Tuesday, August 19, 2008

Law and the Mentally Ill

(I posted this originally on my campaign site but I wanted to carry it here as well. Mental illness and the people who suffer from it are so thoroughly misunderstood, but for those of us who work with them so darned interesting at the same time.)

Mental illness is a bigger problem than people who don’t work with the mentally ill are willing to admit. Part of the problem is the lack of awareness to how much of a problem we are facing. For most of us, the mentally ill are those people wandering around downtown with multiple layers of clothing and muttering to themselves. But the mentally ill include high school honor roll students who are cheerleaders and commit suicide. More people die from suicides than from car crashes, but we always see Public Service Announcements on TV that tell us not to drink and drive, or to drive carefully. How many public services ads do you see about mental illness?

In Montana, we suffer from a shortage of available mental health caregivers. Professionals who are trained to diagnose, treat and care for the mentally ill deserve our greatest appreciation. But we don’t have enough. Right now, if someone is suffering from severe depression in Missoula, they will either have to wait for up to four months to get an appointment to see a psychiatrist, or the county attorney will have to get a court to order that they be involuntarily committed to Warm Springs, which is also understaffed and overcrowded.

What we need are regional crisis beds that can be used to provide protection and care for someone who is a potential risk to themselves or others for up to ten days. Believe it or not, there is actually a cost savings in having these kind of facilities, because many county budgets are being depleted by transporting the mentally ill to Warm Springs for incarceration up to 90 days. Plus, keeping the patient in the vicinity of family and friends can be enormously beneficial to long term treatment in the community.

We also need to examine if there should be more people who can provide care. Specifically, I am thinking that PhD. psychologists should be trained and given the authority to prescribe drugs to help the psychotic, the schizophrenic and the manic-depressives that exist in our community. We should also look at trying to recruit psychiatric nurses who could function under the supervision of an M.D. and provide care to those who need it.

While this cause is important to me, I have delayed posting on it waiting for the Supreme Court to rule on an appeal that I filed that involved a hopelessly psychotic individual who thought he was being attacked by the devil in the form of an 86 year old woman. After his arrest, he was sent to Warm Springs, where he was medicated to the point that he could stand trial.

In Montana, we do not have an insanity defense. If it is your conscious object to swing your fist, even though you may honestly believe that you are swinging at the devil, you are guilty of the crime. As a result, the client, who also became my friend was sentenced to be in custody for 40 years. He first went to Warm Springs, where they verified that he was still doing well while under medication, and they transferred him to the Montana State Prison to serve out the remainder of his sentence. At least he won’t be alone. Some estimates put the number of inmates in Deer Lodge on psychotropic medicine to be near half.

I would like to propose a change to the law that would allow someone who if found Guilty but Mentally Ill to be given another hearing before the sentencing judge when the maximum medical benefit has been reached to review the appropriate sentence. It may be that keeping the defendant under supervised probation that requires he maintain his drug treatments is more effective for the defendant and the community than simply replacing lunatic asylums with prisons.


Anonymous said...

This is an incredibly complex and frustrating area for those of us with family members suffering from a mental illness. I don't know what the answers are, but I do know that our current legal and penal systems are woefully inadequate to deal with the problems.

Steve said...

I agree completely. Especially the last part.

Anonymous said...

Sorry, Steve, but this is all Nanny State stuff you’re proposing. And besides, most of the population is already medicated.

It makes no difference if someone is sane or crazy. If they harm another person, they’re out of here. You can put them wherever you want, but don’t expect me to spend a lot of money on their cold storage. And if they hurt themselves? Who cares? I mean, really.

Anonymous said...

Good work, Steve.

Steve said...

Sorry, pcn, but your concerns are misplaced. The ultimate version of the nanny state is a prison. We are paying over $40,000 per year to keep people in prison, who, if properly medicated can still be productive members.
As to hurting someone, I agree that we need to protect society. What you don't understand is the world that they live in. It is not your or my world, but something completely alien, but just as real to them as it is to us.
This is why fiscal responsibility can be married with moral action. If it costs us $600 a year to supervise someone and make sure that they stay on their meds, it is a heck of a lot cheaper than keeping them in prison. Money that you as a tax payer have confiscated from your income every year.

Unknown said...

Surprisingly astute post, Steve, about an issue that is very relevant to my life experience. My mother has spent the bulk of her adult life working within what passes for a mental health care system in Montana. I note that because her impressive efforts and her frustrations with the system ripple well beyond the women in her charge.

I am surprised at your post mostly, Steve, because the conservative response, (especially in such 'enlightened' locals as Bozeman) has been to let the 'free market' deal with the mentally ill. In Bozeman, that means "mental health by Greyhound"; shipping them off to Missoula or Billings. But there is no market incentive in dealing with mental illness. It isn't 'profitable', except to society at large, and Society makes a poor customer.

Once again, just so you don't think I'm being insincere, I applaud this post, Steve. Well said.

Anonymous said...

First, Steve, you know you’re on the wrong track when the likes of Mark T. and Wulfgar agree with you. Their fawning acclamations should be enough of a warning.

Second, as I have already pointed out, it makes no difference where you warehouse the mental cases so long as they cannot harm members of the public. You can call it a prison or a state hospital or a rubberized community home. You can also classify them by any name you like—criminals, mentally disturbed, extraordinarily weird, etc. But they must be confined. They must be confined because they have already demonstrated that they’re a danger to society.

Last, your $40,000 figure does not impress me at all. That is the average cost of a federal incarceration. In Montana, the average cost is about $29,000. Whatever. It doesn’t matter. We spend the same amount of money when we lock people up for multiple drunk-driving offenses, and very often such offenders have harmed no one.

On the other hand, when Johnny buries an ax in little Meagan’s head because he thought she was a Martian, the money to put Johnny away seems well spent. And I would much rather have the state prison warden looking after Johnny than I would some ditzy PhD.

Steve said...

pcn- I think that we may be talking past each other. I agree that the violently mentally ill should not be released to prey upon the public. But, if they can be medicated to a point that they are not a threat to society, (which is successful in the majority, but not all cases) why keep them incarcerated? Especially if they can get out, be safe and still be productive members of society?
I would rather have them out but safely monitored and medicated and working than to simply warehouse them.
To confine them because they once were a threat is unrealistic. How long do we keep them? Forever? Sorry, that is too costly.
The $40,000 per year cost is the cost for a prisoner in Deer Lodge., and it does not include any costs for administration, outside medical costs and other associated costs. I assume that your figure is based on averaging in the Womens Prison, and the contract prisons which hold low threat prisoners. So I stand by my figure.
While verifying the numbers, I also found out that for elderly prisoners, (meaning those over 55, which annoys the heck out of me since I am only two years away from that designation) the costs increase to $69,000 per year.
Other fun facts, in 2002, we spent over $31.5 million to incarcerate non-violent offenders. That would be a nice chunk of change to give back to the taxpayer, don't you think?

Steve said...

Oops, I forgot to mention your last point. For the Guilty but Mentally Ill (GMBI) I am thinking that they could be supervised by a probation officer to ensure compliance with the medical regimen while maintaining the proper treatment. Still cheaper than a prison, guards, wire, etc.

Anonymous said...

By your logic, we might as well let everybody out of prison and just make sure they take their meds. The really violent ones would be heavily medicated, the semi-violent moderately medicated, and the non-violent ones lightly medicated. Our army of PhD councilors, monitors, probation officers, etc. could then follow our ex-prisoners around all day (or wheel them round in the case of the heavily medicated) and make sure they’re taking their pills on time, preferably with orange juice.

I can easily imagine your new society, Steve, and all the money I will save as a taxpayer! However, I’m not so sure I want to be around the criminally sane or criminally insane, no matter how doped-out they are. I mean, you’d probably make a law that I had to hire them or let them eat in my restaurant or something like that, right? I would have to treat them like regular folks, right? And I would just have to pray to God that they didn’t go off their meds, I guess.