Wednesday, August 11, 2010

Would Assisted Outpatient Treatment Impact the Death Penalty Exemption?

On August 11, dozens of mental health advocates attended the KY Senate and House Judiciary Committee hearing regarding the exemption of the death penalty for the mentally ill. NAMI Lexington was well represented, as was representation from NAMI KY, NAMI Somerset and NAMI Nelson County.

Rep. David Floyd (R-Bardstown) co-sponsored the HB 16 bill with Rep. Darryl Owens (D-Louisville) with the goal to abolish the death penalty in Kentucky for people with severe mental illness.

Reporter Stephenie Steitze from the Louisville Courier-Journal reports Sheila Schuster, executive director of the Kentucky Mental Health Coalition, said groups such as the American Bar Association, American Psychological Association and National Alliance on Mental Illness hope the legislature would consider such legislation during the next session. Those who are less severely mentally ill would still be eligible for the death penalty, Schuster said. She said just 2 percent of the state's total population is considered severely mentally ill, while up to 20 percent of the population is mentally ill.

HB 16 only applies to those who are determined by a judge to have been severely mentally ill at the time of the offense. Severe mental illness results in diminished capacity to appreciate the consequences of one’s conduct or to exercise rational judgment. The death penalty cannot serve as a deterrent for someone who cannot understand the consequences of his/her actions.

I admired the testimonies from Dr. Russ Williams and Psychologist, Ernie Lewis with the Kentucky Association of Criminal Defense Lawyers. This panel of experts presented compelling affirmations on behalf of those that suffer with serious and persistent mental illness which are biological brain disorders. These disorders such as schizophrenia, schizoaffective disorder as well as mood disorders such as major depression, bipolar mania, or mixed mania, often impact a person’s ability to understand consequences. Dr. Williams explained that in the past few years, science had come a long way in accurately diagnosing mental disorders with a reliability of 70-90%. Dr. Williams mentioned his experiences and history of working with criminals with mental disorders at the Kentucky State Reformatory, and is now the director of psychology at Central State Hospital, a 192-bed adult psychiatric hospital located in Jefferson County. While Dr. Williams illustrated the path of complexity of symptoms associated with serious brain disorders, Mr. Lewis lead a legal defense worthy of any capital case regarding the defense of people suffering with these disorders.

Much discussion was opened to the floor to discuss competency vs. criminal responsibility, including an excellent report by Mr. Lewis regarding the US supreme court has ruled in favor that individuals with mental retardation and juvenile offenders (under the age of 18) cannot be subject to the death penalty due to their diminished capacity. “The Court held that it is inconsistent with evolving standards of decency and would be cruel and unusual punishment to execute persons whose moral culpability is less due to their mental condition and development.”

As an advocate on a mission to help others understand “symptoms of mental disorders". I was frankly shocked to hear the question posed from Representative Harry Moberly (D) House District 81. Moberly asked, “what about these criminals with mental disorders that intentionally do not take their medications?” The audience of advocates groaned, as we all know this specific population of individuals who suffer with severe mental disorders, often do not realize they are sick. Therefore, they do not see a need to be in compliance with their medications! This symptom is called anosognosia or “lack of insight” and is often more debilitating than delusions or hallucinations. Anosognosia keeps the person from receiving the medical treatment they need to remain stable and out of jail. This is one of many reasons states such as Kentucky need better assisted outpatient treatment, (AOT) laws to help people that would normally end up in jail or prison and costing the state millions more than it would to support them in the community.

As recent report from the Treatment Advocacy Center, (a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses) … mentions there is an interim version of the DSM (Diagnostic and Statistical Manual) called DSM-IV-TR, which has been in circulation since 2000 and will be withdrawn when the DSM-V is released. The interim version recognizes anosognosia, the inability to recognize one’s own illness, as a frequent feature of schizophrenia. The importance of including anosognosia in the DSM-V cannot be overstated. Clinicians must understand that a severely mentally ill who insists that nothing is wrong is not merely “in denial.” As stated in the DSM-IV-TR, “[t]his symptom predisposes the individual to noncompliance with treatment and has been found to be predictive of higher relapse rates, increased number of involuntary hospital admissions, poorer psychological functioning, and a poorer course of illness."

This is a message to all that read this: please help me educate our legislators and all public officials running for office! How can we expect better funding and treatment for those suffering with these severe mental disorders if we are spending our money and time paying for them to be ill in jail?

Additional information about this hearing can be viewed here:

Judiciary Committee hears testimony on ending the death penalty for the severely mentally ill

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