The Halloween triple-murder in Bono, Ohio of William Liske, Jr., his wife Susan, and son Derrick has again focused the public's attention on what to do to prevent violence by people with serious and untreated mental illnesses. If media reports holds up, the murderer was their son William 'B.J.' Liske "who has suffered from schizophrenia and at one time has been off his medications." A violent past was also suggested.
Six rigorous investigations by multi-disciplinary teams just published in October, 2010 Psychiatric Services--combined with previous research--shows Assisted Outpatient Treatment (AOT) could help prevent incidents like this. AOT reduced arrests, homelessness, hospitalization and violence among people with mental illness.
AOT is a law that allows courts to order treatment for certain individuals with very serious mental illness who refuse treatment and have a past history of becoming violent without it. This is the small discrete subgroup most likely to become violent in the future. In addition to committing the patient to accept the treatment, under the "Model Law" AOT 'commits' the mental health system to providing it. All patients are 'forced' to accept a case-manager who facilitates services and monitors compliance. Other services like medications, day-treatment attendance, and substance abuse services are determined by negotiation between the patient's lawyer, and the mental health system and must then be approved by the judge. AOT takes place in the community, making it less restrictive, less expensive and more humane than its alternative: inpatient commitment.
The six studies were based on interviews with patients and an analysis of AOT administrative and clinical services data from New York State which has the most extensive program ("Kendra's Law") involving about 3,000 individuals. The studies span nearly a decade and were conducted largely at the behest of the few who thought it unconstitutional or who doubted AOT would work. Here's are major findings:
"The odds of arrest for participants currently recieveing AOT were two-thirds lower...""(T)he likelihood of psychiatric hospital admission was significantly reduced by approximately 25% during the initial court order"
(Patients) who received court orders for AOT appeared to experience a number of improved outcomes: reduced hospitalization and length of stay, increased receipt of psychotripic medication and intensive case management services, and greater engagement in outpatient services."
Benefits of (AOT)...as indicated by improved rates of medication possession and decreased hospitaliations were more likely to persiste after (AOT) ends if it is kept in place longer than six months.
"In the long run...overall service capacity was increased, and the the focus on enhanced services let to greater access to enhanced services for both voluntary and involuntary patients."
"Taken as a whole," writes Marvin S. Swartz, MD, guest editor and professor of psychiatry at Duke University School of Medicine, the reports "suggest that New York State's AOT program can improve a range of important outcomes for consumers, apparently without feared negative consequences, such as dissatisfaction with services received under court-ordered treatment."
Approximately 1500 murders a year may be committed by individuals with serious and often untreated schizophrenia. The Liske family may have been the most recent three.
California, Tennessee and numerous other states are considering adoption or implementation of AOT Laws. The results of the largest and longest studies show they're on the right track. AOT helps people with mental illness and keeps the public safer.
COMMENT POLICY: Comments are encouraged that address the facts raised. Comments that attack those who support or oppose AOT, are off-topic, or are needlessly repetitive may be deleted. Thank you.
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Perhaps most importantly, in the context of AOT, is medications are mainly used if the patient has a past history of violence (to self or others) that is associated with going off medications. If the 'human-human touch' was successful, the person would be ineligible for AOT. Thank you.
1. Who funded the research that you used to substantiate the effectiveness of AOT?
2. Why was it done only at the behest of the "few who thought it unconstitutional..." and not as a follow up to ascertain whether this is truly the best policy to have in the best interest of those who are court ordered?
3. Given the fact that this Country is in the midst of a mental health transformation that is, consumer driven, where are the voices of the consumer's in this effort to medicate distress?
4. Why is there no effort to protect those with these diagnoses from being victimized by violent crime at a much higher rate than is committed by this group?
5. Why is it the never a tragedy of a person with one of these diagnoses being victimized by violent crime that is capitalized on to bring attention to the advocacy for this group?
Taken as a whole," writes Marvin S. Swartz, MD, guest editor and professor of psychiatry at Duke University School of Medicine, the reports "suggest that New York State's AOT program can improve a range of important outcomes for consumers, apparently without feared negative consequences, such as dissatisfaction with services received under court-ordered treatment." This statement is meaningless without any data derived from negative consequences or from consumers and family members who are dissatisfied with services rendered.
1. The report was funded by the NYS OMH itself an opponent of AOT. That makes the findings even more outstanding, since they were positive in spite of being funded by an opponent.
2. The reason it was done at the behest of opponents, is that there already existed extensive scientific data showing it's effectiveness.
3. Great Question. While some organizations that purport to represent people with serious mental illness, represent religions (scientology), or ideologies, say patients oppose AOT, the research shows consumers overwhelmingly support it: March 2005 research found: • 87% of participants interviewed said they were confident in their case manager's ability to help them • 88% said they and their case manager agreed on what is important for them to work on. • 75% reported that AOT helped them gain control over their lives, • 81% said AOT helped them get and stay well • 90% said AOT made them more likely to keep appointments and take medication. A study by Columbia U. released in 2010 found "(P)eople who underwent mandatory treatment reported higher social functioning and slightly less stigma, rebutting claims that mandatory outpatient care is a threat to self-esteem."
4. Greater use of AOT is an important part of the effort to reduce victimization. AOT has been found in numerous studies to reduce victimization mainly by reducing incarceration and homelessness, the two settings where people with serious mental illness are most likely to be victimized.
5. Your last question is profound. The fact is not many care about people with mental illness. If someone with mental illness is victimized it goes unnoted.
Your final comment seems to suggest that the data was derived without any reference from negative consequences. That is not in keeping with the facts. The data on all studies was derived by studying objective outcomes (violence rates, incarceration rates, homelessness rates, etc.) and others through interviews of those who actually experienced AOT. It is those consumer voices and experience that make up all the studies.
I do want to thank you for putting your questions so appropriately, i.e, you addressed AOT. Thank you for that. I do hope the facts matter and given the facts, you will understand for some, this is a very useful and important treatment that can make a real positive difference in their lives. And that is not just me saying it: it is those who have experienced it.
All due respect to your prompt response to my comment, I am disturbed by your tone. Specifically, in response to question number three, you chose to attack organizations that do not subscribe to your brand of advocacy instead of answering the question about the efforts of the entities you yourself belong to or align yourself with.
I can attest that as a result of my son being court ordered back onto a higher level of medication his functioning DECLINED.
Your response to number five is as much as acknowledging that you and the advocacy you practice this is not part of the effort, period.
Please understand I believe that any one who gets involved in advocating for a marginalized group does so with good intent and may do so for the very same sort of reason that I myself am so passionate about this. That said, the fact is that "the seriously mentally ill" are victimized far more often than they perpetrate crimes, it is not rhetoric. Which leaves me to wonder why, given the forum you have, do not do more to bring awareness to the general public about this? Do you really think that advocacy for these people who are far more often victims that victimizers is not important? I know my son was at a serious disadvantage to protect himself; not due to his diagnosis, but due to the deleterious effects of the treatment your advocacy effort insists is required.
The treatment AOT should include is testing for and treating the underlying causes of psychosis and mania that are commonly labeled as Bipolar Disorder and Schizophrenia.
http://investigatingmentalillness.blogspot.com/p/dsm-iv-classifications-of-psychosis.html
In some cases it is the psychiatric medication that is responsible for violent crimes. The Ryan Ehlis case is an example of the indifference psychiatry has to this fact.
http://icspp-icspporg.blogspot.com/2010/06/despite-slaying-reality-of-psychosis.html
Court ordering an individual to take psychiatric medications could be a perscription for their death.
Too many reporters taking on the subject of "mental illness" are spoon fed information without checking the facts. For example, author Pete Earley misses this fact in his book "Crazy".
http://icspp-icspporg.blogspot.com/2010/10/crazy-commentaries-part-iii-is-fathers.html
The real crime is that psychiatry takes advantage of the lack of knowledge individuals have in what causes psychosis.
I do agree that individuals should have tests to find underlying cause of psychosis as part of finding right treatment regimen.
The claim that a specific med caused a specific person to do a certain violent crime is tenuous at best.
I agree that no one should court order someone to take a med if it will lead to death. That is why patient and lawyer get to participate in developing treatment plan. To the best of my knowledge, not a single person under AOT has died as a result of court prescribed medication.
On the other hand, many have died because they refused to take treatment and many others have killed people because of their refusal to take treatment.
Thank you for your comment.
PS: I would point out to others reading this, that some of the links the above author uses comes from an anti-treatment organization so anti-science, that Dr. Peter Breggin, the founder of the anti-treatment movement, has withdrawn from any association with it.
For many who have received a diagnosis of bipolar and schizophrenia the key to their recovery has been rejection of psychotropic medications, advocated here.
Never ever stop questioning.
Thanks.
1. Mental illness is a real disease (see here: http://bit.ly/9lsC5W ).
2. Most people w/MI are not violent. Most people with serious MI are not violent. A higher percentage of people with serious MI, who have been violent in the past when off medicines, will be more violent in the future if they go off meds. (see here: http://bit.ly/aM2eXh )
3. I agree that there are individuals who have recovered and reject medicines. They would be ineligible for AOT because they are in fact 'recovered'.
Thanks for your comments.