The struggle to treat mental illness

Families of severely mentally ill adults struggle to support their loved ones

When "Jake Johanson" had his first psychotic break on his 21st birthday, his parents worked hard to find a psychiatrist and medications that worked for his schizophrenia. For the next three years, he was a model of recovery. He lived with his parents and took his medicines every day. He ate nutritious, regular meals. He graduated from college and got a full-time job.

"We couldn't ask for a more normal son," his mother recalled.

Two years ago Johanson moved to Monterey for work. Over time, he stopped communicating with his family. He lost his job and possession of his car; then he couldn't pay his rent.

"We had not seen or heard from him at all for the past 1 1/2 years," his mother recalled. "In October, we were notified by his landlord that he had been evicted. We went down to bring him home, but he did not want to come back."

Johanson's parents faced a hard reality known to many families with severely mentally ill loved ones: They don't have control over their son because he is an adult. And when the loved one forgoes treatment for the illness and ends up living on the street or becoming incarcerated, family members say, that lack of control turns to anguish.

Over the next several months, Johanson's parents sought to keep in contact with their son. They drove to Monterey every weekend and learned that he was sleeping in the sand dunes, shielded from the elements only by a thin sheet. At one point, they filed a missing-persons report.

One day, they found him at a recycling center.

"He was so paranoid and symptomatic that he told us to go away," she said.

Johanson's parents lobbied police to take him in on a 5150 hold — a legal procedure allowing authorities to place persons involuntarily in a hospital for evaluation. But when police officers did a welfare check on Johanson, he was coherent and eating — albeit junk food — so he did not meet the criteria for a 5150 hold, police told the family.

"It was mind boggling. He has a mental illness. He has no insight into his condition," his mother said.

Johanson's parents again lost track of their evasive son. In mid-January, he was found sleeping in filth in an abandoned building, and he had lost weight, she said.

"It was a mess. When (police) saw that, they took him in on a hold. I felt such relief. It was the first time in months and months that we were able to help him. He was taken to the emergency room, and he had a bed to sleep in and a warm and nutritious meal. It was a prayer of gratitude," she said.

Johanson was taken to a locked institution in Sacramento the next day, but the relief his parents felt at knowing where he was didn't last. The Health Insurance Portability and Accountability Act (HIPAA) prevents hospitals from releasing any information about an adult's medical condition unless they sign a waiver; and their son has not signed a consent form, she said.

Johanson's mother believes the pendulum toward patients' rights has swung too wide.

"The privacy laws and HIPAA rights have gone too far when his parents, who are his only advocates, can't help him," she said.

No one wants to return to the days when people with severe mental illnesses were chained to their beds, say family members and health professionals. But some families want a greater ability to compel treatment for a loved one who refuses treatment, and they want less restrictive conservatorship laws.

But there are mental health professionals and patient advocates who reject those ideas. They say there are already laws to compel treatment in cases where people will harm themselves or others. And those with mental illness could be harmed more when constrained to undergo treatment they don't want, advocates say.

Additional laws restricting individual rights are not the answer, they argue, but greater funding for outpatient programs and community facilities that provide appropriate care is.

Thousands of Santa Clara County residents are hospitalized annually for a serious mental health issue, ranging from debilitating depression, threats of suicide or violence, mania and psychotic episodes caused by schizophrenia and bipolar disorder.

Throughout Santa Clara County in 2012, more than 6,500 people were hospitalized for a mental illness in private and public facilities, according to the California Office of Statewide Planning and Development. Of those, Stanford Hospital's emergency room saw 1,254 patients with mental disorders, or 3.9 percent of overall emergency room visits. The hospital admitted 794 patients with mental illness of all types and transferred 248 people to other hospitals, according to the state report.

The percentage was similar for El Camino Hospital in Mountain View. The emergency department

at the county's public hospital, Santa Clara Valley Medical Center, saw 12,886 mentally ill patients, which accounted for 17.5 percent of its overall emergency visits. It admitted 1,526 patients and transferred 2,250 to other facilities, according to the state database.

The majority of mental health admissions were for psychoses, the report stated. During fiscal year 2011-12, Stanford diagnosed 641 patients with psychoses; El Camino Hospital diagnosed 803 patients and Valley Medical Center 1,447.


Advocates and families hotly debate whether severely mentally ill persons, such as those with delusions, should have a right to choose — or are capable of choosing — their care.

Kathy Forward, who has a sister who has been hospitalized for delusional or psychotic episodes numerous times and who also has a mentally ill son, believes that many are not capable.

Forward is the executive director of the National Alliance on Mental Illness (NAMI) in Santa Clara County, although she emphasized that she was speaking for herself for this article and not for the organization.

Forward said the law makes it too difficult to hospitalize someone with psychosis.

"I strongly believe in people's individual rights. There are many levels of mental illness. But when that rationality, that reasoning is gone, we have to protect people," she said.

Forward's sister has been ill with schizo-affective disorder (schizophrenia and a mood disorder) since she turned 18. Her sister is compliant with taking her medications, but if they stop working, there is no reasoning with her, Forward said.

"She thinks she's clairvoyant and working with the police department. She will say that her boyfriend is a racist, and there are serial killers all around her. She has just been in the hospital two times in the past three months. She thinks she is pregnant. I can try to hope that if she goes to the hospital that someone will recognize she is ill and will treat her. She doesn't see anything is wrong," she said.

Since the Sept. 11 terrorist attacks, society has been less tolerant of delusional persons. Her sister's calls to the police have gotten her arrested, whereas before police would take her to the hospital, she said.

The stigma of mental illness plays a large role in noncompliance with treatment and acknowledgement of illness. And social ignorance of mental disorders adds to misconceptions, she said.

Mental illness should not be treated any differently than dementia and other brain disorders that impair cognitive function, Forward said.

"It's a brain illness. When people get Alzheimer's or dementia, we don't let people walk on the streets. ... With any other severe illness, they would ask, 'Where's your family?' But not with mental illness. It's not only the person but families are also destroyed by the illness," she said.

Palo Alto resident Gloria Bush, 72, lived on the streets for 15 years. Last Dec. 21, she died of hypothermia in Heritage Park.

Her daughter had sought for years to help her homeless mother.

Bush was hospitalized at age 18 for a mental illness and again in mid-life, her daughter said. She led a meaningful and functional life until she had another psychotic break in her 50s. She lost her job, and she ended up on the street.

When Bush became homeless, she was guarded with people, but she initially accepted help from strangers and family. She stayed in shelters, took their gifts of clothing and money, and she had hopes of holding down a job and getting her own apartment again, her daughter said.

But gradually, she became harder and harder to reach. She stopped staying in shelters, turned down housing when it was offered, wouldn't accept financial assistance, and refused to draw on her Social Security benefits or apply for Medicare, her daughter said.

Bush's daughter recalled her frustration as she tried to help her mother. Before Bush became homeless, her daughter called the Santa Clara County Medical Center's mobile mental health unit to get a psychiatric evaluation for her mother. The woman who arrived started the interview, but then Bush refused to talk further. The mental health professional confirmed there was definitely something wrong with Bush, but she didn't have enough to diagnose her, her daughter said.

"The biggest challenge I faced with my mother's situation is that she refused any treatment. The fact that she denied even having a mental illness made treatment nearly impossible. Legally, unless she threatened to hurt herself or someone else or was gravely disabled, no one could force her to accept treatment," Bush's daughter said, referring to the 1972 Lanterman-Petris-Short Act, which states people must be considered a danger to themselves or to others, or they must be "gravely disabled" and unable to feed, clothe or shelter themselves.

"I felt frustrated and helpless. It was heartbreaking. It was difficult just accepting that this wonderful, kind, strong woman who raised me was mentally ill," her daughter said.

Bush's daughter began a long process of consulting with mental health professionals, homeless outreach workers, National Association for the Mentally Ill representatives and the local police about conservatorship over her mother.

"No one thought it could happen in my mother's case. It would have required the police taking her to Valley Med for a 72-hour hold, and then the health professional recommending conservatorship before it could go to court. Some thought my mother would be happier having her freedom, even though she was living on the street, than confined in a facility," she said.

Seven years ago, Bush cut off contact with her daughter.

When Bush's daughter and son-in-law came to Palo Alto to find her, Bush was at the nonprofit InnVision Shelter Network food closet, but she did not recognize her daughter. She called her daughter an impostor.

The family stayed in contact with outreach workers at InnVision Shelter Network. While workers checked on her welfare, Bush always refused offers for housing and other assistance, officials there said.

As Bay Area temperatures plummeted last December, Bush's daughter again called InnVision Shelter Network out of concern for her mother's welfare. Staff searched for Bush, but she was not found.

Bush died of hypothermia, lying on the ground next to her favorite bench, according to the Santa Clara County Coroner.

"If my mother could have received treatment early in her illness, it's possible that she could have continued the life she deserved. The longer she went without treatment, and the worse her illness became, the less likely she could ever live a 'normal' life again. Like many illnesses, early intervention is so important," Bush's daughter said.

Laws that protect an individual's rights are "extremely important," she said. "But in some circumstances, it does go too far. In my mother's case, I was unable to get conservatorship for her. A particular sticking point was the criteria for determining whether or not someone is 'gravely disabled.' Inability to provide shelter is one of the criteria, along with food and clothing. I was told that sleeping under a tree or in a doorway can be considered shelter, so my mother did not meet that requirement," she said.


Some mental health professionals think that compelling a person to take treatment may do more harm in the long run, except in cases in which someone poses a clear danger to themselves or others.

Momentum for Mental Health, the largest private nonprofit provider of mental health services in Santa Clara County, serves 3,800 people annually at multiple locations, including Palo Alto. Its programs include residential treatment that provides alternatives to hospitalization, assisted living and outpatient treatment programs that help mentally ill persons maintain independent living, and family support.

Momentum's outreach focuses on developing a strong rapport with the individual and building trust. Paul Taylor, president and CEO, acknowledged that trust can take years in some cases.

"I wish I had a magic bullet, single answer for you. There are some people, who out of anger and frustration, need to force people against their will and put them in a hospital. While I understand those feelings, there's a reason people don't want help from the system," he said.

There is a time and place when someone needs to be kept safe and monitored in a hospital setting, he said. But being handcuffed and put into a squad car or being hospitalized or given medications with severe side effects can be traumatic. Sometimes people have agreed to accept help, but then they've had frightening experiences, he said.

"It's about building a relationship with somebody. It is not a simple thing — it's hard. People with severe mental illness are more like people without mental illness than not. What makes for a relationship is the same as for anyone. If you feel respected, if you feel listened to and you feel treated as an equal, you are more likely to trust someone. That's where you start. People have to be willing to talk to you.

"If someone is unwilling to talk to you, no matter how hard you try you won't succeed. You cannot win a food battle with a child unless you sit on them and pry their mouth open. You can't force them to swallow. It's the same thing — it's like forcing a child," he said.

Some of the most severely ill people are capable of making choices — just not the choices their families and others think they should make, he said.

Taylor tries to meet the person based on their wants and needs.

"We don't say, 'You've got bad judgment because you don't want help.' Instead, we'll bring a blanket and a sandwich. It doesn't matter if someone is ill or not. Everybody always wants something. It's not your job as a mental health professional to convince someone to adopt goals you think are good for them. It is your job to get them what they want. If someone who is unhoused wants to be a schoolteacher, you can help them to take the first step. You can ask what they think the first step might be. Maybe it's washing your clothes. If they stumble on a step, you never tell them it's a terrible mistake or say it's too ambitious," he said.

Brian Greenberg, vice president of programs and a psychologist at InnVision Shelter Network, said building relationships with clients and offering small incentives — conditional reinforcement — can slowly leverage relationships and encourage people to take housing and medical services.

"We give away a lot of things to get people on Social Security," he said. "You have to have a relationship with someone. They can become extremely untrusting after living on the streets for years."


There are no easy solutions to the complex situations that arise due to severe mental illness, said the Palo Alto parents of "John Rutherford." Diagnosed with schizophrenia at age 19, his deterioration became progressive with each psychotic episode, his parents said. By law, they could not force their adult son to take medication, and eventually they could not handle him in their home.

"We tried to keep him calm, but it wasn't possible. He would steal our money, get drunk, steal our car," his mother said.

Rutherford became homeless and wound up in county jails for petty crimes. In between, he stayed in board-and-care homes and did well while on his medication. The comprehensive care he received in these homes was largely good, and it helped to preserve his dignity. But the quality differed, his parents said. He grew dissatisfied with each location and moved from place to place, trying to escape his illness and always hoping a new environment would bring relief, his father added.

Often, they did not know where he was.

One day he showed up at 2 a.m., and his mother answered the door. She inquired why he was coming there so late, and asked if he wanted to take a shower.

Rutherford shook his head "no."

"I have to kill somebody," he said. He had never been violent, and his parents believe he came to them out of fear. Most people with schizophrenia do not act on their hallucinations, they said.

Calmly, his mother suggested that she should call the police. Rutherford agreed.

Police took him to Santa Clara Valley Medical Center.

"This time they kept him. They placed him in a long-term psychiatric facility in Santa Cruz. He was there for four months. It was a nice arrangement. You could visit, and if they behaved themselves, you could take them out for a burger. He was the best I'd known him since he was sick," his father said.

"He was taking his medicines and almost making plans for the future. We got our hopes up," his mother added.

Rutherford wasn't angry about his hospitalization, his parents said. But one month after his release, he disappeared again. Feeling better, he probably saw no need to continue taking his medicine, his parents said.

He committed a carjacking in Los Angeles, and he went to prison. His parents did not know about the arrest, trial or imprisonment until they received a call from the prison. Rutherford was in with the general population. A prison employee recognized he wasn't well and called his family for confirmation about his mental history.

Rutherford was transferred to another facility where he received treatment. When he was released in 2003, he took part in a special program for parolees with mental illness. He was 25 years old and was living in a residential facility in Redwood City.

Three days after he moved into his new home, Rutherford visited his parents. He was feeling good, he said.

His mother was impressed by the change.

"He eats my vegetable soup, which was very unusual, and he wants his picture to be taken. He said it was the happiest day of his life. He kissed and hugged me," she recalled.

Then Rutherford caught a train to San Francisco, where he died by suicide.

For his parents, there is a certain irony that after finding lucidity, their son ended his life, they said. Looking back, the couple felt they did everything they could.

But there could be changes to the system that would improve care for the mentally ill, they said.

"Unless there is evidence of abuse in the family, parents shouldn't be cut off. You know your kids and you love them," his mother said.

The greatest challenge is societal, they said, pointing to a lack of value placed on services to treat mental illness and thus a lack of funding.

"Everybody's in the same situation. You don't have public support. It takes collective action," Rutherford's father said.

"We're working against a real bad cultural problem and fashionable austerity," he added. "Nobody wants to be mentally ill. It's more of a stigma than cancer. Cancer is just bad luck. ... We're swimming against a very powerful tide. (People think that) 'If you're down and out, you deserve it.'"

But no one is very far from mental illness, he said, a notion he tried to instill in his son so that he might feel less stigmatized and perhaps be more willing to accept treatment.

"A tiny little tweak in that neurochemistry, and we're all ill," he said.

Staff Writer Sue Dremann can be emailed at

NEXT WEEK: In part 2 of this series on mental illness and its consequences for the ill and their families, the Weekly examines policies and laws regulating the treatment of mental illness.


Like this comment
Posted by Anonymous
a resident of Another Palo Alto neighborhood
on Feb 7, 2014 at 9:58 am

We can thank Reagan and the ACLU for closing the old Mental Health hospitals and not funding a realistic alternative.

1 person likes this
Posted by John Jacobs
a resident of Adobe-Meadow
on Feb 7, 2014 at 11:15 am

Thanks for this very thoughtful, well-researched article about the difficulties of treating the mentally ill. Between the HIPPA laws protecting individuals' rights and the scarcity of effective community-based programs and practitioners, those with severe mental illness often end up as the folks you describe in your article. If, indeed, a society is measured by how well it treats its least fortunate citizens, the U.S. deserves a failing grade.

Note: Any individuals or families affected by mental illness who are looking for information or support can contact the Santa Clara County NAMI chapter at, or by calling the NAMI county office in San Jose at (408) 453-0400 between the hours of 10 am and 2 pm.

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Posted by CrescentParkAnon.
a resident of Crescent Park
on Feb 7, 2014 at 12:33 pm

>> Inability to provide shelter is one of the criteria, along with food and clothing. I was told that sleeping under a tree or in a doorway can be considered shelter, so my mother did not meet that requirement," she said.

That is ludicrous, really ridiculous! Whatever authority gave that answer should be responsible for it.

I'd have to guess that this is all about just not wanting to provide the funding and infrastructure for this effort. I can understand that because we as a society can spend all kinds of money and end up with abusive hell-hole institutions that imprison people, abuse them and from which they can never be released. Maybe what we have is a bit better than that, and maybe the only alternative is to maintain places where these people can get free food, shelter and some kind of health care or assistance if they want it on a voluntary basis. It would be hard to run these places because homeless people are famous for not wanting to go to them. No one is looking at it from their point of view or trying to satisfy them as "customers" because that is not what we are used to seeing it as.

Like this comment
a resident of Jordan Middle School
on Feb 7, 2014 at 1:53 pm

Thanks Palo

Alto community for posting this article part one hoping to read part 2,3,4,5.
I find it very stressfull dealing with three crazy relatives who should be in a mental facility in 2015 [Portion removed.]

Like this comment
Posted by Mary G
a resident of Duveneck/St. Francis
on Feb 7, 2014 at 2:41 pm

Thank you for this article.In the 1950s and 1960s I worked in a very progressive private psychiatric hospital. We had a significant number of patients who would never have admitted themselves voluntarily. Family members went through commitment procedures on their behalf, and then they could be in a locked facility for long enough to become stabilized and amenable to treatment. They would never have been helped on a 72 hour hold and most, after "talk" therapy and sometimes medication (which was in its early days then) were successfully discharged after several months and were grateful to their relatives for helping them. Yes, the system was widely abused, but that is no excuse for trashing it completely and leaving these folks on the street to fend for themselves. I look forward to the follow up articles. We need to address this problem humanely.

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Posted by Barbara
a resident of another community
on Feb 8, 2014 at 11:54 pm

Ongoing illnesses require ongoing, flexible care. Until individuals experiencing mental illness are given the same services offered for other medical illnesses, recovery largely depends on availability of family members and the compassion of the police. I am unaware of any other serious illness treatment that relies largely on these types of support systems.

Imagine telling your loved one who just experienced a life-threatening medical illness such as cancer or diabetes, "Oh, have your family find out what to do for you and call 911 if you feel you can no longer function."

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Posted by true
a resident of Barron Park
on Feb 9, 2014 at 3:00 pm

This article provides great insight to the struggle surrounding mental illness. It is so sad that there is no straight-forward or easy fix to this problem. Hopefully we can innovate as a society and learn how to accommodate individuals with severe mental disabilities.

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Posted by ALSO
a resident of Barron Park
on Feb 9, 2014 at 3:01 pm

we can blame Reagan or whatever else we want to blame, but blaming anyone or thing is not going to solve the issue. The truth is, is that this is a serious problem in our community that needs to be fixed.

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Posted by Scrofula
a resident of Crescent Park
on Feb 9, 2014 at 4:41 pm

Mental illnesses should be classified as BRAIN illnesses, for that is what they really are. The latest imaging equipment can see brain damage due to emotional and physical trauma, child abuse, malnutrition, disease, injury, etc.

The term " mental" implies that the problem is imaginary and self-inflicted, and can be treated by simply deciding not to be mentally ill any longer.

The same goes for autism: most insurance companies do not consider it the brain/neurological disease that it is, and will not provide monetary compensation for treatment, no matter how effective it is ( and it IS, if started early enough). They class it as something beneath mental illness.

When it comes to the treatment of sick brains, we really are in the Dark Ages!

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Posted by Scrofula
a resident of Crescent Park
on Feb 9, 2014 at 6:19 pm

When I was in college, a few years after Reagan closed down all the mental hospitals such as Agnews and released the " inmates", unmedicated, into society, several "halfway houses" were opened near schools and inner-city colleges where housing was inexpensive.

Apparently, these people had very little supervision, because they would walk the city street day and night, doing bizarre things ( such as dancing barefoot in crosswalks in heavy traffic during freezing winters, or urinating on the floor of a Mc Donald's during peak lunch hours, etc)

Anyway, one night, long after my roommates and I were asleep in our apartment, one of them broke in and put one hand over my mouth and another down the top of my nightgown! He then took the one hand off my breast, and unzipped his pants. I was in a small bedroom by myself where my roomies were not awakened. knowing what would come next, I rolled out of bed, stood
up, picked my art history book off the foot of my bed and screamed, "Get out, NOW!" This both freaked the guy out and woke my roomies, who called the cops.

Thanx, Mr Reagan!

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Posted by to Scrofula
a resident of Another Palo Alto neighborhood
on Feb 9, 2014 at 6:34 pm

to Scrofula: how do you know this wasn't a regular criminal rather than a mentally ill person? I don't care for your assumption that mentally ill persons are perverted criminals. I know some Palo Altans have a superior attitude towards just about everyone, but that assumption really is not helpful to this story of a situation that afflicts some families. Don't assume criminality with mental illness.

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Posted by Carol Irwin
a resident of Downtown North
on Feb 9, 2014 at 7:09 pm

After reading this article I see that things have still not changed. Providers who think it's about giving patients what they want instead of giving them what they need to be well, was clearly demonstrated by the comments from the head of a non-profit county mental health system. Mental health care is about understanding the nature of brain based mental diseases. This being said, you can not reason with a psychotic brain. The nature of the psychotic illness is not being able to think rationally. So giving the patient what they need becomes paramount. I struggled with the Santa Clara County mental health system for 20 years for my daughter. The only way she got care was through my persistence. I sent mass faxes to county officials, I joined NAMI, I sat on the county mental health board for 10 years, advocating for change! I was unrelenting. Things have not changed in 20 years,people and their families are being destroyed. What do patients need? They need competent treatment, they need the support of their families, they need good nutrition and exercise, they need competent, compassionate care.
The Mental Health Services Act was passed to deal with these issues that are being discussed in this article. Unfortunately , the money has not gone for treatment of the severely mentally ill, but rather to planning, meetings, high priced consultants and PR material for the public. Let's step back and take a good look at the where all the money has gone. If it were being used for it's intended purpose we wouldn't be hearing these horror stories.
Speak up people, demand the money be used solely for treatment of the mentally ill.

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Posted by Scrofula
a resident of Crescent Park
on Feb 9, 2014 at 7:24 pm

to Scrofula: I gave a pretty good description of the guy to the police, and this young man, not thinking clearly, was caught hanging around my apartment building, a few days later, still wearing the exact same smelly clothing. The police informed me that they knew him pretty well, he had been pulled in for several acts of lewd behavior in public previously, and he lived in a halfway house less than one block away from my building, on the same side of the street.

I was seventeen years old and it shook me deeply. I felt very violated and did not sleep well for six months. Originally I thought he was a vagrant, or homeless, because he was so smelly--I did not immediately think he was an unmedicated, schizophrenic resident of a halfway house ( in my youthful innocence I thought they were better cared for than THAT).

Please do not be judgmental or vilify the victim! This actually changed my thinking about mental health!

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Posted by Jim
a resident of another community
on Feb 10, 2014 at 12:05 pm

Great article Mrs. Dremann - it gives a face and a story to those who are forgotten and have no voice.

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Posted by danger
a resident of Greenmeadow
on Feb 10, 2014 at 2:00 pm

there are pl;aces where people are force injected drugs against their will and they now have permanent physical damage that has not gone away for years. they have problems walking perfectly . these people had never hurt anyone .you could be in shock from something and cannot communicate well. so they give or force drugs on you. you didn't know that was going on because they keep it hushed. your friends or kids could be in danger with that attitude of ''drugs'' for every problem. there are also people who've attempted suicide and are now severely injured for life. these people were on some form of chemicals. but their attempted suicide is only known to people who know them. it wasn't officially declared an attempted suicide. only few know this. it was a very beautiful person that was once known in town. its something palo altans don't realize. its kept quiet for obvious reasons. there are hidden things going on with any person you might see anywhere. they may have experienced things they don't tell people even acquaintances. people are scared these days and should be. you cannot trust too many people. many don't ''seek help'' because they are afraid of coercion. better to be free than under ''care'' of someone who wants to drug you. bottom line. the ''mental health'' system is all drug oriented. some people don't even drink alcohol but they want to drug people? that is truly insane. contact mental health dept and ask them do they force or encourage people to take drugs. they did it years ago now is a rote practice. thats why many don't ''seek help'' ''help'' is a relative term.

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Posted by anon
a resident of another community
on Feb 10, 2014 at 2:23 pm

I think you forgot to close a tag guys! You open a bold tag on line 572 of this page's source and never close it!

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Posted by Jeanne
a resident of another community
on Feb 10, 2014 at 9:42 pm

I'm an adult psych/mental health clinical nurse specialist and LCSW who has worked as a jail psych RN, private practice, in community mental health as well as in the general acute hospital setting and as a clinical psych nursing educator. This is a very thoughtful article about complex issues, including the restrictiveness of HIPAA in sharing practical information that can be beneficial in treatment....Very sadly, correctional facilities and short-term acute treatment is the treatment of "default". The only "treatment plan" most of the time is temporary stabilization....which doesn't include long term mentoring and 1:1 encounters or group therapies and rehabilitation including life skills, housing and financial management (including, but not limited to payee services and in some cases, conservatorship). See an interesting Sacramento Bee newspaper link: <Web Link;

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Posted by Jeanne
a resident of another community
on Feb 10, 2014 at 9:50 pm

Hopefully this is the accurate Sacramento Bee web link:

Web Link

2 people like this
Posted by Help the mentally ill
a resident of Another Palo Alto neighborhood
on Feb 11, 2014 at 9:41 am

Thank you Sue and Palo Alto Weekly for publishing this artcile! I think we really need raise the awareness of the predicament of the people, and the family suffering from the devastating effect of mental illness. I hope we realize that we as a community really have to come together, discuss and debate, and find better solutions to help this group of people among us.

1) I just want to raise a few points that perhpas we can do something to change:

As mentioned in Sue's article, "The Health Insurance Portability and Accountability Act (HIPAA) prevents hospitals from releasing any information about an adult's medical condition unless they sign a waiver; and their son has not signed a consent form, she said." This seems utterly unreasonable. For a person who had been regarded as unable to make reasonable decisions on his or her welware, and had been committed involuntarily, how could the law expect he or she still be able to make a reasonable decision about her privacy? The effect of the above requirement of HIPAA is that it helps to cut the ties of the committed patient to the family. It excludes the family from the patients treatment. It makes the treatment process all the more scary and excruciating for both the patients and the family. Can we please change this part of the law? Give the immediate family (spouse or parents) the right to be informed when a patient is committed involuntarily. This is consistent with person's indivdiual right. It is also consistent with the right of patient when he or she can not make medical decisions for himself or herself.
Let the family be involved. Help the family take care of the mentally ill. Don't make it even more difficult for them. Don't isolate the patients from their family.

2) Have separate mental hospitals and general "behavior" hospitals for people with substance abuse problems. Substance addiction is not a disease. Mental sickness is a brain sickness, like Alzheimer, Autism, not very much different from Leukemia or Cancer. It needs dedicated research, it needs special treatment. I believe a jail like environment is not approprate for people with minor or severe mental illness. it really should be treated in a hospital like environment. A change in how we treat mental illness would make both the patient and the family less afraid or less ashamed of seeking professional treatment.

3) Train the police and emergency personnels about how to treat people with mental illness. People with mental illness are different from criminals with a gun. I understand how dangerous it is to be a policeman, but please dont just come and shoot a mentally ill person who look crazed or who resist arrest. Make a clear, guideline and train our police on how to react.

Further more, start a discussion on how business, schools, services, and we as a community should treat people with mental illness. I personally believe that isolating the mentally ill, locking them up at home or at the hospitals is not the solution. It is not good for the patients, it is not good the society.

4) NAMI and other organizations could do more. When is the last time you see a NAMI ad or any ads for mental illness awareness on TV? National or local? Never for me. In the last 20 years, I didn't see a single one. Every time there is a sensational tragedy involving a mentally ill person, this topic would be all over the media. However very rarely the media would get into any depth of it. Every little attempt was made to educate people about what mental illness is, and how we could improve how we treat is. On this side, I hope NAMI could do more. Have a TV ads compaign. Have a donation compaign. Send volunteers to the streets. It is not a topic that the society can stay hush-hush about.

Sue, thanks again for doing this article. I hope more people will participate in this discussion and we will be able to do something to change the status quo.

Sorry, but further commenting on this topic has been closed.

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