Published on: Mar 3, 2016
Transcripts - NAMI_Summer2015_Newsletter
V2: 1 Summer 2015The Official Newsletter of NAMI PA, Berks County
NAMI Family Support
2nd Wednesday of each
month, 7 - 8:30 p.m.
NAMI Peer-to-Peer Recov-
ery Education course:
Inside this issue:
NAMI PA, Berks
1234 Penn Avenue
Wyomissing, PA 19610
Phone: (610) 685-3000
Fax: (610) 775-4000
Mental Health and the Criminal Justice System
by Dr. Anthony J. Fischetto, Forensic Psychologist
June 1, 2015
last 30 to 40 years,
we have seen
many more indi-
viduals with men-
tal illness incarcer-
ated. The National
that the deinstitu-
t i o n a l i z a t i o n
movement of the
1960s, which shut
down large treat-
ment facilities for
the mentally ill,
(Photo courtesy of Deseret News)
coupled with the lack of community resources to treat them, resulted in some people going to pris-
ons and jails instead. One study found this trend accounts for about 7 percent of prison population
growth from 1980 to 2000, representing 40,000 to 72,000 people in prisons who would likely have
been in mental hospitals in the past. (Source: “The Growth of Incarceration in the United States:
Exploring Causes and Consequences,” The National Research Council, 2014.)
Mental illness among today's inmates consists of 64 percent of jail inmates, 54 percent of
state prisoners and 45 percent of federal prisoners reporting mental health concerns, the report
found. Substance abuse is also substantial and often co-occurring.
According to Torrey and Stieber (1993), “many American jails have become housing for
persons with severe mental illness arrested for various crimes.” Approximately 29% of American
jails hold persons with severe mental illness either on misdemeanors or on no charges at all. A total
of 69% of American jails also reported seeing far more inmates now with severe mental illness
than just ten years ago (French, 1987; Torrey & Stieber, 1993). French contends that criminaliza-
tion and incarceration are an unintended consequence of the deinstitutionalization process. Torrey
states that one of the reasons for criminal behavior is that persons with severe mental illness obtain
discharge from inpatient psychiatric hospitals with no provision for aftercare or follow-up treat-
"Part of what's really swelled our jail and prison population, especially our jail population,
is our inability to deal with the mental health crisis that we're facing in this country," says Tang-
ney. "We have an enormous number of people who are suffering from very treatable illnesses who
are not getting treatment and who end up getting caught in the criminal justice system as opposed
to the mental health system." (American Psychological Association, 2014)
In association with Greater Reading Mental Health Alliance
Mental Health and
the Criminal Justice
Mental Illness A
Much Bigger Problem
For Poor, New Study
Farewell Letter from
Director of NAMI
2nd Annual Walk for
Continued on pages 4 to 5
National Alliance on Mental Illness of Berks County, PA
discovered that about
30.4 percent of
with serious distress
had no health
with just 20.5 percent
of working-age adults
Mental Illness Is A Much Bigger Problem For The Poor, New
The Huffington Post. May 28, 2015
If you want to talk about inequality in America, you should be talking about mental illness
-- and the ability of people to get treatment for it.
On Thursday, the U.S. Centers for Disease Control and Prevention released a new study
that demonstrates, in vivid terms, something that public health experts have known for a while:
Mental health problems are far more common among the poor than the rich.
The basis for the study is five years of responses to the National Health Interview Survey,
an in-person poll that the federal government has operated continuously since the late 1950s. To-
day’s version includes questions designed to measure the prevalence of “serious psychological
distress,” a standard that public health experts use as a proxy for certain kinds of mental illness.
Infographic by Cameron Love
According to the new CDC paper, 8.7 percent of people with incomes below the poverty
line, or $20,090 for a family of three, reported serious psychological distress from 2009 to 2013.
For people with annual incomes at or above four times the poverty line -- that’s $80,360 for a fam-
ily of three -- the figure was just 1.2 percent.
Researchers also discovered that about 30.4 percent of working-age adults with serious
distress had no health insurance, compared with just 20.5 percent of working-age adults without
The study, whose lead author is CDC epidemiologist Judith Weissman, does not address
the issue of causality -- in other words, whether mental health problems lead to more economic
hardship or whether economic hardship leads to more mental health problems. But most research-
ers believe the
Studies have shown, for example, that infants and toddlers growing up in low-income
communities are more likely to experience the kind of “toxic stress” (neglect, abuse, seeing vio-
lence in the home) that can hinder brain development and lead to mental illness in adulthood. Ad-
ditional studies have suggested, though not conclusively, that adults who become unemployed are
more likely to develop depression.
“...infants and tod-
dlers growing up in
ties are more likely to
experience the kind of
“toxic stress” [….]
that can hinder brain
development and lead
to mental illness in
National Alliance on Mental Illness of Berks County, PA
Letters to the Editor and other
articles and contributions are
encouraged. Please send
them to 1234 Penn Avenue,
Wyomissing, PA 19610, or
email inquiries into
The Berks Bulletin is
published quarterly by
NAMI of PENNSYLVANIA ’ s
At the same time, somebody who had mental health problems might have a tougher time
holding onto a job -- or, at least, a good job. And without employment, historically, it’s been tough
to get health insurance or to have enough money to pay for timely detection and treatment of psy-
For the people and families that deal with mental illness, the result can be a vicious,
downward spiral that -- in the worst cases -- ends with some combination of medical and financial
A major goal of the Affordable Care Act, or Obamacare, was to address these problems --
partly by helping millions of additional people to get health insurance and partly by requiring in-
surance plans to provide more comprehensive coverage of mental health care. These regulations
were an extension of bipartisan efforts, dating back to the 1980s and 1990s, to establish parity be-
tween mental and physical health care coverage.
The data in this latest CDC study isn't recent enough to capture most of the Affordable
Care Act’s effects. But another study, focusing on a provision of the law that became effective
back in 2010, found that young adults who obtained insurance were more likely to get mental
health treatment. Studies of past government initiatives with similar characteristics, such as an ex-
pansion of Medicaid eligibility in Oregon, have provided yet more evidence that access to health
insurance leads to better mental health.
Still, many people who obtained insurance under the Affordable Care Act struggle might-
ily to get mental health care -- either because they have trouble finding providers who accept insur-
ance or because they face daunting out-of-pocket costs for every treatment session and prescrip-
tion. That’s why organizations like the National Alliance for the Mental Illness have called upon
officials to find ways of further improving mental health coverage -- whether by providing people
with more protection from high deductibles or strengthening the regulation of networks of mental
health care providers.
Not everybody would favor such an approach. The Affordable Care Act’s conservative
critics frequently call for scaling back the existing requirements on mental health insurance, be-
cause, they say, such mandates tend to drive up insurance premiums. They are probably right about
that, although untreated mental illness can lead to future health problems, both mental and physi-
cal, that can be expensive to treat.
Cohn, J. (2015, May 28) Mental Illness Is A Much Bigger Problem For The Poor, New Study Shows. The Huffington Post.
Retrieved from http://www.huffingtonpost.com/2015/05/28/mental-health-coverage_n_7456106.html.
A Message from Our Director of NAMI Services & Programs
It is time to humbly move on from my position as Director of NAMI Berks as I relocate to
be with family. Much gratitude goes out to Greater Reading Mental Health Alliance for giving me
this fantastic opportunity to strengthen and grow NAMI Berks County for our community.
Throughout my 18 months here, NAMI Berks’ programming has indeed strengthened and
grown. NAMI Family Support Group now warrants a second grouping of family members and
facilitators to support one another. NAMI Family-to-Family ran in spring 2014 for the first time
solely by NAMI Berks; through two spring sessions, admirable facilitators Nina and Alan McDan-
iel have graduated 19 committed family members/caretakers of individuals with mental illness.
Additionally, since implementing NAMI Peer-to-Peer Recovery Education in fall 2014, 12 com-
munity peers have graduated onto healthier ways of coping with their mental illness. NAMI In Our
Own Voice has reached hundreds of Berks County consumers, students, professionals, and family
members, emblazoning the reality that mental illness recovery is possible.
NAMI membership has increased by 5 times the active members. For this increase, I
thank our NAMI Berks members for their continued contributions and vouching for NAMI’s in-
credible influence on their lives.
I hope my replacement (as yet unknown) will continue what I’ve established and nur-
tured, carrying on awareness of brain disorders in our families, criminal justice system, and com-
munity. I want to thank my GRMHA coworkers, NAMI peer mentors, class teachers, and support
group facilitators, and Berks County community partners for embracing NAMI and helping to pro-
mote the message of “Find help, find hope”. Take care of each other. --Megan Faulkner
National Alliance on Mental Illness of Berks County, PAPage 4
I have seen in my own experience, for example, an individual I treated for kleptomania,
which is a psychiatric diagnosis according to the DSM, who was misunderstood by the legal sys-
tem. The DSM-5 (The American Psychiatric Association, 2013) categorizes disruptive, impulse
control, and conduct disorders as mental illnesses that affect a person’s ability to regulate his or her
emotions and behaviors. Kleptomania is an impulse control disorder characterized by the inability
to resist the impulse to steal. Rather than the legal system recognizing the mental disorder in this
individual I treated, the behavior was treated as a deliberate act of an antisocial type of behavior
resulting in multiple incarcerations. Kleptomania is a rare disorder, and is only diagnosed in 0.3-
0.6% of the population, and there are three females for every one male diagnosed (The American
Psychiatric Association, 2013). This would amount to one to two million people in the United
States who have kleptomania. Kleptomania is treatable to reduce the impulsive urges to steal. (See
references Grant & Odlaug, 2008; Grant, Kim, & Odlaug, 2009; Grant, 2006; Grant, Odlaug,
Schreiber, Chamberlain, & Kim, 2013; Rudel, Hubert, Juckel, & Edel, 2009).
This man that I treated was involved in the legal system for shoplifting and never received
the needed and available help for kleptomania. If he was not finally, properly diagnosed and
treated, he would have most likely continued to be in and out of jail with no improvement of his
acts of shoplifting. Once he was properly diagnosed for his impulse control problem, received psy-
chotherapy, and psychiatric treatment with the appropriate medications, he no longer stole or had
urges to steal. He was extremely remorseful for his behaviors. If he went to prison, again without
the proper treatment, he would be very likely to continue to steal when he would come out of jail
as he did other times. Kleptomania should be distinguished from ordinary acts of shoplifting and
other types of disorders, such as antisocial personality disorder, conduct disorder, mania, psy-
chotic, or major neurocognitive disorders (The American Psychiatric Association).
There are various reasons that people with mental illness who commit crimes do not get
the proper treatment and are instead sent to jail. One reason is the limited mental health training for
police and judges in order to recognize or at least question the possibility of a mental health issues
with the person who committed a crime. Whenever a mental health issue is in question, a forensic
psychiatrist or forensic psychologist should be consulted to evaluate the individual in question as
well as educate the judge as to the mental health mitigating factors if any, with the individual. An-
other reason this procedure may not be enacted is due to limited funding and a lack of time to take
the necessary steps to properly understand one who may have a mental illness contributing to his
or her crime.
In a House Co-Sponsorship Memoranda from PA State Representative Thomas Caltagi-
rone, posted: December 17, 2014, proposing a bill to help in this situation, he states,
This bill allows for training for police and minor judiciary in the identification and
recognition of individuals with a mental health condition or an intellectual disabil-
ity. As a first step to address the significant problem of individuals with mental
health conditions or intellectual disabilities ending up in our prisons, we need to
better equip our police and minor judiciary with the tools and training needed to
identify these individuals at the earliest point in the criminal justice system and
help these individuals get proper treatment. Moreover, with proper training our law
enforcement officers may be able to avoid dangerous situations if they can quickly
identify an individual experiencing a mental break and use proven crisis interven-
tion techniques to de-escalate a situation.
The number of inmates in our state prison receiving mental health services is stag-
gering. More than 21% of all inmates and 49% of female inmates in state prison
receive mental health treatments at a significant cost to the taxpayers. This bill will
provide law enforcement with the tools they need to protect themselves and pro-
vide judges with the wherewithal to divert certain individuals into treatment rather
than prison. (Caltagirone, December 2014)
Page 5National Alliance on Mental Illness of Berks County, PA
People with mental illnesses are being incarcerated at a greater percentage since the 1960s deinstitutionalization. Some of the current
reasons for the mentally ill not getting the proper treatment, but instead being held in prisons where they are inappropriately diagnosed or
treated are as follows:
Reason: Limited training and education of the police and judges as to mental illnesses of people.
Solution: More training.
Reason: Lack of funding and awareness to retain forensic experts to train, diagnosis, testify to educate the trier of fact (Judge or jury) and
to provide treatment.
Solution: Be aware of and use the forensic mental health services available and provide funding for such.
Dr. Fischetto is a Licensed Psychologist with a specialty in Forensic Psychology. He has performed thousands of forensic evalua-
tions over the last 25 years. He is a Diplomate in Forensic Psychology. Dr. Fischetto is a consulting Psychologist at the Reading
Health System and has a full-time private practice in counseling, consulting, and forensic evaluations for criminal and civil cases.
Office Phone: 610-777-3306
475 Philadelphia Avenue, PO Box 36, Reading, PA 19607
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington,
VA: American Psychiatric Publishing.
Collier, L. (2014). Incarceration Nation. American Psychological Association. 45(9), 1-2.
French, R. (1987). Victimization of the mentally ill: The unintended consequence deinstitutionalization. Social
Work, 32(6), 102-105.
Grant, J.E., Kim, S.W., & Odlaug, B.L. (2009). A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptoma-
nia. Biological Psychiatry, 65(7), 600-606.
Grant, J.E., Odlaug, B.L., Davis, A.A., & Kim, S.W. (2009). Legal consequences of kleptomania. Psychiatric
Quarterly, 80(4), 251-259.
Grant, J.E., & Odlaug, B.L. (2008). Kleptomania: Clinical characteristics and treatment. Revista Brasileira de
Psiquiatria, 30(1), S11-S15.
Grant, J.E., Odlaug, B.L., Schreiber, L.R.N., Chamberlain, S.R., & Kim, S.W. (2013). Memantine reduces stealing
behavior and impulsivity in kleptomania: A pilot study. International Clinical Psychopharmacology, 28(2), 106-111.
Grant, J.E., Odlaug, B.L., & Wozniak, J.R. (2007). Neuropsychological functioning in kleptomania. Behaviour
Research and Therapy, 45(7), 1663-1670.
Grant, J.E. (2006). Understanding and treating kleptomania: New models and new treatments. Israel Journal of Psychiatry and Related Sciences, 43(2), 81-
House Co-Sponsorship Memoranda from PA State Representative Thomas Caltagirone. Posted: December 17, 2014 04:47 PM To: All House members. Sub-
ject: Training for law enforcement and minor judiciary to recognize individuals suffering from mental health conditions or intellectual disability.
Odlaug, B.L., Grant, J.E., & Kim, S.W. (2012). Suicide attempts in 107 adolescents and adults with kleptomania. Archives of Suicide Research, 16(4), 348-
Rudel, A., Hubert, C., Juckel, G., & Edel, M.A. (2009). Combination of dialectic and behavioral therapy (DBT) and duloxetin in kleptomania. Psychiatrische
Praxis, 26(6), 293-296.
The National Research Council (2014). The Growth of Incarceration in the United States: Exploring Causes and
Torrey, E. E, & Stieber, J. (1993). Criminalizing the seriously mentally ill: The abuse of jails as mental hospitals. Innovations and Research in Clinical Ser-
vices. Community Support and Rehabilitation, 2(1), 11-14.
Turnquist, K. (2015). Where did the "Deinstitutionalization Movement" take us? Readings in Humanistic Psychiatry, 1-7.
Funding will also need to be available to provide for the mental health evaluations, for expert witnesses to testify in order to
educate the trier of fact, and for ongoing mental health treatment.
As of now, all of these elements are lacking, hence overcrowding of prisons with a significant percentage of people who
have mental health conditions either are not being accurately diagnosed or not properly treated for these mental health conditions,
which could contribute to their criminal behavior.
National Alliance on Mental Illness of Berks County, PAPage 6
Top Reasons to
Join NAMI PA, Berks County
You become a part of the nation’s largest grassroots organization dedicated to improving
the lives of individuals affected by mental illness
Your membership extends to the local, state, and national levels
You receive a FREE subscription to The Advocate, NAMI National’s mental health maga-
Member discounts on materials from the online NAMI Store at NAMI.org
Annual National Convention registration discounts
Access to the NAMI online member community to keep up-to-date with research and edu-
cation about mental illness
FREE programming that helps improve the quality of life for individuals and family
A network of support
Local, quarterly newsletter entitled Berks Bulletin
To become a member, please send a check or money order—payable to the Greater
Reading Mental Health Alliance—to the mailing address below, or submit your payment
online at NAMI.org.
1234 Penn Avenue, Wyomissing, PA 19610
NAMI has worked for more than 30 years on a national level to become the Nation’s Voice on
Mental Illness. Your membership is vital to this on-going movement.
When you become a member of NAMI Berks County, you become part of America’s largest
grassroots organization dedicated to improving the lives of persons living with serious mental
illness and their families. Join now for just $35, and become a part of NAMI at the na-
tional, state and local levels. Become a member and show your support of our mission in pro-
viding education, support and advocacy to improve the lives of people affected by mental ill-
ness. You can join at the following levels:
Individual/Family – $35
Low-Income – $3
NAMI PA, BERKS COUNTY MEMBERSHIP / DONOR CARD
___Membership dues enclosed: ___Renewal ___New
___Consumer/low income ($3.00)
___Individual/family/community member ($35.00)
___Enclosed please find my tax deductible donation of:
___$100 ___$50 ___$25 ___$10 ___other $___
Please make checks payable to Greater Reading Mental Health Alliance
and kindly send to 1234 Penn Avenue, Wyomissing, PA 19610.
Thank you for your support!
NAMI PA, Berks County
1234 Penn Avenue
Wyomissing, PA 19610