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When Russell Weston, a person known to have been treated for mental illness, shot and killed two police officers at the U.S. Capitol last month, the incident made national headlines and focused public attention on the treatment of the severely mentally ill and prevention of violence.
In the wake of the tragedy, APA and consumer advocacy groups have spoken out about the failure of the mental health system to help individuals like Russell Weston. Last month APA and the National Alliance on Mental Illness (NAMI) applauded Representatives Marge Roukema (R-N.J.) and Marcy Kaptur (D-Ohio) for urging House Speaker Newt Gingrich (R-Ga.) to establish a special task force to review the state and federal health care delivery systems for the mentally ill.
"For too long, those suffering from mental illness have been subjected to gaps in treatment that is unconscionable," according to Jay Cutler, APA's special counsel and director of government relations.
APA President Rodrigo Muņoz, M.D., commented in a press statement, "We look forward to the institution of this task force and its report to Congress on the results of its probe and legislative recommendations."
Muņoz later told Psychiatric News, "The tragedy involving Russell Weston represents an awful national situation where people are hurt because those who need help don't have immediate access to psychiatric treatment. We want to make sure that we have proactive strategies so that these impaired patients don't escape the mental health system safety net. We need to create coalitions to better support these individuals."
NAMI's executive director, Laurie Flynn, also applauded the proposed national task force and recommended that it address the gaps in the mental health care system by implementing a full spectrum of services that include the following four critical elements:
NAMI has also published a detailed manual describing how to implement assertive community treatment programs. The manual, PACT Model of Community-Based Treatment for Persons with Severe and Persistent Mental Illness has been distributed to state mental health directors and program administrators. Flynn commented, "The manual is based on the recognition that schizophrenia is a medical illness. APA's Board of Trustees and its district branches can help in this effort by promoting assertive community treatment programs."
Flynn added, "We believe that had Russell Weston been part of an assertive community treatment program when he was discharged from the hospital, this tragedy might not have happened. Like many with severe mental illness, when he failed to keep two or three appointments, he was dropped from the rolls."
APA's Division of Public Affairs also responded to the Weston shooting tragedy last month with a statement about schizophrenia to reassure the public that the "vast majority of people with schizophrenia and other mental illnesses are not a danger to themselves or to the people around them." The statement also notes that "many who need treatment don't get it because public mental health systems nationwide are chronically underfunded and lack the resources to adequately care for patients, and most private health insurance plans don't cover treatment of mental illnesses like they do medical illnesses."
According to APA's director of public affairs, John Blamphin, "The next opportunity for us to speak out will be at Weston's arraignment if the insanity defense is used. At press time, Weston was scheduled to be arraigned in mid to late August in Washington, D.C.
Ronald Shellow, M.D., chair of APA's Joint Commission on Government Relations, commented to Psychiatric News, "The tragedy of Mr. Weston's case points to the need for continued advocacy efforts for parity and third party coverage for mental disorders and for coordinated care for schizophrenia and related disorders. It's important that the severely mentally ill be in an integrated system where they can get medication, supportive education, and help for their families."
Shellow added, "Many managed care companies and community mental health centers are deficient in providing coordinated comprehensive care."
Paul Appelbaum, M.D., past chair of the Council on Psychiatry and Law, told Psychiatric News, "This episode highlights the fact that all states have mandatory inpatient commitment laws but only a minority have laws that require mandatory outpatient treatment in the community upon discharge. This raises questions about our disconnected system of care and the scope of mandatory treatment."
Appelbaum noted that APA developed a model statute for outpatient commitment over a decade ago and many district branches have lobbied for passage of such laws in their jurisdictions. "However, they face two obstacles. Civil libertarians object to what they see as expanding the scope of coercive intervention and there is also a lack of state funding for the treatment of the mentally ill. Many legislators are delighted to see people wander away from the system because it means one less person to treat and pay for."
Appelbaum added, "Even in states that have adopted outpatient commitment laws, there has been insufficient funding, which makes them a hollow gesture."
For more information on related subjects see NAMI's web site at www.nami.org.