Friday, January 27, 2012

The Criminal Defense Role: Our Part, And The Help We Need in Kentucky:

By: John Landon, from the KY Department of Public Advocacy   
    Long ago, an astute Kentucky lawyer described the courtroom as the “arena of human tragedy.”  For the past three years I have observed the production.  Victories, tragedies, romances (both sweet and bitter), comedies and mysteries all make their appearances in the arena.  An observant onlooker may experience greater depth of feeling then is available on stage or screen, because the stories that play out do not involve actors.  Most people miss the subtext behind the scenes; they never see the story that happens behind the curtain.  Early in my career, I observed a tragedy that played out on a daily basis, but remains largely unseen to this day.
    An unfortunate side effect of the deinstitutionalization movement is that persons with mental illness and with no support structure oftentimes become entangled in the criminal justice system.
   Most of the time, the clients public defenders represent are charged with extremely minor infractions (criminal trespassing, disorderly conduct, etc.).  In most of these cases, the person is given a “credit for time served” plea agreement, or the court simply dismisses the charge, and the person is allowed to go on their way, sans medication, support or shelter.  The cycle then repeats itself again and again.  Sometimes, a person suffering from a mental illness is accused of a more serious offense, and that takes far longer to sort out.  But, the result is normally the same, with the person being released only to return again later in a deteriorated mental state.
    The Kentucky Department of Public Advocacy, our state’s public defender program, represents clients suffering from mental illness on a daily basis.  We have clients undergoing evaluations for criminal responsibility, we represent clients at competency hearings, and we represent many clients undergoing civil commitment procedures.  In short, most of our attorneys know the intersection of mental illness and the criminal justice system.  The Fayette County Office of the department set up a team of lawyers specializing in mental health issues to address some of the problems faced.  However, we often see a lack of structured support for clients once they their criminal cases have been resolved, leading to recidivism.  Also, sometimes this lack of support becomes a factor when we attempt to negotiate a favorable resolution.
    The debate between long terms of commitment and community based care has continued since Geraldo Rivera’s expose on Willow brook (where he publicly exposed horrific conditions in a Staton Island mental hospital).  Long-term commitment to mental hospitals presents many problems, especially if those institutions are under funded.  However, those same problems can be seen if community based treatment fails to the point where incarceration becomes a substitute for hospitalization.  Keeping a person in a jail cell during a mental episode is certainly more inhumane than keeping them in a hospital.
    Kentucky’s mental health laws follow a simple formula.  This summary is admittedly overly simplistic, to say the least.  If a person is mentally ill, but that person does not present a danger to themselves or others then they cannot be committed on an involuntary basis.  Further, if there is a “less restrictive option” compared to hospitalization then that person might not be held involuntarily at a mental health facility.  Those standards are completely different from a person’s competence to navigate the legal system and also from an analysis of a person’s responsibility for a criminal act.
    Ideally, this system would work.  Those suffering from a mental illness and posing a danger would be committed to the mental hospital in the area until such time as they posed no danger or there was a less restrictive mode of treatment.  They would receive treatment at the hospital to the point where they could manage with a less restrictive form of community-based care.  If a resurgence of mental illness creating a danger took place, then that person could be recommitted to the hospital until regaining composure.  This is how the law is supposed to work.
    The system breaks down when community based care becomes under funded or inaccessible.  People suffering from mental illness often don’t have basic resources necessary for survival.  They wind up homeless.  Many are victimized.  And, as their mental illness progresses, they can often times commit criminal acts.  At that point they are arrested, taken to jail, and oftentimes referred back to the mental hospital or simply released. 
    The grey area exists when people don’t meet the criteria to be involuntarily hospitalized, but still exhibit mental illness clearly.  Community based treatment should be the favored method of treating those with mental illness.  But, without sufficient safeguards and community help, those with mental illness have a far greater likelihood of being funneled into the criminal justice system rather than being re-hospitalized initially.  The process of incarceration prior to hospitalization is actually illegal under our current law.  And this process arguably costs the taxpayers of this county more than if the process allowed under the law was followed. Kentucky already offers these services to a limited extent.  Many committed men and women attempt to help those needing them.  Yet, this problem persists because we need to re-engineer a system better designed to provide care to those with mental illness but without the knowledge or ability to access it.
    We have already begun to slowly move forward on the legal issues through motion practice in Fayette County, with favorable results.  However, without a reliable community based treatment option, we are almost certain to see the same recidivism.  As lawyers, the Kentucky Department of Public Advocacy litigates predominately criminal charges.  When the case is closed, we lose our ability to help our clients in a substantive way with state resources.  It becomes necessary for the community to gather around these individuals and help them once a criminal case is resolved.  This help has been shown to produce results, and end the cycle.  An investment in community-based treatment will provide better results for our clients and concomitant cost savings in the long run.  Without committed, accessible and effective community based treatment for all of those suffering from mental illness we will always be stuck with the same problem.

Friday, January 20, 2012

Government survey finds that 5 percent of Americans suffer from a ‘serious mental illness’

I concur with the statements made on Treatment Advocacy Center's Blog about this survey. 
"As advocates, we find the implications of this message troubling.
“Mental illness” is a big umbrella that covers everything from mild, transient mental health issues to disabling brain disease. To the degree that all of these are homogenized into one giant garden-variety health complaint akin to, say, high blood pressure, policy makers find still another excuse to ignore the treatment needs of those who are most severely ill. After all, if the country is perking along just fine when 20% of its population is mentally ill, what’s the problem!?! (Or … if mental illness is such a widespread problem, there’s no hope in addressing it so why bother?)"  To read more click here:
 

Washington Post
By , Published: January 19

About 20 percent of American adults suffer some sort of mental illness each year, and about 5 percent experience a serious disorder that disrupts work, family or social life, according to a government report released Thursday.
The annual National Survey on Drug Use and Health sketches a now-familiar picture of a country where mental illness is common and the demand for treatment high.


Mental illness is most prevalent in women, young adults, the unemployed and people with low incomes. Drug and alcohol abuse is more than twice as common in people with mental illness than those without it. About 4 percent of adults contemplate suicide each year.
According to the study, slightly less than half the people with any mental illness — and only 60 percent of those with serious, disabling ones — get treatment each year. Whites and Native Americans are more likely to get treatment than blacks, Hispanics or Asians.
To continue reading this article click here:

http://www.washingtonpost.com/national/health-science/government-survey-finds-that-5-percent-of-americans-suffer-from-a-serious-mental-illness/2012/01/18/gIQAjp5h9P_story.html

Monday, January 2, 2012

Op-Ed: Find state funds for mental health care that works


Lexington Herald Leader Jan 2, 2012

Posted: 12:00am on Jan 2, 2012; Modified: 1:38am on Jan 2, 2012

By: GG Burns

A home, effective treatment and a chance to contribute to the greater good — that's what it takes to recover from mental illness.

Against the odds, people rebuild their lives after the devastation of illnesses like bipolar disorder, schizophrenia or depression, but finding effective treatment and wraparound services is key. Kentucky has some outstanding programs, but the dollars haven't increased since 1995. In fact, the dollars have shifted to the justice system.

Thanks to professional support, self-determination and a safe home managed by New Beginnings Bluegrass Inc., many people are on the road to recovery. New Beginnings, a non-profit agency, supplies housing and support services in Fayette County for people diagnosed with mental illness. From New Beginnings' success rates, we can learn how housing and treatment work and assist individuals to become productive citizens.

Consider the example of Peg. For more than 20 years, she survived a hellish existence trapped in the revolving door of jail, homelessness and hospitalizations. Now she is living a rewarding and independent life surrounded by friends, her pet and a support system, which includes treatment from the Bluegrass Mental Health-Mental Retardation Board. Today, Peg regularly gives back to the community by volunteering at Saint Joseph Hospital, her church and the National Alliance on Mental Illness.

According to a recent report by NAMI, Kentucky maintained state spending for non-Medicaid mental health services from 2009 to 2011. However, the state still shortchanges mental health, ranking 46th nationally in per capita spending. Nationwide, cuts in 2012 totaled $1.6 billion. NAMI appreciates the efforts of Gov. Steve Beshear and the Kentucky legislature to maintain the mental health safety net, but in this distressed economy, more people than ever need help.

The NAMI report "State Mental Health Cuts: The continuing crisis" (www.nami.org/budgetcuts) describes threats to Medicaid, the largest payer for public mental health services. Following the loss in June 2011 of "enhanced" federal Medicaid matching funds, part of economic stimulus legislation, Kentucky's budget was squeezed by an estimated $159 million.

To meet fiscal challenges, Kentucky Medicaid is moving to a managed-care approach where the state pays a set "capitation rate" for every person enrolled in Medicaid. NAMI is worried. Kentucky is saving money by contracting with for-profit, managed-care companies, but does this just push the problem downstream? Will community mental health providers be squeezed to enable the for-profit companies to meet the terms of the contract?

Lack of mental health funding leads many who don't get the care they desperately need to fall into the criminal justice system. According to a recent report from Clinical Psychiatry-News, more than 800,000 people with severe mental illness are jailed annually in the United States.

Mental illness is a disease, not a crime. It is wrong to allow the criminal justice system to be the default mental health safety net simply because we don't have the will to adequately fund mental health services.

The Kentucky Department of Public Advocacy reports that a large percentage of its clients appear to be suffering with some form of mental illness. This illness can take the form where the person is not competent to stand trial, or was not well enough at the time of an event to appreciate the criminality of the actions. Further, many clients still suffer from mental illnesses, but those illnesses do not qualify under the legal definition of insanity. However, their mental illness can many times explain the criminal action. Also, the Kentucky Department of Corrections runs a separate psychiatric facility in La Grange for offenders with mental illness.

On average, it costs taxpayers from $16,000 to more than $30,000 a year to house an inmate in a Kentucky prison.

Ginny Vicini, executive director for New Beginnings, reports that 40 percent of the people in its program had a history of incarcerations before moving into New Beginnings. In the past three years, none have been reincarcerated.

While best practices exist in some regions, the lack of adequate funding continues to plague operations. Efforts to spread good models to more communities are on hold.

Kentucky needs to strengthen effective mental health programs. People's lives hang in the balance. We have moved from de-institutionalization in the 1970s, to trans-institutionalization today. How humane is it to allow lives to be wasted in prisons instead of funding Kentucky's mental health budget?

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GG Burns of Lexington, is an artist and mental health advocate for the National Alliance on Mental Illness Kentucky. She volunteers as the NAMI State Advocacy Network Representative
and is the Founder of: Change Mental Health Laws in Kentucky Blog