Monday, March 29, 2010

Mental Illness and Justice: The Need for a New Paradigm

Last fall, I received a call from a distressed father asking me to review his son’s case. His son had been diagnosed with bipolar disorder (manic depression). The son was on parole for a crime that he had committed when he was in a manic stage. He quit taking his medication again, went manic, and committed another series of crimes. The son was eventually sentenced to seventy years in prison with twenty suspended.

I talked with the son’s attorney before sentencing and expressed my sorrow that the parole officer, family, or someone else hadn’t been able to force the son into treatment when it became clear that he was off his medication and headed for serious trouble. In many cases, a couple of days or a few weeks with the proper medical care would be all that it takes to stabilize a patient’s brain chemistry so they can return to their normal life.

The attorney looked at me in disgust and responded “but that would have violated his civil rights.”

I can’t think of a clearer depiction of our profession’s inability to grasp the realities of mental illness. The system that we’ve established and operate helped this young man avoid a short involuntary stay in favor of a lifetime in prison. It’s not surprising that under this system our State Prison houses several times more people with serious mental illness than the State Hospital.

Last month, our office worked with the family of a Helena man who suffered from a mental illness-induced psychosis that involved a major battle between angels and demons. According to his delusions, the battle would end on a specific day in early March when the man must kill the Antichrist. The family was terrified that the delusion of the Antichrist would be projected on an innocent victim on the street. The legal and medical communities felt legally blocked from averting potential tragedy.

While I understand that there is a real need to revise some of Montana’s laws pertaining to mental illnesses, I can’t help but think that part of the problem is our profession’s failure to understand the role of brain chemistry in mental illnesses and crises. Would we be this paralyzed if the dangerous delusions had been caused by someone slipping him LSD? I have to believe that we would have done more to keep this poor man’s path from intersecting with the SWAT Team or the coroner.

The man was arrested before the delusional apocalypse and sent into treatment. While we can all be happy that broad tragedy has been averted, it is shameful that he had to become a criminal in order to be freed from his debilitating hallucinations.

We can and must do better than that.

The legal system flounders when faced with someone whose biological brain disorder affects how they think, feel, and act. People who live with serious mental illnesses and their families expect us to do better than seizing someone who acts irrationally because of a medical condition and punishing them for acting irrationally. Our profession must update our conception of mental illness to reflect society’s new understanding of the effects of mental illnesses on the functioning of the brain.

The realities of the challenges presented by mental illness mirror the plight of a person who is “involuntarily intoxicated.” For instance, bipolar disorder drastically alters the release of the brain chemicals dopamine, serotonin and norepinephrine. The different levels and timing of these chemicals affect mood regulation, stress responses, pleasure, reward, and cognitive functions to cause mania, depression, or even a mix of both. A man or woman in the grips of a manic or depressive episode has effectively been drugged by their illness.

While not a silver bullet, the involuntary intoxication paradigm can be can be a valuable tool to help attorneys navigate through the complex civil rights, neglect, and public safety issues presented by someone in a mental illness crisis. It offers a major step forward in adapting our legal system to reflect the medical realities presented by these devastating illnesses.

Tuesday, March 9, 2010

Mental Illness, Football, and Dangerousness

"BOTTOM LINE: MENTAL ILLNESS IS A TRAGIC THING THAT CHANGES LIVES AND FAMILIES FOREVER." Family Quote.

Please be patient for me. but it has been a bad week for individuals who live with serious mental illnesses and their families. On this beautiful Montana Winter day I would like to be a little philosophical.

Long before I was a passionate advocate for those individuals who live with serious mental illness and their families, I was just as passionate about the game of football. That is why I have attached the following story which was printed in the "Helena Independent Record" this past Wednesday. Because of my passion for mental illness and football, I have followed this story closely. Until I was old enough to play high school football, my father took me to every Grizzly home game. I enjoyed a 25 year career as a high school and college football official until mental illness entered my family. My youngest son played college football and has been a successful college and high school coach since 1996. Sandra and I have had season tickets for Bobcat football since we returned to the state in 1971. Every Friday night and Saturday afternoon in the Fall we can usually be found at a high school or college football game.

This last week has again shown how the mental illness treatment has failed those individuals who live with serious mental illnesses and their families again. The Pentagon shooting involved a young man suffering from mental illness, The suicide in Helena probably involved mental illness and the attempted suicide in Butte involved mental illness. And it is all topped of by the attached story.

I do not know how much longer we can rely on the current commitment laws to meet the needs of the mentally ill. For almost 40 years we have used the criteria of "imminent danger to self or others" to commit individuals for treatment. One definition of insanity is to keep doing the same thing over and over again and expect different results. People! The system is not working. The present laws allow people to become so sick some of them lose their lives and sometime harm others. We need to change the commitment laws so to allow the mentally ill to access early intervention and experience the hope of recovery. We can no longer afford business as usual!

Helena Independent Record, Sports, Wednesday, March 3, 2010

"Iowa jury convicts man in football coach killing." by Nigel Duara, Associated Press.

Allison, Iowa -- Mark Becker stood passively Tuesday as a jury found him guilty in the shooting of a nationally known high school football coach. He seemed far removed from the man whose mind was filled with images of angels and horned demons who lurked in the shadows of every room, telling him that the community was plotting against him and that Aplington-Parkersburg coach Ed Thomas-known for his winning record and town leadership-was Satan.

Becker, 24, had explained to psychiatrists that after months of torment, he short Thomas at least six times in the high school weight room, then kicked his body before walking away.

Jurors deliberated 24 hours over four days before convicting Becker of first-degree murder, rejecting his plea of not guilty by reason of insanity. The guilty verdict carries a mandatory life-in-prison sentence. Minutes after the verdict was read, Becker's mother, Joan comforted a crying relative sitting behind her. "It's OK," Joan Becker said. "Just pray he gets the right medication." Details of Becker's mental state emerged during the 14-day trial healed in tiny Allison, about 150 miles northeast of Des Moines. Jurors heard from defense attorneys that Becker's delusions were so severe that he didn't know right from wrong.when he shot Thomas. Psychiatrists testified Becker believed invisible forces were pushing down on his eyes. Police interrogation videos showed him sitting alone, speaking to no one, swatting the air.

Prosecutors acknowledged that Becker suffered from a mental illness, but said that he also coldly calculated the killing, taking practice shots with his .22 caliber pistol he used to kill Thomas and lying to people in search for the coach.

After the verdict, the Thomas and Becker families-who attend the same Parkersburg church-said they would pray for each other. But they took away different lessons from a system that couldn't help Becker but ultimately succeeded in convicting Thomas's killer.

Joan Becker said the mental health support system in Parkersburg and Butler County failed her son. A psychiatrist in a Waterloo hospital agreed to his release just days after he was hospitalized following a violent incident and arrest. Police weren't notified when he was let out of the psychiatric unit. "Ed Thomas was a victim of a victim," she said. "Although Mark and we as his parents attempted to go through proper channels to get Mark the proper mental health treatment he desperately needed, the system failed miserably."

Thomas's son, Aaron, said both families have only begun to grieve, and the conviction wouldn't change that. But he said the justice system did what was necessary. "We do want to recognize that there truly are no winners in this case, but the system worked," he said.

The question of why Becker's delusions focused on Thomas remains unanswered. Thomas last coached Becker six years before the shooting and Becker had spent significant time away from Parkersburg.

Thomas amassed a 292-84 record and two state titles in 37 season as a head coach-34 of them at Aplington-Parkersburg High School- and coached four players in the NFL. He also was a leader in rebuilding Parkersburg after nearly one-third of the 1800-person town was wiped out in May, 2008, by a tornado that killed six people.

TRAGICALLY ONE MAN HAS BEEN KILLED, ONE YOUNG MAN IMPRISONED FOR LIFE AND TWO FAMILIES DEVASTATED FOREVER. THINGS MUST CHANGE!

Dr. Gary Mihelish
Former President of NAMI Montana