Tag Archives: Treatment Advocacy Center

RIP Dr Fred Frese

By Marvin Ross

The world just lost another advocate for serious mental illness. Dr Fred Frese was a psychologist with schizophrenia and an active promoter of better care for the seriously mentally ill. He had been a board member of the National Alliance on Mental Illness and one of the founders (along with Dr E Fuller Torrey) of the Treatment Advocacy Center.

I met Fred, and his wife Penny, when they gave a talk at the Hamilton Program for Schizophrenia in the late 1990s and did a profile of them for one of the medical papers that I wrote for. Both of them were incredible speakers. Fred first got sick when he was an officer in the US Marine Corps guarding the largest repository of nuclear weapons in the US.

He became quite paranoid and was eventually transferred to Walter Reed Hospital in Washington where, he said, may of his fellow psychiatric inmates were high ranking officers. While a patient there and elsewhere, he pursued his education and obtained a PhD in psychology. He joked that he went from being an involuntary patient in one hospital in Ohio to becoming its chief psychologist years later.

He commented that he continued to study because people with mental illness simply cannot find work. His sense of humour was evident when he talked about dating his wife. They had gone for a long walk in the woods and it was then that he decided to tell her that he had paranoid schizophrenia. Not the best place to do that, he commented. She did not run off screaming, they married and had four children.

Dr Frese has always been a strong supporter of involuntary treatment when it is necessary (as it often is) and for the fair treatment of those who are ill.

He explains his position in this presentation below:

As he said in the video clip below, he refuses to be ashamed of his illness and that he is not recovered (despite all his credentials) but is in recovery.

I should also mention that Fred was very generous with his time and was an active supporter of the late Dr Carolyn Dobbins (another psychologist with schizophrenia) and was gracious enough to write a very good blurb for Katherine Flannery Dering’s book, Shot in the Head.

Those of us who advocate for improved services for the mentally ill will have to step up our efforts to make up for Fred’s loss.

Should We Bring Back Mental Asylums?

newer meby Marvin Ross

Dr Dawson provided an excellent history of how much we have regressed in our treatment of those with mental illness in his five part series. Despite better (but not perfect) medications, and greater knowledge of the brain, we have, as he said, “For a significant number of mentally ill people (and their families) we have, over the past 30 years, reversed the reforms provoked by Dorothea Dix in 1843.”

Certainly, the statistics for Canada, the US and the UK, bear this out. The Canadian Journal of Psychiatry pointed out that there was a rapid closure of beds in the 1970s and 1980s but that was offset by an increase in days of care in the psychiatric units of general hospitals. They called this transinstitutionalization. But, by the 1990s the overall days of inpatient care began to decrease. Between 1985 to 1999 there was a decline of 41.6% in average days of care per 1000 pop in psychiatric hospitals and a decline of 33.7% in psych units in general hospitals. Days in hospital declined but there were more frequent stays for patients – the revolving door.

In a document by the Public Health Agency of Canada called the Human Face of Mental Illness, it was stated that “This discontinuity and inadequacy of care after hospitalization is common among seniors who have lived with schizophrenia for most of their lives. After being transferred from psychiatric institutions they may find themselves in long- term care facilities that generally have limited availability of mental health professionals.”

Meanwhile, there was a near-doubling in the total proportion of prison inmates in Canada with mental illnesses between 1997 and 2009. Prisoners often end up in segregation units and without adequate treatment because the prisons don’t have the staff or resources to properly care for them.

In the US according to the Treatment Advocacy Center, in 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. And we know that the largest psychiatric facilities in the US are the jails in New York City, Chicago and LA.

The Guardian newspaper in the UK recently reported that more than 2,100 mental health beds have closed since April 2011, amounting to a 12% decline in the total number available. It also found that seven people had killed themselves since 2012 after being told there were no hospital beds for them.

On one occasion last year, there were no beds available for adults in England.

In 2011, Dr Peter Tyrer, a professor of community psychiatry at the Centre for Mental Health at Imperial College, London, wrote in the British Medical Journal that “I am now rueing the success of the community psychiatric movement in the UK, where the inane chant of “community good, hospital bad” has taken over every part of national policy. At some point in the steady reduction of psychiatric beds, from a maximum of 155 000 in 1954 to 27 000 in 2008 the downward slope has to level off or rise.”

Meanwhile, earlier this year, three medical ethicists at the University of Pennsylvania, Dominic Sisti, Andrea Segal and Ezekiel Emanuel, argued for a return of the mental asylum in the Journal of the American Medical Association. They said that their use of the word asylum wasn’t meant to be “intentionally provocative.”

“We’re hoping to reappropriate the term to get back to its original meaning, which is a place of safety, sanctuary, and healing, or at least dignified healing for people who are very sick.”

The United States, they said, now has 14 public psychiatric beds per 100,000 people, the same as in 1850. On average, Sisti said, countries in the European Union have 50 beds per 100,000.

On a personal level, author Katherine Flannery Dering whose book Shot in the Head discusses how she and her 8 siblings cared for a brother with schizophrenia, described the impact of what she called The Great Emptying on one of the talks that she gave. As she says, the number of people needing hospitals did not shrink as much as hospitals did.

Asylums (or psychiatric hospitals) do not have to be evil places where patients are abused or ignored. There is no reason they cannot be caring compassionate places that give patients the necessary time to heal or to protect them from the outside world if that is what they need.