From Facebook - Depression is a flaw in Chemistry - The Stigmas of Suffering

"I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy.”

~Rabindranath Tagore

Mental illness is tied intimately to suffering.  This is because we live  through our minds and our thoughts. It is one of our most important tools. It is our interface to everything that we experience. It is the battlefield of suffering. It is the veritable, "ground-zero", if you will. It is the epicenter of the struggle for those with a mental illness.

This battle begins with your strongest weapon broken. From the beginning there is a problem something is broken. Why it is broken, really does not matter. Sometimes broken is just simply broken. It is not a moral matter. There is something far more basic and fundamentally practical about the situation. It is something that has to be dealt with no matter why.

The flaws that you that you see may not be motivating the odd behaviors and thoughts. It won't help you put into context what you may see and hear from that person. Research suggests there is usually a lot to it. It is a disease of the mind, body and spirit. There are many things that seem to contribute to what is going on.

It seems that chemistry, genes, and social factors are all likely contributors to the list. Truthfully, in many cases I don't think we really know many of the reasons why. Many of the providers of care are pretty removed from the lives of the people who need the care. It is very hard to provide comprehensive care for people out in the community. While we have some institutional care, we need more care where the people are. Out in the actual community, and not held up and controlled in the institutions. We are not reaching people. If we spent more time out in the community with these people and got to know more about them we would learn more about the real reasons why that people are sick. Maybe then we can head some of the problems off at the pass. It would probably be more cost effective too. Institutions are expensive. Although I will acknowledge some that there are some truly, incredibly talented, and motivated people in some of those institutions.

So while you may find it easy to blame a character flaw; it really has not been easy to find out why people have mental illness. For some people, their level of sickness, some seem to have no reasonable explanations at all. I deal with some of those people. Some are just more sick than we can explain. Perhaps the simple explanation is that life is very hard.

We have come into this world, equipped with the hand we were dealt with. It is all that we can bring to bear. It is what we can use to contend with what gets thrown at us. No matter if we are strong in one, many or few areas of life. We must still try to deal with it all. Because of this  pressure on everyone seems to be intense. If we are wise, we can try to remain conscience and hopefully sane while doing so. The choices we make about how humbly and bravely we face our life, -- that defines our character. Consider this, we are all frail beings. There are many more powerful animals out there.  Yet we have adapted, improvised and overcome most of this planet. There is hope. The same can also be said for mental illness. You can do a lot to adapt, improvise, and overcome. It takes someone of character do anything in this life.

Whether or not someone has a mental illness or cancer, either fight for them or at least get out of their way. The greatest moral and spiritual truth, practice, and social philosophy that I have come to realize is -- don't be a jerk".

I encourage you to this resolve because; you know what your own suffering is like. How much do you really need to know about anyone else's life, to know that it probably sucks for them too? If you know pain sucks for you, then you understand it can for them too right? Don't we all seek hope that things will be okay? This makes us all common. This can and should be the basis for our common pursuit of character.

Finding character can actually happen from having a mental illness. It grants a series of collegiate tests of the spirit and soul. Actually I am finding it to be one of the most important parts of my life's curriculum. It has taught me most of what I consider to be worth knowing. Going out of my mind has been the sanest thing that I have ever done.

I wish you wellness always. Though, if you feel that mental illness is a flawed character, that I take issue with that belief. Mental illness is just that, an illness and not a flaw  Find your path. Don't be a jerk. If you can't help an other find their path, then for your own sake, don't get in their way. Hopefully someone won't get in yours. While life is not easy, mental illness is a not character flaw!

Presidential Mental Illness

(This is an excerpt of a larger piece submitted to the Journal of Psychology & Psychotherapy for scholarly review and publication it remains intact minus some of the demographic and epidemology factors that are not important to this blog)

Abstract: Recent events in the United States have spurned national debates on mental health and crime. Much of the discussion is comprised of gun controls and vague references to treatment. The discussions do not address specifics about the people who are committing these crimes and what makes for meaningful treatment. The more we can learn from the people out in our communities who have mental illnesses, the more we can reduce the costs to our communities. Most of these crimes are perpetrated by a small portion of the estimated 5% 7 of  the adult population with severe mental illnesses. 

The discussions rarely focus on what it means to have a mental illness. Mental illness does not preclude a successful and fulfilling life. This article uses the example of mental illness in some of the people that we expect to be the most highly functioning, our Presidents. One specific example is reviewed. This past President was at times suicidal and would have to be considered at times to have a severe mental illness. While he was significantly impacted by depression, he became one of the most respected leaders in history.  

Keywords:

Mental Health, Presidents, Crime, Treatment, Social Stigma, National Debate

Introduction:  

With the rash of recent school shootings and other major traumatic events that have been perpetuated by those with mental illness, we may be forgetting that mental illness is no respecter of persons. It affects those from all walks of life.  It has become easy to react to these people with doubt and mistrust. What would you think if the President announced that he too had a mental illness? Would you call for his immediate resignation? If you knew that a candidate had such an illness, would you vote for him?

According to the Substance Abuse and Mental Health Administration or SAMHSA; mental disorders are common in the United States and internationally. An estimated 26.2% of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year 1. This demographic is not limited to the poor, under educated, and disaffected. Mental illness can be seen in people from all walks of life. Doctors, judges, artists, neurosurgeons and CEOs all are as likely as anyone else to be impacted at least sometime in their lives.

Body & Discussion

Surely our Presidents are free from this worrisome problem, right? According to an article by Dr. Jonathan Davidson, professor of psychiatry and several of his colleagues at Duke University 2, these mental illnesses have affected Presidents since the formation of our great nation.  This study used diagnostic criteria from the DSM-IV and found that 48% of the Presidents from 1776 to 1974 had a diagnosable mental illness. The most prevalent diagnosis was depression. Of the 18 Presidents with mental illness, 24% of them suffered from depression.  Surely when we look at these men we would find that those with mental illness are worthy of the least regard. But then, perhaps not.

For a moment, let us consider one particular past President. This man was born into a poor family from the South. He was like many poor rural people of his time, he had limited access to formal education. If we look back into his history we discover that he had only about a year and a half of dedicated instruction. His principal teachers  were clergymen and as a result he learned to read by reciting the Bible 3. He would stand for hours reading it aloud and committed much of it to memory. This had a significant impact on the young man. It habituated him to read all of his written works out loud. This method worked so well for him that he may have been one of the most profound of the Presidential speakers and writers. While he was never a well regarded poet there are two poems that are notable. Both of these poems have some literary credibility but their content was an indication of a somewhat morose and insidious suffering that impacted his entire life.

One of his poems, Suicide Soliloquy, was published in the Sangamo Journal on August 25, 1838 4:  

Here, where the lonely hooting owl

Sends forth his midnight moans,

Fierce wolves shall o’er my carcase growl,

Or buzzards pick my bones.

No fellow-man shall learn my fate,

Or where my ashes lie;

Unless by beasts drawn round their bait,

Or by the ravens’ cry.

Yes! I’ve resolved the deed to do,

And this the place to do it:

This heart I’ll rush a dagger through,

Though I in hell should rue it!

Hell! What is hell to one like me

Who pleasures never knew;

By friends consigned to misery,

By hope deserted too?

To ease me of this power to think,

That through my bosom raves,

I’ll headlong leap from hell’s high brink,

And wallow in its waves.

Though devils yell, and burning chains

May waken long regret;

Their frightful screams, and piercing pains,

Will help me to forget.

Yes! I’m prepared, through endless night,

To take that fiery berth!

Think not with tales of hell to fright

Me, who am damn’d on earth!

Sweet steel! come forth from your sheath,

And glist’ning, speak your powers;

Rip up the organs of my breath,

And draw my blood in showers!

I strike! It quivers in that heart

Which drives me to this end;

I draw and kiss the bloody dart,

My last—my only friend!

This moment of despair was not an isolated event. He was a tall and lanky man. This suffering President could not be considered to be handsome. He was at times a loner. He recognized and commented to friends that he was probably a less than eligible bachelor. In his life he had few romantic entanglements. After one relationship was severed, at least temporarily, his friends were forced to search his rooms to make sure that there was nothing that could be used to hurt himself 5. If this were the case today he would likely have been detained and checked into a locked down hospital ward.

Yet he was an entirely remarkable man. Although he had a limited education he was a business owner, the holder of a patent, an appellate level attorney and eventually became one of the most admired people in history. Doris Kearns Goodwin 6, a noted presidential historian, gave a TED Talk about learning from past Presidents. The TED Talks are a series of speeches that are available on ted.com. Their motto is, “Ideas worth spreading. This speech is certainly one of these ideas. During her speech she said:

I was so thrilled to find an interview with the great Russian writer, Leo Tolstoy, in a New York newspaper in the early 1900s. And in it, Tolstoy told of a trip that he'd recently made to a very remote area of the Caucasus, where there were only wild barbarians, who had never left this part of Russia. Knowing that Tolstoy was in their midst, they asked him to tell stories of the great men of history. So he said, "I told them about Napoleon and Alexander the Great and Frederick the Great and Julius Caesar, and they loved it. But before I finished, the chief of the barbarians stood up and said, 'But wait, you haven't told us about the greatest ruler of them all. We want to hear about that man who spoke with a voice of thunder, who laughed like the sunrise, who came from that place called America, which is so far from here, that if a young man should travel there, he would be an old man when he arrived. Tell us of that man. Tell us of Abraham Lincoln.'" He was stunned. He told them everything he could about Lincoln. And then in the interview he said, "What made Lincoln so great? Not as great a general as Napoleon, not as great a statesman as Frederick the Great." But his greatness consisted, and historians would roundly agree, in the integrity of his character and the moral fiber of his being.

Yes, the man who was thus afflicted; who freed the slaves, who won the civil war, and who held a worn and weary nation together was Abraham Lincoln. Lincoln’s greatness as a human being and as President came from his practical understanding of one of Plato’s profound utterances. Plato said, “Be kind, for everyone you meet is fighting a hard battle”.

The Front of the SAMHSA building at 1 Choke Cherry Road in Rockville, Maryland. (Photo credit: Wikipedia)

We have begun a national dialog on violence and mental illness. We must consider those with mental illness in a broad manner. Not all people with mental illness are dangerous or incompetent. Not all who commit violent acts have a mental illness. For all of those with mental illness there is hope. There is a reasonable potential for wellness and achievement. People who have mental illnesses are not a threat on that basis alone. Further, statistics show that severe mental illness affects approximately 5% 7 of the adult population. Although these people can have significant challenges, most are not dangerous. During this time of national discourse please consider people like Abraham Lincoln. Please also consider the 1 out of 4 people who have some form of mental illness. Try to see in them possibility and not disability. I encourage you to learn more about mental illness. It is not a character deficiency nor a reason to throw out the human behind the disease. After many years of research, SAMHSA tells us that recovery from mental illness is possible.

Part of my work with others occurs when people have been arrested. These crimes span the spectrum of offenses. Mental illness can and does have an impact on why people commit these egregious acts.  Most of the time it does not excuse their actions. It should however impact the dispositions of their cases. People with mental illnesses need to get treatment that is appropriate to their needs. Each person has their own path to recovery. For the most part they can go on to lead happy and productive lives and contribute back to their communities. For the small margin that remains we can only hope that the suffering of the community, their families and their own suffering will not spill over into tragedy.

Conclusion

English: Picture of the Abraham Lincoln statue in the Lincoln Memorial. Italiano: La statua di Lincoln al Lincoln Memorial. (Photo credit: Wikipedia)

I believe that if we can look at people like President Lincoln we can develop a balanced approach to evaluating mental illness. It is easy to be influenced into believing that all people who have a mental illness are not able to be responsible with their lives. This is true whether or not they are gun owners. Fear should not dictate our perspective in the debate about mental illness. In Lincoln we have a clear example that for some, mental illness can lead to inspired lives.

It seems that his suffering helped him to understand that all people suffer. It was in this way that he learned so clearly about the human condition and our inherent value as a human beings. It is how he seemed to understand the principles of freedom within the words of the founding fathers: We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happiness. When we begin to see all people from within this perspective, we will have the greatest impact on reducing both the tragedies and horrors of mental illness in our communities.

References

1.) The Substance Abuse & Mental Health Administration web site, http://www.samhsa.gov/data/NSDUH.aspx

2.) Haley Hoffman, The Chronicle (Duke), 23/02/2006

3.) A. Lincoln A Biography, Ronald C. White Jr., Random House, First chapter - Undistinguished Families

4.) Neal Conan and Joshua Wolf Shenk, author of The Melancholy of Lincoln. National Public Radio Broadcast, Talk of The Nation air date 04/09/2004. From the book, The Melancholy of Lincoln

5.) A. Lincoln A Biography, Ronald C. White Jr., Random House, page 112

6.) Doris Kearns Goodwin, ted.com. Posted October 2008

7.) A discussion of the methodology used to generate SMI and any mental illness estimates can be found in Appendix B. For information on mental illness see chapter 2 in Office of Applied Studies. (2010). Results from the 2009 National Survey on Drug Use and Health: Mental health findings (HHS Publication No. SMA 10-4609, NSDUH Series H-39). Rockville, MD: Substance Abuse and Mental Health Administration. Retrieved from http://store.samhsa.gov/product/Mental-Health-Findings-Results-from-the-2009-National-Survey-on-Drug-Use-and-Health-NSDUH-/SMA10-4609

If You Label Me, You Negate Me – A Dialogue On The Labels That Are Used About Mental Illnesses

Introduction

I consider myself to be very fortunate. I get to have dialogues with people on a wide range of topics. one of the topics that I am most passionate about his recovery from mental illness. To that effect, I participate in many discussion groups on the Internet. LinkedIn is one such resource for me. From time to time, I post my responses to others on my blog as articles.

The post that I responded to, unedited

"I haven't seen that particular documentary, Bill, but will check it out. Treatment models in other countries were noted throughout this thread. Some good DVDs to check out are "Healing Homes: An Alternative Swedish Model for Healing Psychosis", "Open Dialogue: An Alternative Finnish Approach to Healing Psychosis", "Crazy for Life" and "Take These Broken Wings". Working to Recovery offers 2 excellent DVDs, "How to Start and Run a Hearing Voices Group" and "Talking with Voices: An Introduction to Voice Dialogue". We hope to bring Ron Coleman and his wife, Wales, UK, who are now researchers in the field, to Wisconsin this coming spring to help teach voice dialoguing to people with lived experience and their clinicians about this effective model of healing for people with psychotic disorders.

Bi-Polar Bear (Photo credit: oxygeon)

I have found that the language we use also lends itself to supporting or dispelling the social stigma around mental illness/substance use disorders. If I may gently point out, you state "I am Bi-Polar". May I suggest that you are NOT your illness. You have Bi-Polar. As a NAMI Connections state trainer, we teach our facilitators that people are not their disorders and we no longer go around and identify each other by our disorders when opening Connection support group meetings. We are so much more than our disorders. I am joyous that you have found a recovery path that works for you. Each individual can do so and we need to foster and support that hope."

My response verbatim - Name Redacted

As always you are a great resource. I find it very interesting to hear the perspectives from other countries. I'll have to check these out.

I don't doubt the labels can and do reinforce social beliefs, including stigma. To reinforce this point, the Dutch theologian Kierkegaard says, "if you label me you negate me". I look at diagnoses is terms that are useful to describe a general predicament. Each pilgrim has there own path up the mountain. Everyone with the mental illness has to find their path to recovery. In my case, I'm grateful for my predicament. I have never encountered anything more instructive. It has led me to a greater understanding of compassion and hope. It has been beneficial in helping to support others. It's that lived experience that we talk about in peer support.

Words themselves have great limitations. For instance, the word moon, is not actually the moon. It is more like a finger pointing at the moon. As far as not being my illness, I suppose that means that I'm not a "graduate" of a masters program (2 of them actually), am not a father, or any other term that we might classify ourselves with. Again, these are merely labels.

The real substance of these labels does not encapsulate me or anyone else. It's interesting though when we

Veronica538 at work as truckdriver (Photo credit: Wikipedia)

ask people in our society what they do for a living they tend to make statements about their jobs as who they are. For instance, A person could drive a truck. How many hours a day are you a truck driver? Are you always a truck driver? At night when you lay in bed are you a sleeper as compared to a truck driver?

I am not disputing what you have to say in any way. As a matter fact I am a great believer that people should understand these terms as a general description of a circumstance. We still call people with cancer, cancer patients. But it is far from inclusive of their whole being.

I would encourage you to look at the body of my work on my blog. I try to be pretty clear in my writing and work with others that they are more than a diagnosis. These issues are more like facets on a diamond, part of the whole. I hope to continue to be able to grow in my ability to not use labels as time goes on.

When I sit next to the bed of someone who has tried to kill themselves I don't look at them as a diagnosis but instead as a human being. I don't try to tell them that I know better about their lives than they do. Most of the people that they've encountered in the mental health system have already tried that. Instead, I feel the most humane thing that can be done in these circumstances is to merely hold their hand and cry with them. In this context, I am a "friend".

So frankly, I am truly grateful for my predicament and could care less if you call me bipolar, Bill or any other label. I do realize though that for some people these terms are a great burden. So again, I would encourage you to read my work. It would be wonderful to get your feedback in areas that I can grow in. I think however that I support what you say entirely. It's just a shame that we do not have more elegant expressions.

I spend most of my life working with various professionals, doctors, lawyers, judges, and my peers (all labels by the way) to teach them to see beyond these terms. To everyone of them I suggest that a person is more than one aspect of their being. I encouraged them all to see people as people no matter the diagnosis.

I was a founding member of the Painting Pathways Clubhouse. I love the term that we use, "colleagues". But again it still a label. It just happens to be a more palatable label than mentally ill. At the clubhouse I have seen many miracles. For a group of people who were supposedly dysfunctional, I have seen us come together as a community and do things that supposedly other "normal people" can't do. Thank you for your continued work. I appreciate you.

With A Little Help From Your Friends - Peer Supported Respite

Institute of Mental Health 6, Nov 06 (Photo credit: Wikipedia)

 Introduction

"What is clear from the results is that these patients could do as well or better in a less restrictive environment," said Tom Greenfield

There is an increasing mental health crisis around the entire world. With worldwide financial resources quickly eroding many countries are running out of the ability to care for those with a mental illness. Due to this, we need to re-evaluate our practices and systems of treatment. Hospitalization, medications, and cognitive therapy may not be enough to promote psychological growth.

Logo of the National Institute of Mental Health. (Photo credit: Wikipedia)

From research done by the State Of Massachusetts, the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration shows that there is hope for increasing mental health and reduce many of the higher costs of services and treatment. Further there are articles in the American Journal of Community Psychology that cover this research extensively.

The goal is to provide a more prophylactic treatment protocol through the use of services such as peer supported respite centers. Peer supported respite centers are residential, pre-crisis and crisis facilities that are staffed by certified professional peer support specialists. According to one study from Massachusetts peer supported respite is not only cost effective but is more likely to lead to psychological growth.

Institute of Mental Health 4, Nov 06 (Photo credit: Wikipedia)

A different and less threatening environment

Respite care is different from traditional inpatient hospitalization. Most respite centers are not locked down wards. The average stay at a peer supported respite center may be longer in duration than hospitalization. This is largely possible due to lower total cost of care that consumers receive.  

The longer duration of inpatient care offers opportunities to build skills in self-advocacy, establishing good support networks, and how to deal with crisis in a safe and effective manner. These centers also allow for more time to adjust to changes in medication. This significantly helps with the side effects and allows for emotional support until therapeutic benefits are realized.

Experienced staffing

These facilities are generally staffed by professionals who have been diagnosed with mental illnesses. These people have very practical experience dealing with mental illness and recovery. They have what is referred to as, “lived experience” and have reached a meaningful level of recovery themselves. This enables them to provide very individualized care and treatment plans. Often these practitioners work closely with human service organizations and other peer supported services in the community. These relationships help to establish long term stability and to overcome problems like housing which can be a significant problem.

Respite care and the criminal justice system
Peer supported care is being looked at more often as a resource for alternative sentencing agreements for those who are involved in the criminal court process. The desired outcomes of this would be to reduce re-entry into the system, increase compliance, and reduce the cost of administering these cases. According to the federal government 61% of inmates have a significant mental illness. Often these people are not receiving adequate care even within traditional systems of mental health. It would seem that financial resources are a major contributing factor. One department of corrections director told me that to get any real change in caring for those with mental illness is to sue them. They have repeatedly asked for money to deal with the increased populations that they are mandated to treat. This problem is extended when inmates are released under community supervision.

If you consider the benefits and outcomes from peer supported respite, it is easy to come to the conclusion that a community based respite center can bring both financial and emotional relief. I encourage the leaders of our communities, counties, and states to take a serious look at this option. If we build stronger Americans, we build a stronger America. Respite centers may offer a significant resource in accomplishing that goal.

Chiropractic & Mental Illness

@chiropractic I Voted (Photo credit: planetc1)

Introduction

Chiropractic care has a broad influence on the nervous system. Although most practitioners focus on physical disorders, it is clear that good nervous system health effects emotional and psychological health. According to B.J. Palmer, the son of the man credited with the discovery of chiropractic care, dislocated cervical vertebrae has a real impact on mental health. According to my Chiropractor Ron Ziolkowoski, D.C. of the Ziolkowski Chiropractic Clinic, only 10% of the capacity of our nervous system is taken up by pain messages. The rest of the bandwidth is dedicated to healing and maintaining the body. When organs can work at their best potential which has a natural effect on the mind.

Several impatient patient programs have implemented Chiropractic adjustments for mental health care. In some of these programs Chiropractic was the primary clinical service. In 1922, The Chiropractic Psychopathic Sanitarium was one of the first in the field. Later the name of the facility was changed to Forest Park Sanitarium.

Early results were promising

English: A diagram of the Human Nervous system. Français : Schéma du système nerveux humain. (Photo credit: Wikipedia)

Early on it became quiet clear that mental health patients got better with out successive re-entry to hospitals for psychiatric  care. North Dakota Judge A. W. Ponath showed that at the North Dakota state mental hospital, the positive outcomes ranged from 18‑27%, compared to 65% at Forest Park.

In 1951, Clear View Sanitarium was purchased by the Palmer School of Chiropractic. Each day the patient was examined using a device called a “neurocalometer” (NCM). From there the chiropractic doctors looked at the results and any nerve impingement was adjusted. In addition to this there was an enhanced focus on proper patient nutrition. They often served vegetables from the garden that was grown on-site.

Impact of insurance companies on research

Both of these early organizations closed by 1961. The insurance companies of the time did not recognize Chiropractic as an evidence based treatment for mental illness. Without on-going funding was not possible to continue these institutions . In 1973, Dr. Schwartz published a report on 350 patients afflicted with mental illness.  It indicates that people with mental illness got better in a measurable way . He wrote a book, "Mental Health and Chiropractic: A Multidisciplinary Approach."  Since this time there has been Interest in this approach to helping in the physical and mental health of all patients.

If you have a mental illness it may be good practice to see your local chiropractor. Mental Illness is a disease that you can have meaningful recovery from. For all of us there is a unique path to healing. I encourage you to look at chiropractic as one tool in your arsenal.  

Mental Health "Injustice System" - Failures Criminal Rights & Just Dispositions

Introduction

If we are to temper justice with mercy,  we have to consider the individual and societal needs of forgiveness in order to soften (temper) our need for justice. This helps us assure that the punishment, if warranted, fits the crime. Today, we have systems where those with mental illnesses are charged for crimes or wrongdoings and are met with such incredibly harsh and seemingly disproportionate punishments. We do immense harm to a person's spirit and ability to overcome, repent, develop and grow from mistakes and recover. Further, we do specific harm to the basic civil and human rights of all. - paraphrased, author unknown.

As a part of the advocacy work that I do, the mentoring, and peer support, I run into a lot of people who have criminal issues. So far my experience in dealing with the criminal court systems have brought up both challenges and opportunities. One thing I can say with certainty is that it has at times been a huge disappointment.

I live in a County where there are five full-time attorneys in the District Attorney’s Office. Between them they deal with 2,500 cases a year. They’re good people who work hard for our community. Unfortunately this is one of the areas where I found some disappointment. In a meeting with the district attorney, he laid out all the things that he would not consider as being partially or wholly mitigating circumstances. The case I was involved with was abstracted and given to him so we could discuss some of the very real problems with cases like this. I’m not sure he actually read it. He is after all a very busy guy. So we never really got to the heart of the conversation.

Are we seeing these cases clearly and early?

One of the first factors that I saw in this case is that early identification and careful evaluation of the arresting officers reports should have raised a flag that this was not a criminal matter. Apparently the attorney presenting the charges to the court did not read the full statement of the arresting officer. I think in any reasonable level the probable cause that a crime had been committed was seriously in question. In fact, it may have been more appropriate to refer the matter to the adult protective service agency and/or medical professionals.

The second factor that I saw in this case is based on my experience in dealing with people who have mental illnesses. I have practical day-to-day experience with people on all levels of the spectrum and have seen major improvement in the quality of their lives and their ability to reach meaningful recovery. Facilitating this recovery is a large part of what I do. I know many the mechanics from practical experience. I feel qualified enough to say; that based on this lady’s diagnoses and my observations of her leads me to believe that her low day-to-day functioning puts her at risk. I did however feel that with the support of halfway house services, medical stabilization, helping her to build healthy support networks, she would be very likely able to stop having interactions with law enforcement. Actually, with this individual, I know I had a significant impact on the outcome of the case. I appeared in the case as a friend to the court to facilitate communications between the court and the defendant because of her significant mental illness. The significant portion of this mental illness was demonstrated by her largely disorganized thinking and varying functionality from day-to-day.

It was pretty clear to me

It didn’t take a lot of investigation to figure this out. In the arresting officer’s report, he noted some issues that clearly illustrate that mental illness may have been a mitigating factor in the crime. The arresting officer says several things specifically; that she was unable to and not unwilling to follow simple commands, that she was incoherent, and that there were large amounts of psychotropic medications visible to him. He does not mention specifically but I assume all of the medications were properly labeled and prescribed to her.

The judge asked me about my general opinion about the case. I pointed out to him that on the face of the arresting officer’s report that it was a lot more likely to be a psychological crisis than it was a crime. Apparently he agreed with me. Once back in session, the judge asked both attorneys to appear in chambers. I know basically what was said in that meeting. The judge simply asked why we were not thinking of a civil solution in this case. It would seem that both the defense counsel and the prosecuting attorney agreed immediately. The terms for a deferred prosecution agreement were discussed and settled upon.

How can someone consent to an agreement with the court if they clearly do not understand it?

English: Justice and Law Suomi: Oikeutta ja lakia (Photo credit: Wikipedia)

In the presence of the defense counsel I participated in the discussion about the deferred prosecution agreement and what it meant to her. I started to grow concerned after about 45 minutes of conversation with her. In that time she was never once able to clearly articulate and/or paraphrase what a deferred prosecution meant to her and what would be expected of her. I am not sure she understood that the prosecution of the crime would only happen if she did not follow along with the civil requirements. As a recall, she was still asking about how much jail time she was going to receive. It didn’t seem to sink in that jail time was not an issue. I think it was at this moment that her civil liberties started to erode. If she could not understand what the agreement meant she could have never consented to it. I did mention this to several parties. I also advised various parties that to reduce the likelihood of seeing her before the court again she would need more comprehensive services than were being discussed.

This is where my conversation with the judge may have had in negative impact. Since it was so easy to put a deal on the table, she was not evaluated for competency. For various reasons she was ordered to comply with state law that did not suit her needs. Because the civil solution came up so fast, any real understanding of her competency was not investigated. Due to this, I felt that the civil solution on the table was a failed solution. She perhaps did not get the care she needed to avoid re-entry into the system. Approximately one year after the first case I got a phone call from her. She had been arrested again and the circumstances were almost the same as the previous case.

If you want changes in our department sue us

There are people who complain about costs in our system. In talking with agencies like the Department of Corrections they realize this is a problem also. They are the ones having to deal with inmates with mental illness in high numbers. I had a director of one such department that flat out told me the only way to affect changes in our organization is to sue us. This is because they lacked funds and resources for treatment.

There are evidence-based solutions that are highly effective. The use of peer support can contribute as part of the answer. Peer support specialists are much more cost-effective and have better percentages of reimbursement rates for their services. Along with this more intermediary respite care facilities are required. Current admission standards for mental illness generally requires that a person say that they have a plan and intention to kill themselves. I think more investigation and research by the criminal justice system needs to be done in this area as viable methods to reduce re-entry are available and these programs are financially prudent.

Training is an important issue also. The need for more training for officers in crisis intervention may help to resolve issues without arrest. It might help identify mental health crisis as compared to criminal intent. I believe that lawyers need better education about evaluating competency. Traditionally, not guilty by reason of mental defect or insanity is almost impossible to make a case for. Competency to assist in defence should be clear if the person can’t understand what they are agreeing to. Lawyers could have a better understanding of what a successful disposition looks like given the balance between justice and civil liberties. Hopefully  this will broaden the defenses that are available.

Change is needed and can be done

An American judge talking to a lawyer. (Photo credit: Wikipedia)

It would seem that the civil and criminal liberties that we all enjoy as citizens are desaturated for those with significant mental illnesses. Insight on this factor comes not only from this case, it also comes to us right from the jails and prisons themselves. The Bureau of Justice statistics reports that says 61% of state prisoners have a mental illness, jails have a rate of 41% of inmates with mental illness. In general our population has about 5% of people who have diagnosable severe mental illnesses in any given year. As an example, our County has around 80,000 people. This suggests that 4000 people in our community have major psychological problems. Considering the high numbers of people with mental illness in the justice system, how many of these cases are being misidentified? How many cases are we missing? Also, what can we do with these people anyway? For many states and counties the resources are very restricted. There are cost-effective and effective recovery methods and resources that can be developed and tend to reduce re-entry into the system. With some willingness, people with mental illnesses can receive the benefit of justice tempered by mercy.