Recent tragic events like Sandy Hook, Seattle Pacific University, and the DC Navy Yard shooting have propelled issues in the mental health system to the forefront of our minds. Many of us continue to struggle with the reality that crimes, violent acts, and even murders are occurring almost weekly, perhaps even daily. We struggle with understanding why and how such evil can continue to elude us. Aren't our schools protected and prepared for tragedies like that of Sandy Hook Elementary School? Aren't our police trained and ready for catastrophes involving mental illness? Can't our mental health professionals cure the sick? All of these questions swarm through the minds and hearts of people everywhere, including those, such as myself, who work in the field of psychology. The answers are hidden beneath a facade of control in our hospitals, clinics, and schools. The truth is that we live in a failed system that lacks the necessary tools to protect society from evil, from illness that controls the mind and consciousness of some of our fellow citizens. Because of this, it is important that families understand severe and untreated mental illness, while maintaining a balanced perspective. While the majority of individuals with mental illness do not intend to harm anyone, there is a great number of cases in which homicide or violence and aggression is likely. For those who have questions about our failed system, this presentation is for you.

2. A typical family scenario
0 Family recognizes there is a
problem
• School, work, community,
home
0 Denial/anger/guilt
0 Seeks M.H. tx
0 Difficulty finding resources
0 No single diagnosis or
“umbrella diagnosis,”
0 No lasting relief from meds &
rejection of tx
0 No insurance coverage
0 Expensive RTF’s
0 Prescribed a combination of
drugs
• Sleep aids
• ADHD meds
• Depression drugs
0 Hospitalization & early
discharge w/referral to
Psychiatrist
0 Person self-medicates
• Marijuana
• Alcohol
• K2 or narcotics
0 Indifference to tx or alternative
education (IEP, charter, home)

3. Mental Health Needs More
Attention
0 Points:
• Parents, families, & caregivers are
often ignored/slighted
• Crime & mental illness has some
common ground, although it does
not characterize every mental
health case
• We must open our eyes to
frequent occurrences of crime
among the mentally ill
• Crime & mental illness are
“connected” due to the systems’
failures

4. Recent cases involving crime &
mental illness
0 According to the TAC – 50% of mass
killings are committed by people
w/untreated or severe mental
illness. 1 in 100 male teens fit
category of aggression/violence.
Seattle Pacific University -Aaron
Ybarra (26):
“I just want people to die and I’m
gonna die with them,” Ybarra wrote
in his journal on the day of the
shooting.
Killed 1; wounded 2 others

5. Two confused systems
Mental Health System
Criminal/Juvenile Justice
System
0 Gray area
0 M.H history or child
development may be
responsible for
behavior
0 Seeks to tx & protect
public
0 Doesn’t want to be
associated with
criminal behavior
0 Black/White view
0 “you did it or you di
not
0 Seeks to punish
0 Developed its own
standards to
determine if M.H
issues are to blame
0 Realizes CJS/JJS lacks
M.H knowledge

6. De-institutionalization: the
disorganized disaster
0 Occurred in early 1950s –
1970s
0 No aftercare/SW support/or
no community tx set up for
discharge
0 Released to community
w/little to no skills to live
independently
0 Homelessness, victimization,
crimes, or hospitalized for
short periods of time
0 Stigma & social ignorance
including community tx
teams led to mediocre system
of today

7. Statistics
0 National Center for Children In
Poverty (2013): 20% of
adolescents have a diagnosable
M.H. disorder.
0 7.7 million adults & 20% of
children and teens between 13
and 18 suffer from severe
mental illness.
0 Suicide is the 3rd leading
cause of death among 15-24
year olds, even on college
campuses as well.
0 National Institute of Mental
Health (2013): 5.7 million
adults age 18+ suffer from
bipolar disorder each year
0 Major depression has
become the leading cause of
disability in the U.S. for
individuals ages 15-24.
0 24-million suffer from
schizophrenia
0 40 million suffer from anxiety
disorders,
0 7.7 million suffer from post-
traumatic stress disorder in
any given year.
0 34.2 million live in low-
income households

8. Today’s mental health system
0 Community Mental Health:
• Mobile therapy
• Family-based therapy
• Outpatient care
• School-based therapy
• Community Treatment Teams (CTT)
0 Hospitals closed in PA:
0 Harrisburg State Hospital (closed 2006)
0 Mayview State Hospital (announced closure = 2007)
0 Overcrowded hospitals/clinics in PA:
0 WPIC (lack of beds)
0 Mercy Behavioral (waiting list)

9. The “Dangerousness Criteria” is
tricky
0 a “clear and present danger” (with a plan) to self or
others. "Danger" specifically includes:
• the inability, without assistance, to satisfy need for
nourishment, personal or medical care, shelter, and self-
protection or safety.
0 a reasonable probability that death, serious bodily
injury or serious physical debilitation will ensue
within 30 days without treatment.

10. What the “dangerousness criteria”
did to us
0 Involuntary commitment is
nearly IMPOSSIBLE to obtain
0 Must have a “clear” plan &
access to weapons, etc.
0 Patient must admit to having
suicidal or homicidal thoughts.
0 No secondary opinions can
sway a hospital’s decision
0 court cases:
• O’Connor vs. Donaldson
in 1975 and Lessard vs.
Schmidt in 1976.
• Both cases ruled it
unconstitutional to
confine someone capable
of caring for their basic
needs.
• States followed these
trend setters.

11. Today’s mental health system
continued….
0 Arguments against hospital stays:
0 Decrease in civil liberties and autonomy
0 Increased familial involvement without permission
0 Over involvement of state decision making
0 Lack of patient input
0 Stigma
0 Fear of hospital policies returning to those of the 1700s

12. Today’s mental health system
continued…..
0 Confidentiality: your moral or legal right to privacy.
• Confidentiality creates barriers for families
0 HIPAA: Health Insurance Portability &
Accountability Act of 1996 – protects 2 kinds
of patient information:
• Privacy Rule: protects M.H. info from “outsiders”
• Security Rule: protects email, faxed, telephone info about a
patient. Holds healthcare providers responsible for sharing
information.
0 HIPAA creates even more barriers
0 Video: (2:13)
http://www.youtube.com/watch?list=PLACD9536723837201&feature=player_em
bedded&v=FKTHncn-5Vs

13. Avoidable mistakes & failures
0 HIPAA:
• Allow
parents/families/caregiver
access to records when vital
• Release records with verbal
consent & do not require
signatures to release
information
0 Confidentiality:
• If an individual threatens to
harm someone else
• If an individual threatens to
harm him/herself
• If an individual reports that
he/she has been abused
0 Depends entirely on
company policy & therapist
discretion

14. Avoidable mistakes & failures
0 Age of consent laws:
0 14yr olds in PA can
reject tx or medication
w/o parental input
0 Hospital policy:
0 Involuntary commitment
should include input from
family/close friends
0 Should never be turned
away due to low # of beds
0Sen. Creigh Deeds
0John Shick – WPIC shooting
0 Should not be admitted
based soley on plan/access
to weapons/intent

15. Kelley Thomas
(top right)
Dylan Andrew Quick: (bottom far
right)
James Holmes (left)
Adam Lanza (right)
Brandon Michael Hill ( bottom right)
Seung-Hui Cho (bottom left)
Aaron Alexis (bottom middle)
Eugene Maraventano (next to Dylan)

16. Alex Hribal –
Murrysville
stabbing (20
victims)
Elliot Roger (right corner)
Jimmy Dikes (middle to right)
Jared Loughner (bottom)
Sen. Creigh Deeds (bottom middle)
Levi Staver (Richland Township)

17. Thoughts?
0 What do you think needs to change?
0 Can we change it?
0 How does stigma play a role in our thinking about
mental illness?

18. What I think needs to change
0 State laws
• Involuntary commitment -72hr hold, need plan & access
• Age of consent laws – 14+ can make decisions
0 Police Training
• Police training occurs in a few states, but many lack knowledge
0 Anti-stigma movements:
• Ignore severe mental illness & emphasizes success stories
0 Promotion of community treatment only
0 Families need more power w/loved ones
• HIPAA laws should allow close family access in emergencies
• Assisted Outpatient Treatment (AOT)

19. What other’s think needs to
change
0 Dr. E Fuller Torrey: the nation’s most
reputable psychiatrist. Treatment Advocacy
Center.
0 Pete Earley: wrote the book Crazy: A father’s
search through America’s mental health
madness (2007).

20. What other’s think needs to
change continued….
0 Xavier Amador: wrote the
book I Am Not Sick I Don't
Need Help! How to Help
Someone with Mental Illness
Accept Treatment (2012).
0 Congressman Tim Murphy:
believes the kills involving
Elliot Roger were preventable
& has bi-partisan support on a
new bill.

21. Where to get the book
BooksAMillion.com
Amazon.com
BarnesandNobel.com
Carnegie Library
0 On sale today (6 signed
copies) for $10.00

22. How to follow me
0 Twitter: @therapisttee
0 Anchoredinknowledge.com
0 Blogs.psychcentral.com/caregivers