Leslie Carpenter

So again, I'm happy to report to you that there are ways that some of these jurisdictions are trying to act on this. Obviously, sometimes they will refer the person for what's called competency restoration. Unfortunately, we have too few of those beds as well in most of our states. And so people end up waiting to get to that. And competency restoration is not the same thing as treatment.

It is just providing some medication and court classes to get the person well enough to be able to participate in their own defense. Now, what I will tell you is that there are more criminal mental health courts now than there used to be.

It would be left up to the jurisdiction to decide whether or not that person who stabbed somebody in a leg would be considered dangerous enough where they felt like they had to handle that through the criminal system and keep the person secure, right?

If it were less than that and the person weren't found to be at risk for hurting somebody else, there's the potential to potentially either get them into a mental health court treatment program or dismiss their charges and get them referred to an AOT or assisted outpatient treatment program.

And so eventually I decided to retire from my career as a physical therapist to spend the rest of my life working on improving the system so it'll help the next person who gets sick more than it helped our son.

In any of these cases, I think the basic thing that has to happen is the recognition that it was the untreated illness. that caused that incident to occur in the first place. It was not endemically the person being a bad person.

And that's where we still have work to do because once we get that to be understood, then it's easier to get these systems to work together better to get somebody treatment. And even if the person is charged and found guilty and placed into incarceration, they still deserve to get treatment while they're there.

And the opportunity to do things to help make it easier if they get back out, if and when they get back out so that they aren't just released from a jail or a prison with no connection to treatment because that doesn't help anybody.

It does. So much of it is education.

I agree. There's not. There's not enough. How do we do it? We get ourselves invited to professional conferences of various types, get ourselves to judicial commissions, get ourselves to the attorneys association meetings, get ourselves to provider meetings and conferences. It is a huge amount of work that will take many different people coming together to work toward that.

And not necessarily all in the same way, but we all need to be working on it.

So I wear two hats. With one hat, I am the co-founder of Iowa Mental Health Advocacy, in which my husband and I basically created a website, created this agency, which is really just a mom and pop shop. And from that, I have evolved into being a lobbyist at our state legislature here in Iowa. But I've also gotten involved in a lot of community work, committee work, statewide work,

Correct, yeah. And wearing my Iowa mental health advocacy hat, I have been speaking for several years now during the crisis intervention team trainings that happen here locally in our county. I've also started doing it at other counties through the state. And I will tell you that there are a lot of mental health

Advocates, especially the moms of people with severe mental illness and peers who live with illnesses who go out and speak at these trainings to help give them both the patient and family perspective to provide that very education. Now, thankfully, there's a lot of crisis intervention team training going on around the country as well as having mental health responders or co-responders.

And we fully support all of those models because you're right. If they can understand and deescalate it in the first place, you can avoid that whole criminal legal system and have them help get the person into treatment. That's really critical work. And I will tell you that there's probably hundreds, if not thousands of people across the country engaged in doing that education and work every day.

Absolutely. Absolutely. I live in a county in Iowa. I live in Johnson County, Iowa. I was the first one to start getting involved in doing this. And now there's been a huge, a lot more state support for it in terms of providing funding from our MHGS regions or Mental Health and Disability Services.

services regions to help facilitate helping local police precincts being able to afford to send one or two staffers to a training without completely depleting their own staff, right? It's complicated because they have to be able to do that for 40 hours.

And I will tell you that once they are doing it and they see the effects of it and the positive outcomes that happen because they've got everybody trained, it really does help.

But it takes time to build up enough of those trained officers, any one location, so that potentially you have people that can respond to more than one at a time crisis, as well as throughout the three different shifts that happen in terms of a 24-7 cycle.

Correct. And luckily, I can tell you locally, these people are included in the yearly trainings that happen. So all new people coming into these roles go through that training. And I'm seeing more and more of that happening across the country. We definitely need that in addition to trying to get more people to call 988 instead of calling 911 when that's appropriate.

Correct. But using 988 as your first phone call is a way to hopefully encourage more of a mental health response as opposed to a law enforcement response. It increases your likelihood that that will happen.

Absolutely. And it is a major impact on all of those people. But the better care we can provide early on and the more consistently we can keep somebody in that treatment, the less of a detrimental effect there is on everyone, and most especially that person.

to work in various ways to improve the mental health care delivery system in Iowa. And then with a separate hat, I also work for the Treatment Advocacy Center for about the past year and a month on a part-time basis as their legislative advocacy manager.

It's important to hear that we need to have providers providing more hope to people when they're first getting sick. All too often, we hear from families where they get told their loved one's sick. The loved one who is sick gets told by the doctors, oh, you've been diagnosed with this. You're going to be taking medication for the rest of your life.

You can't possibly go to college now, da, da, da, da, da. And that's really harmful because I think the most important ingredient for the person who's been diagnosed is hope. They need to understand that if they are engaged in treatment and they do the work with the treatment providers beyond medication, right?

And they can still work towards going to college, having a degree, having a relationship, getting married, having kids. All these things are entirely possible. And too few people get told that when they're first diagnosed. And we as a society need to do a better job coming around them and supporting that hope.

Extremely possible. We just need to do better providing all the supports, even sometimes on an involuntary basis when that is absolutely necessary for a time. to help get the person well enough to engage on their own.

might. I'm not sure how much money or people would be interested in financing something like that. It might help. I would never say it wouldn't help. But really, it's the people working in the system being able to work with each other and educating a lot more people in every realm. So from the point of education standpoint, yes, that would be helpful.

And I track legislation across the whole country in all 50 states and the federal government and then help advocates to either pass or hopefully block bills depending upon how they affect the treatment of people with severe mental illness.

Absolutely. And sharing success stories, sharing the stories of somebody who was homeless, who did get into treatment and turned everything around and ended up being able to go on and live a very successful but happy, peaceful life. That's the thing we need to have people understand that this can happen.

You bet. Thank you for the opportunity and thank you for the work that you're doing.

Yeah, that's a really good question. So for me, that started, my first step was with research. I did extensive reading of books related to policy in this area to understand exactly that question, where do you start, right? Because it's not all about fixing laws. It's not all about education. And it's not all about just changing practices. It's all of it.

So I did extensive research and then just began. So I kind of think I break it down into a couple different ways. One is some of the work has to be community-based. Some of the work needs to be getting better collaboration and cooperation and communication between the players and the system in your area.

area to work with each other to help plug the gaps of where people are falling through and not getting care. So that's one level of work that needs to happen and I'm very much engaged with here in Iowa City, Iowa.

Another level of work is what can happen at the state level in terms of both getting improved laws so that the law allows for some improved practices, but also in terms of influencing the education of the players in the system at the state level to do, again, high level communication, collaboration and coordination of care.

Because when we're talking about the individuals with the most severe mental illnesses, it's not just busting stigma. It's not just getting equity or parity, right?

It is about doing the hard intensive case management that needs to happen around some of the people that are going through the revolving door churn to stop that revolving door, catch them and individualize their care so that they are not left to suffer. So some of the work is there. And then of course, at a bigger level, some of the work is national.

Some of the federal laws also have to change and attitudes. So it's big.

That is exactly the question. That is the whole crux of the problem. It is a lot easier to advocate for little kids for anything that they need, whether it's autism or cancer or whatever it might be, right? It's a sympathetic group to advocate for. It is much harder to get people to care about people with severe mental illnesses And what it takes is sharing stories.

It takes letting these people know that most of these people that are sick started out the same way that all of our kids did. They started out in normal families. Many of them were highly educated, highly talented kids who had an onset of a severe mental illness during their late teens and early 20s that came and robbed them of everything that they had before.

And your question about how do you get people to care if it doesn't personally affect them? That's a much bigger question, right? How do we get people to care about anything that doesn't affect them? That's part of our society today. It's harder to do that.

And the way that I think we need to approach it is to be constantly getting out there with the stories and constantly engaging on it at every single level. And I will tell you that when I attend events, legislative forums that are around mental health, and I'm sitting there next to somebody who is not personally affected, that gives me hope, right?

But we need a lot more of those people if we're really gonna create a social movement and get the change to happen.

And that brings up a very good point. There are people walking around with schizophrenia who are functioning quite well. And I'm so grateful for that. And we're very grateful when they bring their voices to the work. But those aren't the people that we're really needing to advocate for, right?

We're needing to advocate for the homeless guy down on the corner who's ranting at the birds and who doesn't have the right level of clothing on and is starving and is unable to take care of his own needs in any way.

How do we get people to see that this is somebody that is there, not because they're choosing to be there, but because they have a brain illness that they never asked for and we have failed to step up to help them? That's the challenge.

That is exactly right. The treatments that are available now are so much better than they were even just 10 years ago, and certainly better than what they were 60 years ago when we began this massive deinstitutionalization movement, right? It has evolved. It's not as far along as we would all hope, but people can do very well if we are able to keep them in treatment on a consistent basis.

That's a really good question. So part of the issue that we have is that so many people don't understand about psychosis and how it's a very altered perception of reality, right? And that makes it hard for somebody to voluntarily agree for treatment.

And they don't understand that a certain percentage of these people also have anosognosia where they don't know that they're sick because the brain has changed because of the brain illness itself that makes them unable to engage in treatment. We are doing a better job of getting that education out there, not just to families, but also to providers.

Unfortunately, there's a lot of providers who don't understand that. but also to the general public and especially legislators. And I would tell you that it seems that the tide is starting to turn where we are seeing states start to make changes, understanding that New York City is a wonderful example.

They are doing things to provide compassionate treatment to people that have been, unfortunately, neglected and left on their streets for far too long. California is another example where we're starting to see the transition with the introduction of the care courts to allow for better ability to get help to people who don't know they're sick.

We're starting to see that happen more and more across the country, and we're starting to see states take actions like adding state hospital beds. removing certificate of need requirements to get a new psychiatric hospital built to start to resupplement the need for acute care settings for people in psychosis.

And we're starting to see the acknowledgement that we need more long term permanent supportive housing of various types for people with various needs. And that's all very encouraging.

Right. That's the bigger challenge. I call it the sick person in the basement syndrome, where everybody in the house knows that the person is very severely sick, but we can't get them help because they won't voluntarily agree to it. And unfortunately, our laws don't allow us to step in in many states until somebody becomes a danger to themselves or others.

Meanwhile, there's a huge amount of brain damage happening to that person while they're actively in psychosis. So how do we change that? It's twofold. One is changing the laws to allow us to recognize psychiatric deterioration as a reason to allow for involuntary assessment and treatment in the first place. but it's also education to law enforcement, to psychiatrists, to ED doctors, right?

You bet. I'm happy to be here.

To all the players in the system that the laws, many of the laws, allow us to intervene much sooner than what we currently do in terms of how it's practiced, in terms of how they do that. And so much of that is fed by the bed shortage. So adding more beds and adding more education and to some extent improving the laws

all of those things should allow us to be able to intervene sooner and provide medical care in a way that makes medical sense, not bound so much by the laws.

Yeah, it's a really good question. And what I'm excited to tell you is that there are changes in the legal system. In fact, the courts and many of the judicial commissions that are in each of our states being led by the National Center for State Courts They are ahead of us. They are working on improving the legal system's ability to be agile.

Well, my husband and I have two adult children, one of whom lives with a very severe schizoaffective disorder, and he's been sick for about 19 years. So we've had extensive experience navigating the whole mental health system, if you can call it that, you know, meeting more barriers than we did help.

And if somebody has committed a very minor crime, maybe they slept in the wrong place and they got arrested for being homeless and they get taken into jail, right? So the charges like trespassing, allowing for assessments to happen. Okay, why did this happen? oh, the person's mentally ill. Let's divert this person to treatment and drop the charges, right?

And that recognition is starting to happen among the legal professions as well as the legal systems. Is it a lot of work still to be done in this case? Absolutely. But they're actually a little bit ahead of us. They're ahead of the medical system in recognizing this actually.