that insurers should not be able to provide less coverage for biological brain disorders than they do for illnesses in other parts of the body. While many of our members may have different opinions about what the overall medical care treatment system should look like, those are our general goals.

Senator Baucus’s staff said that the Senator also supported those objectives and they felt we would be happy with their legislation. Then we discussed some of the challenges that they expected the legislation to face. The Senator’s staff was very clear that it was going to be hard to get a healthcare bill through the Senate. Anything too liberal or too conservative would fail. A bill with too high of a budget would also fail. They had to put aside utopian visions in favor brass tacks ways to improve the current system.

In the year and a half since that meeting, the healthcare reform debate stewed and then exploded. The men and women fighting for and against the legislation have been repeatedly tarred and feathered. For the most part, NAMI Montana stayed out of it. NAMI National has a federal advocacy staff that read every bill and fought for each point. But as far as we were concerned, Senator Baucus knew what Montana families affected by serious mental illness wanted and we trusted him to deliver it.

It’s too early to know what the final legislation is going to look like, but I asked NAMI’s Federal Advocacy Director to examine the Senate Bill to determine whether Senator Baucus kept his promise to our families. According to his analysis, the expansion of Medicaid eligibility alone will extend “health coverage and security to literally millions of Americans living with serious mental illness, including childless adults not able to qualify for Medicaid in their state.” The Senate bill also specifically requires that all of the health plans offered through new health insurance exchanges comply with the federal parity law that requires insurance companies to provide coverage for mental illnesses to the same degree they cover other illnesses. With those provisions, the Senate Bill honors Senator Baucus’s commitments to Montana families affected by serious mental illnesses.

The Senate Bill goes far beyond those provisions to protect the public from some of the more insidious practices in the insurance industry such as prohibiting the use of pre-existing health condition exclusions and caps on insurance payouts. The Senate Bill also provides for guaranteed issue and guaranteed renewal of coverage in the individual and small group markets. These consumer protection provisions will make a big difference in the lives of Montana families who are unfortunate enough to have a family member become seriously ill.

Senator Baucus, thank you for sticking your neck out to improve America’s healthcare system. When the dust settles, your efforts are going to improve the lives of a lot of Montana families. We really appreciate it.

Sincerely,
Matt

Matt Kuntz is the Executive Director of the National Alliance on Mental Illness for Montana (NAMI Montana).

Montana Legislature

2009-12-21T12:47:00.000-08:00

Earlier this weekend I sent many of you the NAMI E-Advocate Newsletter. The emphasis of NAMI National this year is to maintain funding for state mental illness treatment budgets. Massive cuts to mental illness treatment budgets are occurring nationwide and we may be just beginning to feel the effects here in Montana. Interim Legislative Committees are sounding like there will be limited funding during the 2010 Legislative Session. Last week is was rumored there is currently a $250 million budget shortfall. And to rub salt in the wounds, last Monday the Health Care & Benefits Division of the Department of Administration sent out a letter informing state employees that the State of Montana has elected to exempt the Employee Group Benefit Plan from the following requirement; Parity in the application of certain benefits to mental health.

Individuals suffering from severe mental illness continue to be throw-away citizens. Even though 1 in 17, or 6%, of our population suffer from severe mental illness and the expected life span of those who suffer from severe mental illness is 25 years less than the average citizen, our society continues to greatly discriminate against this population. Until the 20% of the Montana families who have a family member who suffers from severe mental illness can convince the other 80% of families who don't have a family member who suffers from severe mental illness, our family members will continue to suffer.

Even if there is a budget shortfall we must continue to advocate to maintain these necessary services. The recent suicide at the Montana State Prison demonstrates what happens when an individual is unable to access needed mental illness treatment services. We must find ways to make improvements in the system even if there is not new funding. And, it can be done.

Dr. Gary Mihelish

Prison Suicide

2009-12-17T09:59:00.000-08:00

Tuesday I read articles in both the Helena Independent Record and the Great Falls Tribune about the tragic suicide of the 28 year old inmate who suffered from schizophrenia who hanged himself on Monday. Please forgive me if I offend anybody, but please allow me to vent.

I do not pretend to know any of the circumstances related to this young man's incarceration related to the fact he was convicted of killing his mother in 2006. I have heard his mother also suffered from schizophrenia, but I do not know that for sure. This story is all too familiar to NAMI families. As I said, I do not know the actual circumstances of this tragedy, but let me guess how these events has transpired over the years.

Brandon John Orr probably developed schizophrenia in either his late teens or early twenties. From the story it would appear that he did not receive adequate treatment or did not receive any treatment at all. I do not know if his mother tried to access treatment for him, but in most cases she would have tried. Then one night while she was sleeping his command hallucinations instructed him to kill his mother. He may have done this because he hated her or wanted to save her from a worse fate. He then hit her in the head with a hammer while she was sleeping and then slit her throat.

He pleaded guilty to the crime and was hospitalized in the Montana State Hospital. There was probably no chance he would ever be released back into public life. He was receiving treatment at the Montana State Hospital until July when he was transferred to the Montana State Prison. He probably received better treatment at the hospital, but since he would probably never be released and the hospital is overcrowded, he was transferred to the prison. He probably received some treatment at the prison, but it was not as effective as the state hospital. The prison's responsibility is to incarcerate dangerous felons and protect the public and they are effective in doing that. He was very cordial when the staff brought him his food. :"He was kind and the staff did not see any problems." Then he hanged himself in a one person cell on Monday.

Who is to blame and who will take the responsibility? We can say "the system" failed and everybody is off the hook. We know that mental illness cannot be prevented, but disability can be prevented. Early intervention and appropriate treatment can prevent disability. We now know that early treatment to avoid psychosis, mania and depression can prevent damage to the brain and reduce cognitive deficits and an individual can lead a rewarding life and recover. But the law implies that a criteria of "imminent danger" is required to mandate treatment. By the time Brandon Orr was an "imminent danger" his mother was dead.

Now Brandon Orr is dead and two lives have been tragically lost to mental illness. If the pattern continues another Montanan will lose their life to mental illness in the near future or maybe even take the life of another individual. But, we do not have to accept the blame or responsibility. We can continue to blame "the system" and that relieves our guilt. There is an old saying, "The more things change, the more they stay the same." There have been significant changes in the mental illness treatment system in Montana, but people still die because they cannot access early intervention and appropriate treatment.

Every person suffering from a severe mental illness has, or had a mother and a father. They may have had a brother and a sister. The may have even had children. In most cases they had, or have someone who cares!

Dr. Gary Mihelish