Major Bipartisan Effort At Montana Legislature to Improve Montana's Mental Illness Treatment System

The Interim Children, Families, Health and Human Services Committee of the Montana Legislature finished up its work yesterday.  One of their main efforts was a study of Montana’s public institutions and how they care for people with serious mental illnesses.  Representative Jenny Eck developed the study proposal based on a NAMI Montana request. 

The Interim Legislative Committee and staff tackled this massive, complex and unavoidable problem.  It was really contentious; but they were able to come up with strong bipartisan solutions to challenges which include a State Hospital that is well over capacity. limited options for transitioning forensic patients back the community, and a dramatic rise in children placed in residential treatment facilities.

Some of the highlights of the bills they developed are:

• Significant investment in community mental health crisis services to help people get treatment in their community and avoid stays at Montana State Hospital and correctional facilities.
• Significant investment in transitioning forensic patients out of Montana State Hospital/Montana State Prison and back in the community.
• Significant investment in developing community crisis services for youth to reduce suicide and reduce the number of children placed in residential treatment facilities.
• The expansion of mobile crisis teams to care for people with co-occurring mental illness and developmental disabilities before they require hospitalization.

These bills offer tangible methods to help Montana families access effective care in their communities to minimize expensive stays at state institutions and residential treatment facilities. They were developed with input from a large number of organizations including: mental health providers, the Resident Council at MSH, Disability Rights Montana, the ACLU, law enforcement, Montana’s County Attorney Association, the Montana Association of Counties, developmental disability advocates, and others.   The specifics of the Committee’s efforts are available at the Committee website.

The members of this committee are: Senator Dave Wanzenried (D) (Chairman), Rep. Ron Ehli (R) (Vice-Chairman), Rep. Carolyn Pease-Lopez (D), Rep. Scott Reichner (R), Rep. Casey Schreiner (D), Senator Terry Murphy (R),  Senator Roger Web  (R), and Senator Jonathan Windy Boy (D).  They each played a critical role in finding ways to improve Montana’s mental illness treatment system. If you’d like to thank them, their contact information is available at this link.

If you’d like to support the Committee’s work, please take few minutes and ask Governor Steve Bullock to support the Interim Children and Family Committee’s efforts to improve Montana’s mental illness treatment system.  You can call the Governor’s office at (406) 444-3111 or send him a message through this link.

Thank you,

Matt

Matt Kuntz

Executive Director

NAMI Montana

www.namimt.org

(406) 443-7871

Please support the fight against mental illness by donating to Montana’s NAMIWalk. You can make a donation at my Walk page. Thanks for supporting this critical cause!

NAMIWalk Team Captain Duties

Are you looking to make a big difference in the fight against mental illness in Montana? Sign up to the be a Team Captain at the 2014 Montana NAMIWalk! It's a great way to take a leadership role in this critical effort.

NAMIWalk Team Captain Duties

• Register to be a Team Captain. You can either register online at www.namimt.org or call 443-7871.  Registering online will allow you to participate in Team Captain contests that award team fundraising and online recruitment.
• Pick a Team Name.
• Set Participation and Fundraising Goals for Your Team.  Each Team should consist of at least five Walkers and each Walker should have a minimum fundraising goal of $100.  Encourage each Walker to set a fundraising goal. 

      GOAL
     – My team will have _____ Walkers
     -  We ill raise $_________  

• Recruit Walkers to your Team.  Recruit as many Walkers as possible to your Walk Team.  Ask them to register and fundraise online as well at www.namimt.org.
• Register all Walkers.  Use the Team Captain & Walker Registration Form to list all Walkers, their contact information, and the amount of checks and cash that they collected. [Do not list online donations on the Team Captain & Walker Registration Form.]
• Raise funds for the Walk.  The most effective way to raise money is through an email or letter writing campaign.  Encourage your Walkers to send out messages or letters to their friends, family, colleagues, etc.  If you would like you may have incentive contests to encourage your Walkers to go the extra mile in their fundraising.
• Team T-Shirt. Team T-Shirts are optional, but they are a great way to build team spirit and let the other teams know who you are. 
• Team Sign. Team signs are optional, but are a fun way to provide visibility on Walk Day. 
• Kick Off Luncheon. Attend the Mary McCue NAMIWalk Kick Off Luncheon at noon on Thursday, August 14th in the basement of St. Mary’s Catholic Church, 1700 Missoula Ave. in Helena.
• Bring Your Team to the Walk. The NAMIWalk will be held on Sunday, September 28th at Memorial Park in Helena, Montana.  Registration begins at 11:00 a.m and the program starts at 12:30 p.m.  Team Captains must be there by noon.
• Turn in Your Donations.  Turn the large NAMIWalks envelope into the Registration Desk.  Each large envelope should include: (1) a completed Team Captain & Walker Registration Form, (2) a Walker Donation Form for each Walker (including yourself), and (3) each Walker’s small envelopes containing all checks and cash that they collected.  Please contact NAMI Montana at (406) 443-7871 or info@namimt.org if you need additional forms or envelopes.
• Have Fun.  The NAMIWalk is a great chance for you and your Walkers to have a great time while raising funds for NAMI Montana’s critical mission of supporting, educating, and advocating for Montanans suffering from severe mental illness and their family members.

Neuroscience in the Courtroom: Daubert, Frye, General Acceptance, and Replication Studies

by Matt Kuntz, JD - NAMI Montana's Executive Director

I was fortunate enough to spend a few days with some of the nation's most innovative neuroscientists, psychiatrists, psychologist, and medical researchers as part of the founding of the new Center for Mental Health Research and Recovery at Montana State University. It was a powerful event that left me with a pragmatic hope for long-term improvements in the process of mental illness diagnostic and treatment. While the field is not changing fast enough for some of us, it is changing.

One of the avenues to that change will likely be the effective use of biological indicators of brain conditions in the courtroom. However, this avenue has had a rough start as court's have struggled to evolve their usual evidentiary standards to the dynamic, yet still developing world of brain scans, genetics and blood tests. It's hard for anyone, much less someone outside of the medical profession, to determine what kind of neuroscience evidence should be admitted and what kind of evidence is not ready for prime time.

According the researchers I met with and the general opinion of other in the field, most of that evidence is not ready to be introduced into court. (Brain Scans, Blood Tests). However, we are moving in that direction and approaching the kind of quandary that the discussed in Frye v. United States, 293 F. 1013 (D.C. Cir. 1923):

              Just when a scientific principle or discovery crosses the line

              between the experimental and demonstrable stages is 

              difficult to define. Somewhere in this twilight zone the 

              evidential force of the principle must be recognized, and 

              while the courts will go a long way in admitting experimental 

              testimony deduced from a well-recognized scientific principle 

              or discovery, the thing from which the deduction is made must

              be sufficiently established to have gained general acceptance

              in the particular field in which it belongs. [emphasis added]

Frye's strong "general acceptance" test has given way in many courts to the standard described in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). Under this standard, the factors that may be considered in determining whether the methodology should be admissable valid are: (1) whether the theory or technique in question can be and has been tested; (2) whether it has been subjected to peer review and publication; (3) its known or potential error rate; (4) the existence and maintenance of standards controlling its operation; and (5) whether it has attracted widespread acceptance within a relevant scientific community.

It's understandable that courts are getting lost when applying this standard to the rapidly evolving field of neuroscience and combining prongs (2) and (5). However, publication in a peer-reviewed journal does not equate to widespread acceptance within a relevant scientific community. Further, evidence of low statistical significance in many neuroscience studies suggests that prong (5) is as important as ever to ascertaining scientific validity. 

I poised the question to these leading researchers about what could act as a concrete factor to demonstrate widespread acceptance within the neuroscience/psychological/psychiatric community and the answer was immediate - an independent replication study published in a peer-reviewed journal.

This answer is supported by a staff article in the American Psychological Association Monitor which stated, 

"In psychology, as in other sciences, replication is the gold standard. In theory, new knowledge doesn't make it into the canon until the studies that produced it have been verified, independently, by more than one researcher. But in practice, critics say the field rarely lives up to that ideal — and the result is a psychological literature rife with findings that may or may not be true, yet are generally accepted as valid."

The adoption of this "gold standard" to Daubert's "widespread acceptance" prong would allow courts to utilize a clear standard to determine when brain biomarkers should be admitted into court. This standard is based upon the actual findings of the relevant scientific community, not the judge's estimate of the acceptance of the scientific community.

A Modified Daubert Standard for the Introduction of Brain Biomarker Evidence in the Courtroom

Under this standard, the factors that may be considered in determining whether the methodology should be admissable valid are: (1) whether the theory or technique in question can be and has been tested; (2) whether it has been subjected to peer review and publication; (3) its known or potential error rate; (4) the existence and maintenance of standards controlling its operation; and (5) whether it has been replicated by an independent research team with their results subjected to peer review and publication.

As an attorney who advocates for people who live with serious mental illness and their families, I'm convinced that the addition of valid neuroscience evidence in the courtroom will be a major addition to both the justice system and the overall fight to effectively diagnose/treat these conditions. However, the science has to be proven and accepted by the field.

Unproven brain scans and and genetic tests do not serve either the interests of justice or the people that depend on the mental illness treatment system.