Wednesday, July 25, 2007

Mental Disabilities

The ABA assessment team concluded:

The State of Florida has a significant number of people with severe mental disabilities on death row, some of whom were disabled at the time of the offense and others of whom became seriously ill after conviction and sentence.@ ABA Report on Florida at ix.

And, while Florida has recently excluded individuals suffering from mental retardation from the death penalty, it has not extended its logic to those suffering from severe mental disabilities. Id. at xi.

The ABA assessment team recommends that the logic regarding those with mental retardation be extended to those with severe mental disabilities, noting that mental illness can effect every stage of a capital trial. Id at xxxviii.

Certainly, the distinction between the mental impairment of the mental retarded and the mental impairment of the mental ill and corresponding culpability of those inflicted with each condition appears to be arbitrary.

Furthermore, even in the case of the mentally retarded, Florida has created a procedure that will produce arbitrary results, as ABA assessment team acknowledges.

The legislation and rule governing mental retardation procedures makes a distinction between those individuals whose cases are final and those who are not. See Fla. Stat. ' 921.137; Fla. R. Crim. P. 3.203. Those whose cases are final receive none of the protections as those whose cases are not final, including, but not limited to a jury`s consideration of the issue and the sixth amendment guarantee to effective assistance of counsel. These distinction depending on where a defendant is in his criminal process are arbitrary.

The ABA assessment team also criticized the burden of proof imposed on capital defendants and recommended that the State be required to disprove a defendant`s substantial showing that he is mentally retarded. ABA Report on Florida at xxxviii.

The imposition of the burden of proof on the defendant will undoubtedly cause the decision as to who is mental retarded and does not get executed and who is not retarded and gets executed to turn on arbitrary factors, such as whether records demonstrating onset before the age of 18 exist, are family members still alive who can advise mental health experts as to the defendant=s adaptive skills, etc.

Sunday, July 8, 2007

The Wrong Place to Treat Mental Illness

By Marcia Kraft Goin

Sunday, July 8, 2007

Last month the Supreme Court rightly blocked the execution of Scott Panetti, a Texas man who was convicted of a double murder and who suffers from delusional schizophrenia. The case drew public attention to the intersection between mental illnesses and executions.

But what about those who are mentally ill and imprisoned but not on death row? A national conversation on this issue is urgently needed.

There is a pervasive attitude in this country that such people are getting what they deserve: After all, like Panetti, they are in jail for something.

But did you know that the Los Angeles County Jail houses the largest psychiatric population in the country? That's not justice. That's emblematic of a national emergency.

Before the 1960s, people with mental illnesses were generally cared for in institutional settings, mostly state-run psychiatric facilities. Many advocates correctly saw this as "warehousing" people who could be cared for in less restrictive settings. Federal legislation and the courts powered a move toward deinstitutionalization, calling on states and counties to provide resources for social services, vocational rehabilitation and treatment services. The introduction of effective antipsychotic medications also drove the trend toward deinstitutionalization.

In the decades since, community-based services have helped many people. But the situation today constitutes a national failure.

What's gone wrong?

Most important, the necessary community resources didn't materialize in anywhere near the level that was needed. Also, antipsychotic medications, while powerful treatments, don't work in isolation. Patients need a relationship with a psychiatrist, clinic or other stabilizing force to ensure adherence to drug regimens and achieve the best possible recovery.

Deinstitutionalization has succeeded in decreasing the overall number of hospital beds, but an unforeseen consequence has been the proportional increase in the number of people with mental illnesses housed in the criminal justice system. Worse, once imprisoned, people with mental illness are shown to have much longer incarcerations than other inmates, primarily because a prison environment and lack of treatment aggravate the very illness that has led to their objectionable or antisocial behavior.

While no one would argue that Scott Panetti belongs on the streets, his case compels us to consider the justice system's role: Is it to mete out punishment that seeks retribution, or are there cases where real justice means effective treatment that seeks rehabilitation?

Consider again Los Angeles County: In 2002 there were 38,600 psychiatric evaluations at the inmate reception center of the Twin Towers jail. Of these, 23,190 people (60 percent) were found to be in need of mental health treatment. A reasonable person could not fail to see the correlation between decreased funding for mental health resources, the closure of hospital beds, homelessness and the criminalization of mental illnesses. Untreated and lacking access to long-term care, people with mental illnesses often end up with symptoms and behaviors that result in jail time.

Cuts in state Medicaid budgets promise to exacerbate these problems. Not only is this shift in funding a blight on our society, it also costs money -- a lot of money. Corrections officials, mental health workers, medication, amortization of buildings and time spent by police in court all cost more than treating patients appropriately in their community. This doesn't make financial sense, much less humanitarian sense.

When considering the direction of public policies that affect those with mental illnesses, politicians and other officials must be guided by the latest research.

Government-funded studies have shown in recent years that jail-diversion programs, which help people get the treatment they need, result in positive outcomes for individuals, communities and the criminal justice system. While jail diversion does generally result in lower criminal-justice costs and greater treatment costs, studies are underway to analyze the differential.

The question the court answered in the Panetti case was about one's fitness to be executed, but in many more cases, the question is about the appropriateness of incarceration at all.

The writer is a past president of the American Psychiatric Association and director of residency training in the Psychiatric Outpatient Department at Los Angeles County General Hospital/University of Southern California School of Medicine.

Thursday, July 5, 2007

Coping with Mental Illness: Help Is Here

COURT HOUSE— More than 44 million Americans suffer from a mental health disorder according to the National Institutes of Mental Health, 80 percent of which also have a sub-stance abuse problem.

“He’s been through counseling, seven rehabs, overdosed four of five times,” said the North Wildwood resident and mother of a schitzo-affected adult son suffering from severe anxiety, bi-polar disease, and substance abuses.

The Herald is withholding the names of mother and son to protect their privacy.

What this mother described is termed by psychiatric professionals as a dual diagnosis, oc-curring when an individual is affected by both an emotional or psychiatric illness and chemical dependency.

The woman describes her son as a shy boy, who experienced extreme emotional highs and lows and delusions of grandeur.

“He doesn’t listen,” said the North Wildwood resident, “he does not think logically.”

She said she feels alcohol and drug use was what escalated the situation with her son’s mental health.

“We had a lot alcoholism in our family, mostly functioning alcoholics, but in those days we didn’t know. People didn’t talk about their problems.”

At 14, her son had his first suicidal overdose.

Afterward, she sought assistance from Cape Counseling Center in Court House.

“It’s very hard for kids,” she said. “He came out of rehab and re-entered school at 16 so-ber, but his friends were drinking and smoking pot. Of course he wanted to do what they were doing.”

Her son, now in his thirties, was in the Ancora facility last year where he connected with Rachel Parzio-Corso, an advocate with New Jersey Protection and Advocacy, Inc. (NJP&A).

Designated by Gov. Christine Todd Whitman in 1994, NJP&A serves as a free service agency of attorneys and advocates who monitor investigations, respond to cases and teach people to be self-advocates.
Parzio-Corso, who also has a son with mental health issues, attends a jail task force monthly and responds to cases such as when a person is in jail and doesn’t have access to proper medication, or in the case of this North Wildwood mother’s son, assists patients in receiving the best treatment for their particular situation and assuring their rights are pro-tected.

Parzio-Corso said issues she comes in contact with are overmedication in psychiatric hospi-tals and extended incarceration for offences that may have been escalated into extended is-sues because the person is mentally ill.

She said she also deals with more minor issues in psychiatric hospitals such as laundry be-ing returned to a mentally ill person with holes and burns, or not returning at all.

“We’re trying to put an end to issues like that,” Parzio-Corso said.

The Group for the Advancement of Psychiatry reports that 320,000 people who suffer from severe mental illness are incarcerated in our jails and prisons today.

Parzio-Corso told the Herald that 15 to 20 percent of inmates are mentally ill, and they will spend an average of eight times longer incarcerated than other inmates due to infrac-tions stemming from response to lack of proper treatment and medication.

Cape Counseling is working to change this situation by heading it off before mentally ill individuals get into trouble.

The non-profit group provides mental health education programs throughout the county, support groups for patients and families, and a free service program, Families F.I.R.S.T., which provides education and support for family members of loved ones with mental ill-ness, to assist them in situations such as this North Wildwood mother and her son.

Cape Counseling also provides psycho-educative services to local police departments in how to interact with a mentally ill suspect, or just in an everyday situation.

“Lower Township has been wonderful,” said Samantha Knocke, a family support special-ist at Cape Counseling’s center in Court House.

Some police departments in Gloucester and Camden counties employ special agents to handle situations with mental health issues because they can be so particular and difficult to manage.

“I’ve seen the police beat my son,” the North Wildwood mother said. “He gets scared, you back him in to a corner, and he reacts. But you have to look at both sides. The person is afflicted and afraid, those interacting with them don’t know how to properly handle them.”

It’s situations like these that called for the creation of the Families F.I.R.S.T. program.

The program defines mental illnesses as physical brain disorders that profoundly disrupt a person’s ability to think, feel, and relate to others and their environment.

Mental illnesses, according to their literature, are more common than cancer, diabetes, or heart disease.
The program has over 40 active participating families in this county; another 60 participants are what the program terms “inactive.”

“But they are always welcome. Once you are a part of Families F.I.R.S.T, you are always welcome to come back,” program manager Jodi Hynes told the Herald.

“You just have to hope you get the right kind of help. It’s scary,” the North Wildwood mother said.

“We work to protect what we call the patient bill of rights,” Parzio-Corso said. “We focus on making sure these people are treated with dignity and respect.”

She told the Herald the three biggest problems she has seen through her work are; lack of housing, affordable and also availability of half-way house situations, safety, because of hos-pital incidents, and mentally ill patients continually being incarcerated, instead of receiving proper treatment.

“It (mental illness) comes in so many shapes and forms. As long as a person gets the treatment, they can live a normal life,” said Parzio-Corso.

Contact Gillin-Schwartz at (609) 886-8600 Ext 24 or at: