Dr Aaron Meyer and Ann Marie Council part 2: Breaking the Cycle: Why Serious Mental Illness Deserves Better Than Jail or the Streets

What if everything you thought you knew about autism and
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embracing autism and mental health worldwide, real conversations about autism,
mental health and the stories that shape our lives. I'm
Tony Mantor. This is where understanding begins. If this kind
of conversation matters to you, follow the show so you
don't miss what comes next. Joining us today for part
two of our two part series our doctor Aaron Meyer
and Anne Marie Council. Last week's conversation was so insightful
and meaningful, we decided it needed more time. Today we
continue that discussion. It has been said that the La
County Jail is the largest psychological hospital in the country.
How do we correct that?
Preaching to the choir? I completely agree.
Could you imagine I've actually heard someone say, what if
we could take the men's prison in LA and convert
it into actually holistic secured placement treatment and not have.
It via jail. But it's the same people. Yeah, I
think you're onto something.
Well, I haven't been doing this a long time. One
story I hear over and over again, from those that
are in the autistic community and from those that deal
with serious mental illness. It is what I call the
ten year loop. It can take nearly a decade from
the time someone realized something is wrong to the point
where they finally get the right support and feel stable
and safe in their lives. Why does that process takes
so long? And more importantly, what steps do we need
to take in order to break that ten year cycle?
I cannot agree more. I think ten years is not
a conservative estimate. I think that is really well. It
is a conservative estimate because it can take more. It's
very true. The one thing I will say is I
want to I'm hoping people can change the whole idea
of people getting stabilized. And when I say that, it's
kind of like the cycle of I don't know, if
you've ever lost somebody, You go through all these stages,
but then it doesn't mean your emotions aren't going to
well up later and you have to relive it. When
someone is stable, it doesn't mean they're going to be
stable next month. So we need accountability and help for
them outreach so when they do start to destabilize, we
can then give them that intensive treatment to keep them stable.
I think that's necessary. I think that's part of housing
that heals. I don't know if you're familiar with that
by Teresa Pasquini.
I have heard of it, to be honest, I'm not
completely familiar with it.
The idea is that some people do need wrap around services,
and that's the only way that they're going to be
able to live in this society, be productive, and not
have crisis after crisis.
I totally agree. Now this question is for the both
of you. If there's one thing you wish the public
could understand about serious mental illness, what would that be.
If there's one thing that I think should change and
should be and people should be familiar with it, I
think not all access should have to come through a hospital.
I think oftentimes the only way someone can get to
a skilled nursing facility is through a hospital, and it's
difficult to do community placement in California. It's difficult when
the majority of counties limit access to conservatorship to only
a hospital setting, and if the person is chronically unable
to live safely in the community and they may end
up repeatedly cycling through the emergency department through the jail
and never make it to an inpatient psychiatric unit. This
happens with people who are connected to AOT. It happens
to people who are connected to assert of community treatment
wrap around mental health teams, and they're never able to
get to the right level of care because access to
a higher level of care has been restricted to an
in patient psychiatric unit.
I wish that people would focus.
On how government can place hospitals as a barrier between
the person who needs help the most and the governmental
energy that's mandated to provide them that care. I think
it unfairly places hospitals and burdens hospitals and leaves the
person cycling through the system.
Well, I think that was a drop the mic moment,
because I mean, that's just it.
Hospitals are there, especially emergency departments, to help us in emergencies.
How many times do we go to an emergency room
and some of the delay is because there's people there
who clearly have chronic problems and they're going every day,
but they're not getting better. Wise, man, I know, doctor
Aaron Meyer always says that these are the people that
are seen the most but treated the least. So if
we could get that was supposed to be just a
shout out to my partner, obviously, but if we could
get access for chronic disability issues through a different avenue
than the hospital, I think it would be life changing.
And in fact, that's what our paper on fifty two
hundred was basically talking about.
When you think about the future of those dealing with
serious mental illness across the US, and of course in
your state, would all the discussions that are going on now,
what gives you the most hope?
I think what.
Gives me the most hope is that people are getting
sick and tired and they're speaking up. The pendulum is
swinging away from neglect towards an awareness that there is
a population that's not getting served adequately or at all
by our current systems, and that we need to course
correct away from a system that has been only designed
for people who are willing and able to access it.
And I think people are starting to recognize the need
to also care for a population of people who lack
awareness into the severity of their diagnosis due to antisignosia.
Well as usually I agree with all that, and I
would just chime in and say that the advocates that
have been born from tragedy. I think are going to
be the people who move this forward the strongest. We
have parents who lost a loved one, and instead of
just worrying about themselves, they don't want their child to
die in vain. They don't want their love one to
die in vain. They want it to be a message,
a message that the system is broken and that there's
a better way. And I have just so much respect
and admiration for those that do that, take their pain
and turn it into something good, good message.
If you had the attention of every single policymaker, health
care leader, community care leader for just one minute, what
would you tell them needs to change right now?
And I would say, we need access.
We need beds, we need places for people to go.
And we need not only new laws, but we need
our current laws to work, and we need to make
sure that there's effective oversight to make sure that they
work well.
I'm glad you brought that up.
I hate to I just want to say, did you
talk about the fifty two hundred issue earlier in the
podcast not in dept. Did you want to take that
because I think you made a really good point, but
I'm not sure the listeners know the depth of it.
Yes, in California, we have court ordered mental health evaluations
where any person can request to the county that there's
a person who may be danger to themselves or others
or gravely to say so, unable to live safely in
the community. This is in addition to the process where
anyone can call nine one one and request mental health support.
The problem with calling nine one one for mental health
support is that it can be limited to a point
in time assessment where it's linked to an emergency, and
when someone is chronically living in such a state that
they can't live safely in the community, sometimes this can
be dismissed as well. This is the person's baseline, and
so for these court ordered mental health evaluations, the county
is required to do the evaluation and have a more
thorough review than a just a moment in time assessment.
And if there's a reason to believe that the person
is a danger or gravely disabled, they can petition to
the court and if the judge here's the evidence and
believes that there's probable cause, can make an order where
the person either voluntarily or involuntarily comes for a mental
health evaluation. We submitted fifty eight Public Record Act requests,
and no county has an active process for this code
section until we recently found one county in California has
been doing it. And so I don't think there has
been hardly enough oversight by the state into why this
code section isn't being used. And if we had more
oversight and the state had ensured that this code section
was being.
Followed, would we need other laws?
So before creating other laws, sometimes, let's make sure the
ones that we have Werek.
Yeah, let's go into the future twenty years from now
when people look back at what we've done and how
we helped and handled those with serious mental illness. What
do you think they'll find that we did right? Then?
What is it that you wish that we will finally fix?
I think what we did right, and it's funny. We
did it right and we did it wrong. And when
I say we, it was well before any of us
were born, when John F. Kennedy first wanted community treatment
as opposed to asylums, and then Ronald Reagan approved the
LPs Act and closed a lot of the mental hospitals
in favor of this community treatment, letting people live within
the community rather than in these large facilities. Absolutely fantastic idea.
The problem that we'd had was when they closed the facilities,
the money went somewhere else. The money didn't go into
those community treatment options. So we had the right idea,
but the ball got dropped. So now what I hope
in twenty years is that we have a population in
jail that's reduced by at least twenty six percent, because
I know that some of the conservative estimates of those
in jail with serious mental illness is about twenty six percent.
If we can reduce our law enforcement needs, our jail needs,
our court needs, and put it into preventative, holistic, compassionate care,
I think then we can be proud of ourselves.
I'm not sure in the county systems that design public
behavioral healthcare, I'm not sure there's even five percent of
the people who have spent time in an inpatient psychiatric
unit and really know what it's like to evaluate and
treat someone with severe mental illness. People who are unable
to care for themselves. And I think if our systems
were more preferentially directed towards the population who can't care
for themselves, I think we'd see a lot less neglect
and incarceration.
Earlier in our conversation we spoke about community and of
course grassroots efforts to help those with serious mental illness.
If one of our listeners today decides they want to
take and make one effort to help those in their
community with serious mental illness, what would you tell them
to do first?
That's actually a hard one.
I would say, first, change your mindset, because mindset, really
it's the only thing we can control truly, and I
think there is you know, I didn't bring it up earlier,
but if somebody wants to see the paper that doctor
Meyer and I were talking about on this other access
point fifty two hundred, if you go on Quarterturnstrategies dot com,
you can get a free copy of that and just
download it. And the reason I bring it up is
quarter Tern. The reason I called the company that was
because I don't want the pendulum to swing to the
other side.
It's not one or the other.
It's not all voluntary or all involuntary.
I want to turn the system.
Just thoughtfully and a little bit, so we have that balance.
So that's what I would say, is, let's change our
mental mindset to say involuntary care is sometimes the compassionate
and right thing to do, as long as do process
is still maintained.
I think we need to listen to parents more. I
think we need to listen to the experience of parents,
and we also need to listen to people's experience who
have been through inpatient psychiatric units, have been through involuntary treatment,
because I think you would see that not only is
access an issue, quality can also be an issue. And
we have, for instance, for people who are on conservatorships,
we have individualized treatment plans, and sometimes the oversight of
these individualized treatment plans is not existed. The whole purpose
of getting onto a conservatorship, besides the support, is to
get off the conservatorship. And so if we focused on
people's experience within treatment settings and caregivers and families experience
of trying to navigate the system and get high quality care,
I think we could learn a lot. I would hope
that our policy makers and also the people who are
in charge of implementing and designing these systems, would pay attention.
One day you decide to have a reflection. That reflection
can be a week, it can be a month, it
can be a year. It can be any timeframe that
is relevant to this question. What is one story or
experience that fundamentally changed the way you look at serious
mental illness and the health care that we give today.
I know exactly the story. It's obviously a sad one.
We had a patient that the first responders were really
trying to help. They love all their patients in their
own way. They care about them, see them as human beings,
and that is what helps them build rapport, make that connection,
and the goal is to save lives. I know a
lot of energy went into getting an LPs conservatorship or
a chronic alcoholic. He'd been an alcoholic for I want
to say over twenty years. I worked with doctor Meyer
on this case, so I know he knows what I'm
talking about. We thought it was it was just enormous
effort to get this LPs conservatorship. Finally got him in
the hospital. He was cared for, he improved, he looked terrific.
The problem there was nowhere to transfer him. There was
no secured placement treatment program bed for someone who was
a chronic alcoholic. This was about five years ago, so
he was in the hospital warehouse for like eight months
and then released from the ITP, the individualized treatment plan.
What did he do?
Twenty four hours later, he was back in the er,
already drinking too much, and he died six weeks later.
That's a system failure.
We had a problem getting access, But once we get
the access, what doctor Meyer was talking about about those
individual treatment plans is critical.
If we're going to put someone in.
Involuntary care, we better have resources to give them, the
programming to give them and the care that's going to
help improve their lives rather than hurt it.
So my case situation would be somewhat similar. There's a
person who we cared for in the hospital who also
had severe alcohol use disorder, and we had our city
teams bring him a PlayStation because he also had a
long period of time waiting for the next step. He
eventually got to a mental health rehabilitation center where he
did very well, and we.
Would visit him.
A colleague and I would visit him, bring him legos,
things that he'd liked to do to keep his mind active.
And when he was transitioned to a board and care
a different type of residential facility, he quickly left and
resumed drinking and was transitioned. Then not to a more
therapeutic setting, but to a skilled nursing facility as a
forty year old. When we have gaps in the behavioral
health continuum of care where you're going to go straight
from an intensive mental health rehabilitation center to an unlocked
board and care facility, there needs to be somewhere in between.
It's painful and ethically brought for me when I'm considering
what's the best situation for this person, for him to
be repeatedly through the er head trauma after head trauma,
intoxication after intoxication, versus in a skilled nursing facility where
he's probably not cognitively engaged. And it's situations like that
where the system failures lead to I think me feeling
haunted by that situation.
Let's say a listener happens to come into this conversation
a little later than we anticipated. What is one important
thing that you think they need to take away that
could be so very important to the surroundings that they
may be dealing with today.
Well, I think on a broader level, mental health touches
us all, and I think that if the stigma stays
and people don't talk about it, you know, my son
is a problem, we can't talk about it. Or my
wife has a problem, we can't talk about it. Then
that obviously pushes the stigma medical insurance, which doctor Meyer
is more of the expert on that than I am.
But we don't have parody of treatment.
If you come in with a heart condition, there is
a treatment for you, and you're going to get that.
If you come in with this severe mental health condition,
maybe you'll get released, maybe you'll get care.
It's not treated the same way. It's not underested in
the same way.
I am so glad you brought that up. I had
this one conversation with a gentleman about his son who
was going through some serious mental illness. He was walking
down the street completely naked and thought he was invisible. Luckily,
he had two really good policemen that came across him.
They put him in the back seat, They did not
handcuff him. They turned on his favorite music, god him
really comfortable. They took him to a hospital and the
hospital said, I'm sorry, we can't treat this person. Yeah,
as luck would have it again, he had a great
first responder, and he asked the doctor what his address was.
The doctor replied what does that have to do with anything?
He said, since he's not a problem, we're going to
drop him off at your house. Wow, then things changed,
they treated him. How do we get past that that
kid needed help? He wasn't a danger to anyone else,
There was no clear danger to himself, but it definitely
showed he needed help. If it wasn't for that good
policeman doing what he did, he would not have received help.
How do we change that scenario?
I mean, what you're asking is, how do we get
people to wake up?
You are one hundred percent correct?
How do we get people to pay attention and think
about themselves in that situation, to have a little bit
of empathy and to I think if empathy led our systems,
we'd have more person centered systems versus system centered care
where looking at how someone can be excluded versus how
we can include someone. And I think we need to
have a much more inclusive behavioral health system that doesn't
discriminate against people who are unable to engage or doesn't
exclude people with physical health diagnoses. We need an integrated system.
And so I would encourage your listeners to help wake
people up.
You know a funny thing about that story, and there's
nothing funny about that story. A good argument could be
made that he was obviously a danger to himself because
he is so vulnerable walking around naked, walk.
Into traffic, the attack.
I mean, so the idea that he wasn't a danger
to himself I do take cause with.
However, I think.
Everybody seems to think you need an emergency to get help,
and that is the practice, isn't it, Because an emergency
department like we talked about earlier, is there for emergencies.
But that's not how the code is written. The code
says danger to self or danger to others. That's half
of it. But the other half is or gravely disabled.
And someone with grave disability is not in an acute
crisis except for the fact that they're an acute crisis
every day for their entire life. They're in a chronic
state of being not able to manage their basic needs.
It can be because of mental health problems or substance
use disorder problems or both. But until we actually follow
the rules that we have, we can't hope to change.
Just like doctor Meyer said, it's not even about new laws,
it's why aren't we following the ones we have, that
person should not have been released.
And we need to get to a point where you
talk about destigmatizing, but we need to stigmatize physician responses
like that. We need to stigmatize behavioral health systems that
exclude people who are unable to access them due to
the severity of their diagnosis. So we need a lot
more intolerance of systems that have lack of access, of
responses that don't acknowledge the reality of a situation. And
until we have situations where people are automatically peer reviewed
for not prescribing or recommending substance use disorder treatment, where
people are automatically peer reviewed for inappropriately dismissing people who
are clearly unable to live safely in the community, I
think until we can get to a point of both
governmental accountability and healthcare accountability, we're still going to see problems.
Unfortunately, we are a country of it's not a problem
until it affects our family in some way. We need
to change this dynamic. They will hear things on the
news and not do their research, only to be totally misinformed.
Before I started this podcast, I knew nothing about autism
or serious mental illness, absolutely zero I would hear the
bad things that would happen on TV, and I thought,
like everybody else, put them in jail, throw away the key. Now,
after doing this for a while, my first reaction is
not that I want more information. Are they really bad
people that just do bad things because they are out there?
Or are they a product of a system failure? How
do we get people to change their view, not only
just people in society, but within the system, because if
the system doesn't change, nothing changes. How do we get
them to realize that we have to make sure the
system does not fail those that are in dire need
of our help.
So we need a lot more. We need a lot
more people who do podcasts. We need a lot more
investigative journalists who are holding people accountable and asking questions
to the government and publishing it because I think people
want accountability.
People want to.
Know that their systems are addressing the problems they see
before their eyes, and I think journalism is one of
the main ways that can cost change.
I also want to do a call out to the
incredible hospital emergency physicians that are having to battle this.
I cannot tell you how many calls I've gotten because
I've been working with doctors for several years, and they'll say,
I have someone.
Where does he go? What's available? What placement options do
I have?
And I feel like if those were available, I think
they would be a lot quicker to say, Okay, this
meets the burden. We can transfer them to get help.
But if we have blocked access and nowhere to put them,
that's pretty hard to fix. So I think we definitely
need to fix where people can get the treatment, and
then I think access will also improve.
When you really look at the homelessness situation, a lot
of people on the streets aren't there by choice. Many
are dealing with severe mental illness and simply have nowhere
else to go. When the only options become the streets
or a jail cell, something in the system is clearly broken.
How do we start building real places for people to
go before it ever gets to that point?
So much of that, I mean, obviously the number one
cause of homelessness is lack of housing, and housing is
healthcare in many instances right, And also housing alone often
isn't enough for some people with the most severe mental
health diagnoses, the most severe addictions, and so we need
a continuum of housing support and I think we need
to be a lot more flexible about what people need
it and what is in localities.
I just want to say that that is just so
spot on with needing the continuum of housing, and I
don't think I understood that as much until I got
into this work. But if you imagine, there's so many
different reasons that someone is homeless. If someone lost their job,
had no family, maybe they immigrated from another country. Maybe
they just need that housing and they can get back
on their feet. But if someone has severe substance use disorder,
they are at the point where all they want is
their next fix, and they may not care about themselves,
so how are they going to care about anything else?
So they get a brand new apartment and what do
they do, Well, they destroy it because they.
Don't have respect for themselves.
Why would they care about their surroundings makes the apartment
look like they feel inside.
But if we give housing that heels where we have.
Treatment and we have housing and we have opportunity, then
I think that's the only thing that's going to work.
Housing first cannot work with the severely mentally ill.
This conversation has been so great, great insight and conversation
I could go on forever with conversations these topics. In closing,
what is one bit of information that our listeners need
to hear that you think is important. Hopefully this way
they can do more research on the positions and not
just the ones that you've been talking about, the ones
they need to hear to better understand what needs to
be done.
I would say, when you hear something, question it. In
other words, just because doctor Meyer and I are explaining
what our experiences, question it. Research it. Make sure that
you're making your own decision. One thing that I have
a really hard time with is information coming out that
is just not true. I remember when doctor Meyer was
talking as a subject matter expert on LPs, and the
opposite side of the conversation, who was against involuntary treatment, said,
oh my gosh, this is Britney Spears all over again. Well,
someone in the audience might think, oh, Britney Spears, that
was a terrible situation.
What then, don't realize is that it has nothing to
do with LPs. That was probate. But if we don't.
Question what we hear and make our own informed decision,
we're going to go by headlines, and then we're going
to believe nonsense. So I would say, take the time
to educate yourself and you'd be shocked. There's a lot
of like minded people out there who are seeking.
The truth, and I would say get involved. So in
San Diego County, for instance, we have a behavioral Health
Advisory board. Every county has behavioral health advisory boards where
the public is invited to attend and is able to
make public comment. I think there are opportunities for voices
to be heard. And one of my hobbies is reading
the law, reading the code at night. So I would
encourage people to take a look at your state's laws,
find out more about why the system might be failing.
Attend you know, board of supervisors meetings, look at laws,
and I think, don't accept the status quo and don't
adopt a fatalistic mindset.
Well, this has been tremendous information and great conversation. I
really appreciate you taking the time to join us today.
Oh yes, pleasure, Thanks for the invitation.
It's been my pleasure. Thanks again, a sincere thank you
to our guests for sharing their journey. If today's conversation
helped you see the world a little different, then we're
doing exactly what we hope to do until next time.
Keep believing, keep learning, and most importantly, keep asking yourself,
why not me