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.

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.

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

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.

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

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.

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 .

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.

Philadelphia opens Mental Health Court

First, be an informed consumer. Just like with a car or washing machine you can learn about medications and other treatments for mental health problems. Turn to websites like your state mental health agency or the National Institute for Mental Health, the National Mental Health Association and the National Alliance for Mental Illness. Google key words about what you want to know, as you would for breast or prostate cancer, diabetes, and heart disease. Ask others who have successfully navigated the mental health care system and taken medications. As has been said, caveat emptor — let the buyer beware — and be prepared.

Second, ask questions of your doctor and other health professionals. Rather than being a marketing arm of the pharmaceutical companies, be a prudent buyer. Don’t be shy — you are your best advocate. When you visit your doctor ask two questions: why are you suggesting this treatment for me and what alternatives do I have? When in doubt get a second opinion: any doctor who does not welcome a second opinion is not worth keeping.

Finally, recognize that medications for mental disorders often help but generally are not sufficient. Great reliance on medications has fostered inattention to individual and family therapy and skill building programs.

Emphases mine. For the rest of the article, click here.

Randall Robbins II, who pleaded guilty to second-degree murder in the 2002 strangulation of 17-year-old Brittany Eurek, argues that both Pfizer and his doctor should have known that Zoloft might have made him attempt suicide and commit murder.

He says the drug intensified his agitation, suicidal desires, hysterical behavior and hostility and diminished his self-control.

Those arguments are similar to claims made in a few other cases since 2004, when antidepressants gained new warning labels highlighting the risk of suicidal behavior in people under 18.

In 2007, the South Carolina Supreme Court upheld the conviction of Christopher Pittman, who is serving a 30-year sentence for killing his grandparents when he was 12. The court rejected his argument that he was involuntarily intoxicated by taking Zoloft and didn’t know what he was doing when he killed his grandparents and burned down their home in 2001.

A year earlier, the North Dakota Supreme Court affirmed the conviction of a man who killed a 19-year-old woman with a shotgun and later tried to blame the 2003 slaying on the antidepressant drug. Zachary Schmidkunz is serving a 35-year prison term.

What puzzles, somewhat, is the conflicting behavior of Pfizer, though their continuing legal victories do justify it. On the one hand, there is the black-box warning, which specifically concedes that this kind of reaction to the drug is possible. On the other hand, there’s the response to a case like Robbins’:

“Pfizer’s evaluation of Zoloft data never has revealed any signal of an increased risk of violence related to either use or discontinuation of use of Zoloft,” [spokesman Chris] Loder said.

The FDA also says the underlying mental illnesses that antidepressants are used to treat are the most important causes of suicidal thoughts and actions.

So is that tantamount to Pfizer saying they don’t believe their own warning? Robbins, who’s in prison for the murder, is now suing Pfizer for $1 million and serving as his own lawyer. (Isn’t that always a bad idea?) Go here for more.

Now it appears that Scott Roeder, who’s being held for Tiller’s death, isn’t just your regular guy who got so agitated by pro-life demagoguery that he had to kill. Instead, reports suggest that he struggled with mental illness. From the Telegraph UK:

In a statement released on Monday, Mr Roeder’s family admitted he had “suffered from mental illness at various times in his life” but insisted they had never believed he would kill anyone.

But it emerged that Mr Roeder had a history of extreme hostility and suspicion towards the US government and later allegedly became dedicated to closing what he called Dr Tiller’s “death camp”.

In 1996, a district judge said Mr Roeder presented a “threat of danger to the public” after bomb-making equipment was found in his car along with a military rifle, gas mask and ammunition.

At the time, his father, John, described him as an “obsessed” but loving man who wouldn’t “kill a fly”.

…

In a statement released by Mr Roeder’s family, his brother, David, said: “We know Scott as a kind and loving son, brother and father who suffered from mental illness at various times in his life.”

…
Dave Leach, an anti-abortion activist from Iowa, … said he met the suspect once. “He told me about a lot of conspiracy stuff and showed me how to take the magnetic strip out of a five dollar bill,” Mr Leach told the Kansas City Star. “He said it was to keep the government from tracking your money.”

This is not to say that every conspiracy theorist is mentally ill. But there are people with mental illnesses whose issues express themselves this way. I’m thinking particularly of the sad case of Russell Weston, who had governmental obsessions.

Suspect in abortion doctor killing ‘had history of mental illness’

Slaying suspect ‘obsessed’ with Kansas doctor, ex-roommate says

Ex-Yankee Jim Leyritz threatened to commit suicide and voluntarily admitted himself—so says FOX Sports.

The background:

Leyritz is free on bail while awaiting trial on DUI manslaughter charges for the late 2007 death of a restaurant waitress Fredia Ann Veitch in a two-car crash that occurred after the former Yankee was celebrating his 44th birthday. Leyritz allegedly had a blood-alcohol content of .14 — well above the legal limit — several hours after the crash, while Veitch had a .18 alcohol level at the time of her death.

…

Davie police then went to Karri Leyritz’s home who told them that Jim Leyritz had blown into the Breathalyzer in an attempt to start his car, but the device indicated he had been drinking, Coyne said.

Karri told cops that Jim had not been drinking. Karri said Leyritz went out to the car a second time, and that when he tried the device that time it indicated he had not been drinking.

That is when Leyritz became upset because he knew the first result would be reported to authorities as a possible violation of his bail conditions, Karri told cops, according to Coyne.

“That caused him to be distraught,” Coyne said.

Karri then told cops that Leyritz said something to the effect that, “He might as well ‘end it’ if it’s too much trouble,” Coyne said.

I gotta say, I’m not feeling deep, deep sorrow for Leyritz right now. It’s hard for me to sympathize given stories like this one. He wasn’t even supposed to be driving, let alone drinking and driving. She was drinking and driving too, so there aren’t any winners here. But sometimes things get really, really simple. Let’s break it down:

If you are drunk, you cannot operate a motor vehicle.
If you are not drunk, you can operate a motor vehicle.

(Unless you’re my mom, in which case alcohol is immaterial. Joking!)

This is the sickest thing I’ve seen in a long time. As someone on ABC News said, I think, the employees are behaving like Michael Vicks with his pit bulls — only these are human beings. It’ll be interesting to see if this incident causes as much furor as the Vick story did. Granted, there’s no celebrity involved, but you know how these things go.

ABC News has a good report on this, and you can link to a Nightline report on it as well.

Unless he’s innocent. But I don’t think he is.

Judge orders defendant’s mouth taped shut

POCATELLO, Idaho (AP) — An eastern Idaho judge who lost patience with the disruptive behavior of a defendant ordered court officials to tape the man’s mouth shut with duct tape during a court hearing. The unusual move was ordered by 6th District Judge Peter D. McDermott during a probation violation hearing for Nicklas Frasure, 23.

Frasure was convicted of felony theft in 2008, but the judge retained jurisdiction for sentencing depending on Frasure’s response to treatment. In October, Frasure was released from a state mental hospital in Blackfoot.

He is accused of violating his probation by not taking prescribed medication.

During the hearing, witnesses told the judge that Frasure’s behavior had been strange and erratic since his release from the state hospital. They also said he has not been taking his medication and has been consuming alcohol, factors also contributing to mood and emotional swings.

Probation officer Julie Guiberson testified that Frasure is a threat to himself and others.

During Monday’s hearing, Frasure interrupted the proceedings with repeated verbal outbursts and unusual behavior and ignored several orders from McDermott to restrain himself. After another series of outbursts, McDermott told bailiffs to silence Frasure.

The bailiffs then found a roll of duct tape, tore off a piece and put it over Frasure’s mouth, according to the Idaho State Journal.

“He’s obviously not mentally competent,” Frasure’s lawyer Kent Reynolds told the judge.

Earlier in the hearing, Reynolds had asked the judge to order a mental competency evaluation for Frasure.

McDermott said he would consider the request, but did not immediately rule on it. McDermott placed Frasure under the jurisdiction of the Idaho Department of Correction. He is being held in the Bannock County Jail awaiting transfer to a state facility.

…

The American Civil Liberties of Idaho refrained, for now, from commenting on McDermott’s decision to silence Frasure.

“The ACLU of Idaho cannot comment on the specifics of this case,” said Monica Hopkins, executive director. “However, on one hand judges have a right to keep order in their court and on the other the defendants have a right to assist in their own defense and be present at trial. Our hope is that judges employ the least restrictive manner of keeping order in their courts.”

Emphases mine. Wacky!

Melissa Huckaby is charged with murdering and raping Sandra Cantu, a little girl in her care. In an interview with Good Morning America, her ex-husband is asked, insistently, about his ex-wife’s mental health. Check out the video of the interview here.

I know it’s valid to ask about her mental state, but the way it’s done in this instance makes me uncomfortable. I notice the Australian coverage of the case doesn’t mention the possibility of mental illness, which is nice, considering she hasn’t even been proven guilty yet.

Perhaps I’m being overly sensitive, but I resent the persistent connection between violence and mental illness that’s played up in the press. I mean, there’s a whole article here about why the insanity plea in this case probably won’t work. It begins:

The fact that the woman charged with killing Sandra Cantu was recently mentally evaluated through the San Joaquin court system raises the question of whether she might use an insanity defense if the case goes to trial.

Emphasis mine, because this kind of speculation is ridiculous! It’s followed up by:

“She might be extraordinarily mentally ill but still legally responsible for the crime,” said Loyola University criminal law professor Laurie Levenson.

Or she might frickin’ not be. WE DON’T KNOW YET. All this article — and coverage like it — does is foster the linkage between mental illness and crime. And the funny thing? Here’s all we know for sure: Her family may have said that she might have been depressed after her divorce.

Eff you, media world. I’m sick of it.

Hoarders have a serious mental disorder, but they lack a voice. KSTP-TV in Minneapolis-St. Paul interviewed two hoarders after they came out of court.

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