Friday, March 28, 2008

Disorderly conduct

A little-known but widespread mental illness afflicts 4 million Americans and their families.

Today's editorial begins with a quiz — and ends with a mystery.

A single mental illness afflicts some 4 million Americans, between 1 percent and 2 percent of the population. It accounts for, or figures in, 20 percent of all psychiatric hospital admissions. More Americans have this illness than suffer from schizophrenia. A third of all young Americans who commit suicide first show symptoms of this illness.

Its name? Borderline personality disorder. Given the disorder's presence in society and the harm it does to so many lives, it is difficult to comprehend how the public and the mental health professions can know so little about it and how to treat it.

The figures above are supplied by the National Education Alliance for Borderline Personality Disorder, the organization founded to educate families, patients and care-givers about this devastating and tragic illness. The alliance, the Nation's Voice on Mental Illness and the Menninger Clinic are sponsoring a conference on new clinical approaches to the disorder, to be held Friday at Baylor College of Medicine in the Texas Medical Center.

Sufferers of BPD can't control their emotions, impulses and relationships. Many are unemployable. Of the men in prison, 12 percent have BPD, as do 28 percent of women inmates.

People with BPD usually suffer from other illnesses — depression and drug addiction, for instance — both mental and physical. A 30-year-old woman with BPD typically has the medical profile of a woman in her 60s, according to the alliance.

As yet, there is no medication approved for the treatment of BPD, but specific counseling therapies and techniques have proved effective. Those treatments are the subject of Friday's conference in Houston.

In May 2003, the Menninger Clinic moved to Houston from Topeka, Kan. It filled a gap in the clinical skills of the Texas Medical Center, and great things were expected for Houston in the field of mental health. Friday's conference is an example of the role Houston can play in increasing Americans' knowledge of mental illness and compassion for those it afflicts.

Apart from its stealth profile and difficulty in treating it, borderline personality disorder has another mystery connected to it: For some unstated reason, the Texas Legislature, by law, forbids local organizations such as the Mental Health and Mental Retardation Authority of Harris County from providing continuing treatment to BPD sufferers, except for those who also suffer from major depression.

If the aim is to save the state's taxpayers money, the result could hardly be further from it. What the state might save on counseling and management of BPD cases, it loses in lost productivity, higher jail costs and heavier burden on the general health care delivery system — a burden borne by employers and taxpayers.

Perhaps before the next session of the Legislature, one of its members will learn more about borderline personality disorder — from attending a conference or reading —and act constructively on that knowledge.

Sunday, March 16, 2008

Second Chance Act Improves Mental Health Services For Prisoners, USA

14 Mar 2008

The American Psychiatric Association applauds recent Congressional efforts led by Rep. Danny Davis, D-Ill., to improve treatment for the large number of people with mental illnesses and substance use disorders who are currently incarcerated in U.S. jails and prisons.

The U.S. Senate passed the Second Chance Act (H.R. 1593) this week by unanimous consent. The U.S. House of Representatives passed the legislation last fall. The legislation would provide transitional assistance to ex-offenders in an effort to reduce a return to alcohol abuse. Additionally, the legislation would extend and provide a full continuum of care for treatment of substance use disorders and improve mental health screening and treatment.

"It is a national tragedy that jails and prisons have become the primary mental health care facilities in the United States today," said APA President Carolyn Robinowitz, M.D. "This bi-partisan action represents significant steps forward in improving access to mental health services and substance abuse treatment programs for those incarcerated within the prison system."

According to a 2006 report by the U.S. Department of Justice, entitled "Mental Health Problems of Prison and Jail Inmates," more than half of the population incarcerated in U.S. prisons and jails - including 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates - were found to have a mental illness. Many of these inmates suffer from treatable disorders such as major depression, bipolar disorder and substance use disorder.

"People with mental illness, left untreated, can develop symptoms and behaviors that lead to their arrest and incarceration," Robinowitz said. "Treatment can help prevent incarceration. Improving funding and cooperative programs between mental health care professionals and correctional agencies is a step in the right direction."

About the American Psychiatric Association

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at and