What is criminalization of serious mental illness? The effect - - PowerPoint PPT Presentation
D ecriminalization of serious mental illness in Oregon By: Lisa Dailey, Esq. Legislative and Policy Counsel Treatment Advocacy Center t rea eat m en ent advocacycen ent er er.org 703 703-294 294-6004 6004 (Direct ) dai aileyl yl@t
By: Lisa Dailey, Esq. Legislative and Policy Counsel Treatment Advocacy Center
t rea eat m en ent advocacycen ent er er.org 703 703-294 294-6004 6004 (Direct ) dai aileyl yl@t reat at m ent ad advocac acyc ycent er.org
Failure to create community treatment
Civil commitment standards that
Lack of robust implementation of
1945: Congressional hearings on the alarming number of military recruits with mental illness
1945: Exposés of conditions in state mental hospitals begin
1946: Birth of the National Institute
1953: First antipsychotic (Thorazine) introduced in U.S.
1955-60: Joint Commission on Mental Illnesses and Health convened
1960: John F. Kennedy elected president
1963: Congress passes the Community Mental Health Act, reversing 100 years of treatment policy for acute and chronic severe mental illness. No provision is made to link the new centers to public hospital patients. President Kennedy signs the bill into law. It is the last bill he signs before his assassination.
1965: Congress passes the Social Security Act of 1965 establishing Medicare and Medicaid – and excludes “institutes of mental disease” (IMD) from Medicaid coverage
The idea behind deinstitutionalization was fundamentally sound. Most patients could live safely outside a hospital while being treated in community facilities, provided that such treatment facilities existed.
Based on a cross-sectional study in 18 countries, Dr. Penrose found that prison and mental hospital populations are inversely related. If one form of confinement is reduced, the other will increase. Where prison populations are extensive, psychiatric hospital populations will be small. And vice versa.
Re-institutionalization
An estimated 8.1 million adults in America have serious mental illness (SMI)
That is a 3.3% prevalence rate of SZ and severe BP in the general population An estimated 50% receive no treatment in a given year
Approximately1.8 million of these individuals are booked into US jails every year Nearly 400,000 are incarcerated on any given day;
40% spend time behind bars during their lifetimes
2015
Adult prison population: 15,245 Prison inmates with SMI: 2,134 (14% ) Adult jail population: 5,755 Jail inmates with SMI: 1,496 (26% )
Incarcerated people with SMI in Oregon
3,631 adults
SOURCE Bureau of Justice Statistics, National Prisoner Statistics Program, 2015
– I na b ility to immine ntly c a re fo r o ne ’ s o wn fo o d, c lo thing , she lte r, a nd me dic a l c a re due to a me nta l illne ss
– Ma y b e a sub se c tio n o f the “da ng e r to se lf” pro visio n o f sta te sta tute
– Ne e d fo r T re a tme nt
n o rde r to pre ve nt de c o mpe nsa tio n a nd physic a l/ psyc hia tric ha rm, pa tie nt sho uld re c e ive tre a tme nt, e ve n if invo lunta ry
Civil Co mmitme nt
da ng e ro usne ss a nd g ra ve disa b ility
c o nstrue d c o mpa re d with o the r sta te s
he le g isla ture c a n a nd sho uld pro vide g uida nc e to the c o urts fo r ho w it inte nds the sta nda rds to b e inte rpre te d
If a system is set up to require
If a gravely disabled standard is
T AC Re po rts
T AC Re po rts
T AC Re po rts
the b ra in tha t impa irs the a b ility to pe rc e ive o ne ’ s o wn illne ss
e nt fr
Conside r e d the most c ommon r e ason individua ls with
psyc ho tic diso rde rs do no t ta ke the ir me dic a tio ns
If I’m no t sic k, why take me dic ine ? Ve r y c ommon with SMI:
e vale nc e in sc hizophr e nia is ro ug hly 50%
e vale nc e in bipolar disor de r is ro ug hly 40%
a s:
) is the pra c tic e o f de live ring o utpa tie nt tre a tme nt unde r c o urt o rde r to a dults with se ve re me nta l illne ss who me e t spe c ific c rite ria , suc h a s a prio r histo ry o f re pe a te d ho spita liza tio ns o r a rre st. AOT invo lve s pe titio ning lo c a l c o urts to o rde r individua ls to re ma in in tre a tme nt within the c o mmunity o f a spe c ifie d pe rio d o f time . AOT pa rtic ipa nts a re g ive n due pro c e ss pro te c tio n, tre a tme nt a nd suppo rtive se rvic e s…
he g o a l o f AOT is to impro ve he a lth a nd so c ia l o utc o me s fo r the individua ls se rve d in the pro g ra m, suc h a s inc re a se d he a lthc a re utiliza tio n, impro ving b e ha vio ra l he a lth a nd o the r he a lth o utc o me s, a nd re duc ing ra te s o f ho me le ssne ss a nd inc a rc e ra tio n.”
t is no n-punitive – pa rtic ipa nts c a nno t b e he ld in c o nte mpt, fine d, o r ja ile d.
in a ll sta te s b ut Co nne c tic ut
llne ss
nte ra g e nc y Bo a rd
nte rna tio na l Asso c ia tio n o f Chie fs o f Po lic e
t is inc lude d in a ll ma jo r fe de ra l me nta l he a lth re fo rm a nd c rimina l justic e dive rsio n b ills, inc luding HR246
nste a d o f re c e iving inte rve ntio ns in the c o mmunity, pe o ple a re de c o mpe nsa ting to the po int whe re the y ne e d e me rg e nc y c risis c a re a nd inpa tie nt ho spita liza tio n
sta nda rds a re pre ve nting use o f AOT
professionals dynamically engaged with consumers so they and the Court can intervene right away if needed.
before an individual decompensates to the point of becoming a danger to self or others.
allows the system to catch people in trouble in a timely way, before they slip fully into a psychosis.