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A Case for “Forced Treatment”?

Dec 19 2011 | Comments 6

Bipolar Burble blogger Natasha Tracy has a post up today about Laura’s Law (California), which mandates mental health treatment for people who are considered both severely ill and dangerously violent as a court-ordered condition of their living in the community. Unlike forced electroshock, mandated Assisted Outpatient Treatment (AOT) (which doesn’t include forced medication) is showing positive results. Tracy cites results from other states, which show that AOT “helps the seriously mentally ill by reducing homelessness (74%), suicide attempts (55%) and substance abuse (48%).” She also cites gains of the implementation of Laura’s Law, including reduced hospitalization and reduced incarceration.

If you have objections to AOT, check out Tracy’s post. You may find she engages your arguments—and dismantles them.

liz | 2:18 PM | bipolar disorder, criminal justice system, electroshock (ECT), assisted outpatient treatment, bipolar burble, forced electroshock, forced treatment, laura's law, natasha tracy

Bipolar Disorder Saves Woman From NZ Pokey

Dec 2 2011 | Comments 41

andrea phipps
You know what I like about New Zealand (aside from the fact that the Lord of the Rings trilogy was filmed there)? I like that their courts prosecute “dishonesty.” In the States, we have all kinds of legal jargon. New Zealand doesn’t go in for that.

Take the case of Andrea Phipps, who just got home arrest instead of jail time because she blamed her actions on her bipolar disorder. Here’s what the Press of New Zealand had to say about her case:

Phipps, who has 72 previous convictions for dishonesty and has served a series of jail terms, including a term for attempted murder, had committed a further 20 offences over a four-year period.

She had previously pleaded guilty to ripping off two finance companies, filling out false loan applications in the name of her mother-in-law to get money for a boat and a car, which were later sold. She repeatedly bought time by issuing bad cheques including one to a solicitor.

She then faxed the solicitor’s receipt for that cheque to a finance company as proof that payment was on its way, which caused further losses when the car involved was released for sale before the cheque was dishonoured.

Phipps befriended a neighbour and found out her PIN when they went shopping. Then she took the woman’s bankcard and withdrew thousands of dollars.

She took cheques from her employers and used them pay a phone bill and a motel bill.

She paid a friend for a cheque for $28.18 and then altered it to $2801.18 and used it for a payment on a tenancy.

She used false documents to apply for jobs – two of them involving airport security clearance, which resulted in more charges today.

Her lawyer suggested that her feelings of grandeur from her “genuine illness” caused the latest bout of “dishonesty” and that she’s actually quite honest when she’s taking medication.

According to the Canterbury Star, the judge told her:

“This was a gross breach of trust in relation to friends, employers and authorities. The level of premeditation and deception was very high.

“You claim to have little memory of your offending, which I find hard to believe. You say that when you’re stressed, you turn to crime. I know a number of people who suffer from the same illness and they certainly don’t turn to crime as you do.

“You have 72 previous convictions for dishonesty. It is thought your mental state was a factor in some of your offending, and I agree.

“But for your mental health issues, a full-time custodial sentence would have been appropriate.”

Cases like this present a difficult challenge for mental health advocates. On the one hand, it’s frustrating to hear about people like this and have their illness associated with bad deeds. There are plenty of us with bipolar disorder who are not fraudsters, and it just sullies the image of people with mental health when stories like this are published.

On the other hand, what if she is being (uncharacteristically) honest about her diagnosis and really was impelled to do these things as a result of her symptoms? In that case, we’d certainly want her to be treated with sensitivity and not just consigned to a criminal justice system if that’s not what’s best for her.


liz | 11:04 AM | bipolar disorder, criminal justice system, andrea phipps, new zealand crime

Liveblogging Primetime Outsiders

Aug 25 2009 | Comments 18

All the below is about this show.

Madigan: They didn’t flatter you with that lighting.

David Oaks: You’re looking so handsome! I had no idea. Your eyebrows are very sexy. (I’m completely sincere.)

“But critics worry …” That’s journalism-speak for “We don’t have any specific sources who say this, but we’ll generalize it so we have reason to focus on …”

… violence. That’s what they’re focusing on. Why am I not surprised?

So of all the things they could talk about related to Mad Pride — and related to mental health — this is what they’ve come up with: criminals and violent crime. Ugh. TV is so predictable and depressing.

Okay, so now we’re telling the story of a kid with hallucinations and delusions (the CIA, yadda yadda) who KILLS HIS MOTHER? Does the average American viewer understand how fucking rare this kind of thing is? That it’s not the necessary result of deciding not to take meds?

On to the withdrawal story: Clearly, the program wasn’t looking for a success story. This poor woman who decided to do the show so they could feed off her misery — I knew that’s what they wanted. Is she doing the withdrawal in conjunction with a doctor? Who the hell knows? The show doesn’t tell you. It hardly tells you her name. And …

Oh! There it is again: “Critics worry … ” (that she’s going to be “a time bomb” without her meds). Who are these critics worrying about this girl? Frank Rich? David Denby? I’d love to know.

“Violence is unpredictable with or without drugs.” Brilliant script.

Blurry homeless images. Madigan cello-ing. … This show is so bad, it’s like a joke. I guess it all goes back to what producer Ia Robinson told me, when we discussed my being on the show: She doesn’t have any friends or family who have mental problems, so the whole topic was like “walking on the moon.” Yes, that’s the phrase she used. The show should’ve been blasted out to Mars.

Except Joey P. He’s delightful and a voice of reason.

liz | 9:34 PM | SCHIZOPHRENIA, alternative treatments, bipolar disorder, celebrities, criminal justice system, depression, hospitals / hospitalization, meds, philadelphia, side effects, stigma, suicide, violence

Cho Docs Released

Aug 20 2009 | Comments 50

As we know now, the man who committed mass murder at Virginia Tech, Seung-Hui Cho, was subject to psychological and psychiatric intervention several times while on campus. Some of what disturbed professors were plays like Richard McBeef, a takeoff on Macbeth that took things a little too far.

On Wednesday, the university finally released the documents that were “lost” after the shootings. They reveal a great consistent gap in the psychiatric system, and one that can’t easily be remedied. Though the documents attest that Cho was interviewed several times, he was lucid and able to say that he wasn’t a threat to himself or others. This is typically the standard that merits commitment, and if a person avers that he’s not a danger, we have to take that at face value. We can’t just go around virtually incarcerating people for being strange.

In the case of one incident, a roommate reported concerns of suicidal ideation on Cho’s part. But Cho voluntarily went to the counseling center to discuss it, and was clearly not psychotic or delusional. He was, to all appearances, under control. Much of what was done (physical tests, etc.) is standard and mandatory, and some might say detracts from really engaging. But on the other hand, if the person is suffering due to a physical problem, this must be discovered.

Here are two pages from that incident report (sorry for the formatting issues):

In this case, I don’t see particular misconduct. Which is the problem. It’s impossible to know a person’s state of mind with any surety. And maybe that’s good, in an existential way. But a later communication breakdown seems to have been a concern. From the New York Times:

A state panel convened by Gov. Tim Kaine faulted the campus center for failing to “connect the dots” related to the dangers of Mr. Cho’s mental condition.

Investigators from that panel concluded that campus officials were not aware of the judge’s order requiring that Mr. Cho receive treatment.

As for those missing documents, the director of the center who “inadvertently,” he said, took them home, was fired. No surprise there.

What’s sad about looking at the records is that it’s not clear what could have been done for this agonized young man. I know from my experience teaching and that of my friends in academia that students write bizarre shit, and you can’t assume that every one of them will kill people on your campus. You don’t know when to worry, and what about. And when does it stifle creativity?

Some of the documents indicate that Cho was seen with frequency, and that should’ve been a red flag. There was clearly knowledge that something was wrong. But again, what to do? Was a 302 (involuntary commitment) in order? That’s a slippery slope, to say the least.

This is not to say there weren’t major, major red flags, in these yellow pages (not all of which are downloaded here) in particular. Note the things that changed — that’s always a key question people in counseling take note of. When habits change, something is wrong, and Cho knew this, which is why he was seeking help. The designation of “Troubled” was ominous, and the deferral of filling out a form was a mistake, obviously — perhaps why the director of the center thought it best to accidentally take things home with him.

I’ll be interested to hear what you all have to say. Oh, and to those who might say that I’m giving too much space to a sensational, violent case — which of course represents a freak episode in the life of people with mental illnesses — I see your point. But this can’t go unremarked by me. The mainstream media has their say; I won’t be silent just because I don’t like the fact that this happened.

liz | 9:02 PM | Uncategorized, criminal justice system, violence

Huzzah and Hallelujah!

Aug 18 2009 | Comments 19

Friends, it’s been a long, long week (plus change) without you. I was feeling the bite quite keenly, but my mutable work situation — my departure from PW as a full-timer — meant a delay in tending to this blog. Now I’m back, and I have to say, it’s like a nice cold brewski on a really hot day. (Unless you’re in recovery from alcoholism, in which case substitute a cranberry spritzer or whatev.)

I feel pretty good. Sleeping late(r) (since working at alt weeklies doesn’t exactly make you rise with the dawn) is nice, though I’ve been a little anxious. So there’s been a fair amount of Ativan consumption that will have my pharmacist givin’ me the fish eye next month.

Aside from the fact that Bob Novak is dead (about which I feel nothing; sorry) and unremorseful bag of shit Michael Vick is going to be an Eagle (about which I feel rage), the most interesting article I’ve read about mental health issues in my absence marries my passions. It was in the New York Times:

Mentally Ill Offenders Strain Juvenile System

It’s heartbreaking and a must-read, and again, I’ll make the assertion that tends to get me in hot water every time I say it: Prison is worse for people with severe mental illnesses than psychiatric hospitals — though the best solution, ideally, is community-supported intervention. It’s tragic to read about these kids who decompensate in prison and then, because that behavior is criminal in the system, not just pathological, get more time. That’s part of what makes it so much worse to be shuttled into the criminal justice system.

But don’t get me started. Just read the piece. Also:

Young, Mentally Ill and Behind Bars

liz | 12:39 PM | children, criminal justice system

Va. Tech Mental Health Records

Jul 22 2009 | Comments 7

Coming soon to a headline near you: The mental health records of Virginia Tech Seung-Hui Cho, who killed 32 people before turning the gun on himself. (That number still stuns me.) Apparently, a worker at the counseling center had taken the records home — I’m guessing to protect someone. And for whatever reason, they’ve just been located now by lawyers working on a civil lawsuit against the university. From the AP:

Kaine said the records would be released as soon as possible. Lawyers in a civil lawsuit found the records in the possession of a former worker at the counseling center.

The governor said taking confidential records from the counseling center was illegal and state police were investigating how the records disappeared.

He said officials first would ask the administrator of Cho’s estate to release the files. A second option was to subpoena the records.

He also said he was not happy that the criminal investigation of the shootings failed to uncover the files.

While a large part of the shooting investigation focused on how university officials and law enforcement responded following the first reports of shootings in a Virginia Tech dormitory, family members of the victims have also inquired about how the troubled Cho slipped through the cracks at university counseling.

In April, on the second anniversary of the shootings, families of two slain students sued the state, the school and its counseling center, several top university officials and a local mental health agency, claiming gross negligence in the chain of events that allowed Cho to commit his killing spree.

The lawsuits also claim a local health center where Cho had gone to say he felt suicidal did not adequately treat or monitor him. The status of the lawsuit was not immediately known.

Holly Sherman, whose daughter Leslie was among those killed, said in November that she was less concerned with continued analysis of how university officials responded to the massacre and more interested in learning about Cho’s mental treatment.

Mike White, whose daughter Nicole was killed, said in November he was concerned about why Cho’s mental records went missing.

Andrew Goddard, whose son Colin was shot four times but survived, said there was more work to be done on mental health services. Goddard was appointed last year to the state board of Mental Health, Mental Retardation and Substance Abuse Services.

liz | 9:14 AM | criminal justice system

This Didn’t Have to Happen

Jul 14 2009 | Comments 15

A woman gets picked up for shoplifting in Edison, NJ, and taken to jail. She’s 30. Things are not looking good. She’s from Somerset, NJ–not exactly a den of iniquity. Who knows what’s going on in her life? The end of this story should not be that she dies, in a jail, of suicide. This is the second inmate suicide at the Middlesex County Jail in recent memory. Their website says:

Middlesex County has a long history of national leadership in jail operations. In 1917, when the jail opened in New Brunswick, Middlesex pioneered a number of architectural innovations.

In 1978, the Board of Freeholders combined the jail and the workhouse into a unified Department of Corrections. A modern facility was constructed in North Brunswick and the old buildings were closed. Since opening in 1984, the Adult Correction Center has been recognized as a leader in Direct Supervision Jail Management. Through the years, jail leaders from all around the country (and even overseas) have visited Middlesex County.

In 2005, the Middlesex County Department of Corrections processed over 12,000 inmate commitments. The average daily population of the facility totaled 1,182.

The Department of Corrections is composed of 292 employees, administrators, correction officers, supervisors and support staff.

Well, isn’t that nice. I’d ask Warden Edmond C. Cicchi, the Director of the Department of Corrections, what happened here. According to the website, “He is responsible to ensure the highest degree of protection for the citizens of Middlesex County and to ensure the safety of the staff through the secure confinement of inmates committed to the Middlesex County Department of Corrections.”

That doesn’t mention anything about the safety of inmates nor the safety of citizens from other counties. Was that why she wasn’t monitored appropriately?

Franklin Township woman commits suicide in Middlesex County jail, authorities say

liz | 8:41 AM | criminal justice system

R.I.P. Mumford Morgan/Further Explanation of Mental Health Court

Jul 13 2009 | Comments 5

The Philadelphia Daily News had a good editorial on Friday about “sequential interception,” which is the approach taken both by the new mental health court and by the Crisis Intervention Teams that work within the police department. From that editorial:

Unfortunately for Mumford Morgan, this unit was not called when police shot and killed him last Friday in Dilworth Plaza. Morgan, 59, who was homeless and apparently mentally ill, made 40 calls in just over two hours from an emergency call box in the concourse under the Municipal Services Building. When two police officers arrived, he raised a utility knife and was shot to death.

Mental-health advocates are rightly asking why the CIT was not called to the scene and why police did not use Tasers instead of guns to subdue Mumford. We urge the Police Department to review the case and renew its commitment to CIT.

The editorial goes on to endorse the new court by explaining its roots and purpose. Please, naysayers, read this carefully:

The court and the CIT are responses to a complex problem that began decades ago when the closing of state hospitals released mentally ill people into the community without adequate support or services.

Decades later, the high numbers of mentally ill people occupying prisons – some reports put the number at 30 percent of the inmate population – suggests that in too many cases, prisons have replaced state hospitals.

This has huge impacts on both management and budgets. Consider: The Philadelphia prison system is the largest provider of mental-health services in the state of Pennsylvania, according to a report from former city prisons chief Leon King.

The mental health court is a small step, but the right one. The new court will begin with 15 carefully screened inmates who are about to be released, who will get supervision and treatment. Funded by a state grant, the court will handle only non-violent offenders. If that works, presumably more ex-inmates will be added to the court’s supervision.

There’s no shortage of prisoners who could benefit. It’s a component of many arrests for public disturbances, theft, drugs, aggressive panhandling and – in less common instances – violent crimes. Add in addiction, homelessness, and an insufficient health-care system and it’s no surprise that more mentally ill people are receiving more treatment in jail than in hospitals.

But hospital stays are short compared to prison sentences, and mentally ill prisoners tend to be incarcerated longer than average due in part to their conditions: In jail, they might be taken off medications abruptly, which can lead to acute episodes, behavioral infractions, and more time tacked on. A similar cycle traps recently-released prisoners as they return to the community, leading to high rates of recidivism.

Full article here.

liz | 9:18 AM | criminal justice system, philadelphia

Mental Health Court, Round Three

Jul 9 2009 | Comments 15

Okay, below I issued a response to a general assertion about probation and parole. But to get Philly-specific, this idea is far from scary for offenders. In fact, it’s already in use, in a sense. From the Inky article:

One reason the Mental Health Court concept was supported by such diverse parties as prosecutor Abraham and Chief Public Defender Ellen T. Greenlee is that pieces of it have been used for at least two years.

Since 2007, criminal defendants with mental illnesses have had their cases assigned to a single Municipal Court judge who works with prosecution and defense lawyers and court-appointed mental-health experts to ensure those awaiting trial get treatment.

The Mental Health Court extends the concept post-prison.

Abraham said 500 nonviolent defendants had gone through the predecessor program since 2007 and “no one has been a recidivist. That’s a very enviable record.”

It certainly is. Also:

A $60,000 state grant will underwrite start-up costs, but personnel will be drawn from existing probation and mental-health-services agencies.

Woods-Skipper said the current staff could handle about 70 people before personnel would have to be added.

Also, we have to keep in mind that the emphasis of this pilot program is re-entry, i.e., reintegration with the community. This is something Philly hasn’t been great at, but is trying all the time to improve upon .

liz | 11:05 AM | criminal justice system

Mental Health Court, Round Two

Jul 9 2009 | Comments 8

Yesterday I linked to a story in the Philly Inquirer about the establishment of a Mental Health Court here in Philly. A reader left this comment:

Well that settles it, not moving back to Philly. MH Courts are just another form of forced drugging. Why not use parole and probation which are set up to do the same thing but do it better?

I have to vehemently disagree. As someone who worked for an agency that advocated for incarcerated people and people with criminal background issues–including many people who have mental illnesses–I can assure you parole or probation do not do it better.

Probation officers are often like any other civil employees: overworked, under-resourced, frustrated by the limitations of the system. They can be burdened by high caseloads and unable–through no fault of their own–to pay sufficient attention to individual needs. They are tasked with ensuring that people who have been deemed problematically unable to abide by society’s rules now comply–with the understanding that further punishment is just around the corner. Anyone who’s been in jail or prison knows that being on probation is a horrendous state of purgatory; and due to lack of appropriate staffing and systemic inadequacies, mistakes get made. People get cycled back into jail by accident, paperwork gets lost, individual concerns go unaddressed. The priority? Keeping society safe from the perpetrator.

At no point in this fabulous process–despite the best efforts of the many wonderful people who work in probation and parole for all the right reasons–is the issue of the best mental health care truly assessed. “You taking your meds?” Check. “You pee into the cup?” Check. “You change your address?” Nope. Hello and goodbye. How many times did I, as an advocate, try to get people to have more fruitful relationships with their parole officers based on expanding the understanding of mental illnesses and how they could or did not promote certain behaviors? How do you educate the world?

The reality is that specialization is key. If someone has a mental illness, and this illness is implicated in their inability to abide by certain rules, it is far better to have their case adjudicated by a body that comprehends such issues and motivations, not by people who lump them in with everyone else. There’s an interesting 2001 article from Law & Psychiatry that talks about the growing use of “therapeutic jurisprudence”:

Both mental health and drug courts have their genesis in the concept of specialty courts and the idea of therapeutic jurisprudence (2). The latter concept reflects a focus on “the extent to which legal rule or practice promotes the psychological and physical well-being of a person subject to legal proceedings” (3) as well as an “exploration of ways mental health and related disciplines can help shape the law” (4) and concern with “the roles of lawyers and judges [in] produc[ing] therapeutic and antitherapeutic consequences for individuals involved in the legal process” (5). Both drug courts and mental health courts embrace a therapeutic approach.

Now, granted, the article is old now. And it talks about the limitations of such courts at the time, which still hold: They’re idiosyncratic. Philly’s court will likely be extremely idiosyncratic, given its judge. But if we trace the possible course of a person through the “normal” system vs. a Mental Health Court, you’d see the positive difference, despite whatever frustrations you might have. The biggest difference? Potentially avoiding jail time. This is crucial. You could only believe that mental hospitals are worse than prison if you’ve never been to prison.

This is all I’m going to write now. Later I hope to write more about the problem of being imprisoned in a punitive facility rather than a treatment facility (and the question of “forced drugging”) when you’re severely mentally ill. But this should get you thinking and talking (civilly?) for now.

liz | 10:18 AM | criminal justice system

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