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State Mental Institution Library Education (SMILE)

 

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To amend Chapter 4 Saint Elizabeth’s Hospital by replacing Subchapters I Establishment And Management; Pensions, Moneys, And Appropriations and; Subchapter II Inmates; Burden Of Expenses Thereof; Detention Of Insane; and renumbering Subchapter III Mental Health System for the District of Columbia to Article X, transfer §321-329 from Chapter 9 Hospitalization of the Mentally Ill National Returned from Foreign Countries to Article 6 §189-194 of this Chapter and to change the name of the Substance Abuse Mental Health Service Administration (SAMHSA) to the Social Work Administration (SWA) to transfer responsibility for the adjudication of mental illness to the licensed social workers of  the Board of Mental Health under the supervision of the SWA and to close all private psychiatric hospitals and state mental institutions.

 

Be the Democratic and Republican (DR) mad house Dissolved, referred to the National Alliance for the Mentally Ill

 

1st Draft August 2004, 2nd May 2005 3rd 28 February 2007, 4th 30 July 2007, 5th 20&22 April 2009

 

1.This Chapter may be titled the State Mental Institution Library Education (SMILE) and the Act the Social Work Act (SWA) to convey, The idea that a free public library education is the ideal treatment for otherwise unemployed people suffering from mental illness, the diagnosis of mental illness or discrimination on the basis of alleged mentally illness in order to freely express their thoughts as they relate to other published author’s thoughts, in writing.  A plan of action for the establishment of a Social Work Administration (SWA) to supervise and replace the federal Substance Abuse Mental Health Service Administration (SAMHSA) and local county Boards of Mental Health and Substance Abuse with the potential to negotiate to consolidate the administration of Family and Children Services, Agency on Aging, Social Services Block grants, within the Department of Health and Human Services, until such a time the social workers are all employed by the Social Security Administration (SSA).

 

2. St. Elizabeth’s Hospital, in was founded by Dorothea Dix in 1855 with a maximum capacity of 250.  However by the 1940s, the Hospital complex covered over 300 acres and housed 7,000 patients. It was the first and only federal mental facility with a national scope. Politicians were importing mentally ill people.  In 1987, the National Institute of Mental Health (NIMH) acting in behalf of the federal government transferred the hospital operations to the District of Columbia, while retaining ownership of the western campus. Under the regulation of the District of Columbia Council the patient population steadily declined, and the Hospital now houses only 600 patients in 1992.  

 

3. The World Health Organization Report on Mental Health of November of 2001 estimates that mental illness and psychological disorders stemming from substance abuse affect a combined total of 450 million people, 7.3%, of the 6,137,000,000 global population.  The Surgeon General’s Report on Mental Health of 1999 stated that 55% of Americans suffered from mental illness at some time in their life and 1 in 5 Americans experience a diagnosable mental disorder in any given year, more than 5% serious.  Suicide is the 3rd leading cause of death among 15 -24 year olds. In 1997 30,535 people died from suicide in the U.S.  It was the 11th leading cause of death in 2000 for all age groups.  The highest suicide rates are found in white men over the age of 85.  Mental health treatment has always been rife with abuse, false arrest and torture.  

 

4. The diagnosis and treatment of mental illness is performed by 40,000 psychiatrists and over 1 million mental health professionals.  Mental illness is the second leading cause of disability, costing disability insurance an estimated $24 billion, medical insurance $65 billion annually with expenditures by mental health organizations growing from $3.3 billion in 1969, to $38.5 billion in 1998 and 2002 declining to slightly more than $34 billion.  Psychiatric medication has become an accepted method for treating mental illness since the deinstitutionalization movement began in the 1950s.  Psychotherapy is a general term for a way of treating mental and emotional disorders by talking about the condition and related issues with a mental health professional. It’s also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.  Through psychotherapy sessions, one may learn about the causes of the condition to better understand it, learn how to identify and change behaviors or thoughts that adversely affect your life, explore relationships and experiences, find better ways to cope and solve problems and learn to set realistic goals for life.

 

5. The most prevalent mental diseases are; a. “major depressive disorder” affecting 9.9 million people or 5% of the U.S. population every year; b “Bi-polar disorder” affecting 2.3 million U.S. adults or 1.2 % of the U.S. population; c. “Schizophrenia” affecting 2.2 million U.S. adults about 1.1% of the U.S. population; d. “Anxiety disorders” affecting 19.1 million U.S. adults; e. “panic disorder” is an anxiety disorder that affects 2.4 million U.S. adults, f. “Generalized Anxiety Disorder” is an anxiety disorder affecting 4.0 million or 2.8% of the populace, g. “Social Phobia” affecting 5.3 million or 2.8% of the populace.  h. “agoraphobia and specific phobia” affects 5 million people.  i. “Attention Deficit Hyperactivity Disorder” is a disorder that affects 4.6% of school age juveniles.  j. “Alzheimer’s disease” affects an estimated 4 million senior citizens.  k. According to US Army reports the suicide rate for American soldiers serving in Iraq is 17.3 per 100,000, nearly five time the rate for the Gulf War and 11% higher than for Vietnam.  Over 19% of OIF veterans and almost 12% of OEF veterans reported some mental health concerns (e.g., PTSD, depression, and anxiety).  Nearly 10% of OIF veterans and 5% of OEF veterans reported symptoms of PTSD.  Even when using a strict definition of anxiety, depression, and PTSD, they found that 8% of those surveyed reported anxiety, 8% reported depression, and 13% acknowledged PTSD-type symptoms.  The National Vietnam Veterans Survey (1990) found that 15% of veterans surveyed could be diagnosed with PTSD at the time of the survey, but that as many as 30% of veterans eventually developed PTSD at some point following their combat experience.

 

6. During 1999 there were 1.7 million admissions to inpatient psychiatric treatment. 424,450 were involuntary commitments.  Although the number of resident patients has gone down the overall number of admissions has increased.  In 1963, when the Community Mental Health Center Construction Act was passed, the median stay in a psychiatric hospital was 17 days and mean 20 days.  In 1975 the median stay was 6.7 days and the mean 11 days.  Since the 1950’s public funding policy has been to close state mental institutions in support of community based care.  The number of patient care episodes has both greatly increased and become increasingly directed to less than 24-hour treatment facilities.   In 1955 there were 1.7 million care episodes of which 77% were treated in 24-hour care facilities.  By 1971 there were 4.1 million cases of which 58% were treated in less than 24 hours, by 1998 11 million care episodes were treated only 24% of the time in 24-hour treatment centers.  The numbers show that de-institutionalization policies between 1970 and 1998 have been successful in reducing the supply of totally government funded psychiatric beds by a total of 376,704.  State and county mental institutions having reduced their number of inpatient beds from 413,066 in 1970 to 63,525 in 1998.  Likewise VA medical center psychiatric beds went down from 50,688 in 1970 to 13,301 in 1998. To compensate private psychiatric hospitals, non-federal general hospital and residential centers for emotionally disturbed children that are funded 68% by private clients’ HMO have increased 51,348 beds.  Between 1970 and 1998 Private psychiatric hospitals have increased in patient population from 14,295 to 33,635, Non-federal general hospital psychiatric wards have increased from 22,394 to 54,266, residential treatment centers for emotionally disturbed children increased from 15,129 to 33,483.  The total number inpatient beds of all “mental institutions” declined from 515,572 in 1970 to 198,195 in 1998.  The objective is to increase the number of residential treatment beds and reduce the number inpatient beds.

 

Psychiatric Inpatient Population by Type of Institution 1970-1998

 

Source: Substance Abuse Mental Health System Administration

 

7. In 2000 at the Conference on the Report of the Surgeon General Ohio Director of Mental Health Mike Hogan Phd promised to, “close all state mental institutions and private psychiatric hospitals to provide unimpeded access to community mental health.”  The message seems to have gotten through, on June 18, 2001 President Bush signed E.O. 13217 Community Based Alternatives for Individuals with Disabilities to (1) commit the United States to community based alternatives for individuals with disabilities (2) community programs foster independence (3) unjustified isolation or segregation through institutionalization is prohibited (4) states must take responsibility to place people with mental disabilities in community settings (5) states must ensure that all Americans have the right to live close to their families and friends, to live independently, to engage in productive employment and to participate in community life.  WHO recommends that in the future, “governments take responsibility for providing treatment for mental disorders within primary care; ensuring that psychotropic drugs are available; replacing large custodial mental hospitals with community care facilities backed by general hospital psychiatric beds and home care support.”

 

8. Dr. Hogan was appointed head of the New Freedom Commission on Mental Health in April 2002 as a commitment to eliminate inequality for Americans with disabilities.  Mr. Hogan is now Commissioner of the New York State Office of Mental Health.  The Freedom Commission found. Stigma remains a significant problem.  A diagnosis of mental illness is often accompanied with fear and hostility by the general public not to mention a person’s own friends and family.  Stigma decreases the willingness of people with mental illness to seek or pay for services. People with mental illness need choice and availability of acceptable treatment options or they are unlikely to engage in treatment or to participate in appropriate and timely interventions.  Thus giving access to a range of effective community based treatment options is critical to achieving their full community participation. Despite the potential millions of people with severe mental illness lack housing to meet their needs.  Participation by people with mental illness in service planning should be a priority and policy makers should increase opportunities for participation. 

 

9. Unlike other medical specialties the quality of care for Americans with mental health problems remains as poor today as it was several years ago.  This comes after decades of political improvement. Patients on antidepressant medication are about as likely to receive appropriate care today as they were in 1999.  Similarly, patients hospitalized for mental illness are only marginally likely to receive appropriate follow-up care according to the National Committee for Quality Assurance in 2006.  Even more alarming, Joseph Parks of the Missouri Department of Mental Health reports that people with serious mental illness die at age 51, on average, compared with 76 for Americans overall.  Their odds of dying from the following causes, compared with the general population.  3.4 times more likely to die of heart disease.  3.4 times more likely to die of diabetes.  3.8 times more likely to die of accidents.  5 times more likely to die of respiratory ailments.  6.6 times more likely to die of pneumonia or influenza. Adults with serious mental illness treated in public systems die about 25 years earlier than Americans overall, a gap that's widened since the early '90s when major mental disorders cut life spans by 10 to 15 years. 

 

10. Torts are infractions of law from whence a substantial right to just compensation for actual or statutory damages is derived.  Torture is the cruel and wanton infliction of pain and physical or mental suffering on an individual in legal custody.  Institutional psychiatry has a long history of physical as well as mental abuse.  The stigma and discrimination of a diagnosis of mental illness can haunt people for the rest of their lives, however many formerly mentally ill people have gone on to lead successful lives and many have taken the time to report and litigate the cruel and unusual treatment they received and many receive SSDI on the rational basis of their diagnosis of mental disability.  In general, it is a struggle to keep the day-to-day operations of the psychiatric institution at a first-degree misdemeanor level for involuntary treatment by a legal authority paying lip service to all due process requirements.  Felonies occur frequently. When former patrons hire psychiatrists to civilly commit their dependents.  When private hospitals falsely arrest people and sell their persona to CMS, state and local government.  When there are adverse reactions to enforced medication.  When patients are physically or mentally abused or killed by staff or other patients.  When patients are denied medical treatment. When patients are denied access to community shelters.  When torturous biological experiments or court orders cause insanity or physical illness or death.  Under 24USC(9)§326 (1&2) a psychiatric hospital must commence judicial proceedings for all involuntary commitments within five days.  Timely torts regarding release create an enforceable Mental Institution Relative Release Order Request (MIRROR).  Should the MIRROR be broken, community integration is enforced under 24USC(4)III§225.

 

Sanders, Tony J.  Hospitals & Asylums. Social Work Act. Chapter 4: State Mental Institution Library Education (SMILE). 5th Draft. 20 & 22 April. 120 pgs.  www.title24uscode.org/SMILE.doc

Test Questions www.title24uscode.org/smiletest.doc