1 INVOLUNTARY TREATMENT ACROSS FLORIDA S PSYCHIATRIC INSTITUTIONS Juan Ohms, M.D. Janetta Cureton,M.D. Joseph W. Poitier, M.D Director of Training Program UM/JMH Forensic Psychiatry Fellowship Program
2 Florida s Inpatient Psychiatric Institutions Civil Facilities Statute 394 (Florida Mental Health Act) Private Hospitals Public Hospitals Inpatient Crisis Units Community Mental Health Centers Criminal Institutions Prisons - Statute 945 Forensic Hospitals Statute 916 Jails? Florida Model Jail Standards NCCHC Standards
3 Baker Act Maxine E. Baker Statute-394 Florida Mental Health Act-1971 Dangerous to self or others with recent evidence of such dangerousness No family or other supports Unable to survive in the community alone If committed, guardian advocate is appointed Before hearing proxy can authorize treatment
4 Civil Facilities Statute Florida Mental Health Act Civil Facilities Private Hospitals Public Hospitals Inpatient Crisis Units Community Mental Health Centers
5 Florida s Inpatient Psychiatric Institutions Criminal Institution Statute Relevant landmark cases Year Prison Statute-945 Washington v Harper 1990 Riggins v Nevada 1992 Forensic Hospital Statute-916 Sells v United States 2003 Jails Riggins v Nevada Sells v United States
6 I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane, idiotic men and women; of beings sunk to conditions from which the most unconcerned would stare with real horror; of beings wretched in our prisons, and more wretched in our almshouses. And I cannot suppose it needful to employ earnest persuasion, or stubborn argument, in order to arrest and fix attention upon a subject only the more strongly pressing in its claims because it is revolting and disgusting in its details. - Dorothea Dix, East Cambridge Jail, Gerald N. Grob The Mad Among Us,
7 Growing Jail and Prison Systems Studies by the Pew Center 7 million as of 2007 in jail, prison and probation systems 1 in 31 in jail, prison or on probation 1 in 18 men in jail, prison or on probation 1 in 89 women in jail, prison or on probation 1 in 11 Black men in jail, prison or on probation
8 Growing Numbers of Mentally Ill in Jail and Prison Systems Beds per 100,000 population: (December) 339 beds 22 beds *study by H. Richard Lamb, American Academy of Psychiatry and the Law. Incidence of schizophrenia in jails and prisons 6 times that of the general population. Incidence of those with a major mental disorder in jails may be as high as 45% (Psychiatric Services). Steadman et al Justice Department Statistics show even higher incidence.
9 He had a wreath of rags around his body, and another round his neck. This was all his clothing. He had no bed, chair, or bench. Two or three rough planks were strewed around the room: a heap of filthy straw, like the nest of swine, was in the corner. He had built a bird s nest of mud in the iron grate of his den. Connected with his wretched apartment was a dark dungeon, having no orifice for the admission of light, heat, or air, except the iron door, about 2 ½ feet square, opening into it from his Prison. The wretched lunatic was indulging [in] some delusive expectations of being soon released from this wretched abode. Reverend Louis Dwight Prison Discipline Society Boston 1855
10 Forensic Hospitals Statue 916-Mentally Deficient and Mentally Ill Defendants. Involuntary treatment-treatment refusals ( non-emergencies). Court hearing-circuit court with jurisdiction Full adversarial hearing Substitute judgment decision (clear and convincing standards) A. Factors to be considered: Clients express preference regarding treatment Probability of adverse side effects Prognosis with treatment Prognosis without treatment Patient/defendant has representation
11 Sells V United States (2003) Sells v US (2003) Constitution permits the government to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, in certain limited circumstances: Court will have to decide whether the case is important enough that forced medication can be justified Involuntary medication will significantly further state interest Treatment is medically appropriate Unlikely to have side effects that may undermine the fairness of the trial If issue is dangerousness, competency issue becomes moot There are strong reasons for a court to determine whether forced administration of drugs can be justified on alternative grounds before turning to the trial competence question
12 Prisons Chapter Corrections Mental Health Act Annual Report 18 % received ongoing mental health treatment Grades S1-S6 S6 mental health treatment
13 Florida Prison Facilities 139 prison facilities within the Florida Department of Corrections divided into major institutions, annexes, work camps, work release centers, and road prisons throughout the state. 101,000 inmates inside as of October 2009
14 Washington v Harper (1990) Prison inmate in prison hospital unit Diagnosed with bipolar disorder Dangerous Institutional committee within the prison authorized use of involuntary antipsychotic medication Appeal rights to superintendent Washington process approved by the Supreme Court
15 Prisons Procedure for involuntary treatment Inpatient Court hearing (full adversarial hearing) Considerations A. Inmates expressed preference B. Probability of adverse side effects C. Prognosis for the inmate without treatment Prognosis for the inmate with treatment
16 Jails Dade-County Jail System 2 ½ floors house the mentally ill Crisis unit 9 th floor 6 th largest jail in the country 100,000 bookings per year
17 Riggins v Nevada (1992) Jail inmate Mentally ill Prescribed 800 mg of Thorazine Conviction overturned Violation of 14 th amendment (Due Process Rights).
18 Involuntary Treatment Process Approved by county attorney s office, Randy Duvall, Esq. Criteria Mentally ill Two psychiatrists Sworn affidavit Full adversarial hearing Dangerous (as evidenced by such dangerousness)***
19 Living in a Troubled World I believe the world can be a better place to live in if people are healthier in their minds. - William C. Menninger, M.D.
20 Sells V United States (2003) Sells v US (2003) Constitution permits the government to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, in certain limited circumstances: Court will have to decide whether the case is important enough that forced medication can be justified Involuntary medication will significantly further state interest Treatment is medically appropriate Unlikely to have side effects that may undermine the fairness of the trial If issue is dangerousness, competency issue becomes moot There are strong reasons for a court to determine whether forced administration of drugs can be justified on alternative grounds before turning to the trial competence question
21 ****CASE PRESENTATION**** 30-year old female with 3 rd degree felony charges refused to: eat speak drink Stayed underneath her blanket Lost a significant amount of weight. Eventually became too weak to stand.
22 ****CASE PRESENTATION**** 23-year old man with serious felony charges. History of: recurrent assaults feces-throwing and other aggressive behaviors. Had to be moved more than 50 times during his incarceration.
23 The world is a dangerous place to live- not because of the people who are evil, but because of the people who don t do anything about it. Albert Einstein, physicist
24 Florida s Inpatient Psychiatric Institutions Criminal Institution Statute Relevant landmark cases Year Prison Statute-945 Washington v Harper 1990 Riggins v Nevada 1992 Forensic Hospital Statute-916 Sells v United States 2003 Jails Riggins v Nevada Sells v United States
WHEN TREATMENT IS PUNISHMENT: THE EFFECTS OF MARYLAND S INCOMPETENCY TO STAND TRIAL POLICIES AND PRACTICES JUSTICE POLICY INSTITUTE OCTOBER 2011 TABLE OF CONTENTS Mission: Reducing the use of incarceration
More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States E. Fuller Torrey, M.D. Executive Director, Stanley Medical Research Institute, and Board Member, Treatment Advocacy
INVOLUNTARY TREATMENT: HOSPITALIZATION AND MEDICATIONS John A. Menninger M.D. 1. Why is involuntary hospitalization necessary? Although the number of involuntary hospitalizations relative to total psychiatric
WHAT TO DO IN A PSYCHIATRIC CRISIS IN INDIANA NAMI Indiana P.O. Box 22697 Indianapolis, Indiana 46222 1-800-677-6442 www.namiindiana.org TABLE of CONTENTS Preface..............................................................
Colorado Commissions on Judicial Performance 2014 Training Garfield County Courthouse Denver City & County Building El Paso County Courthouse (Historic) Weld County Courthouse Montrose County Courthouse
STATEMENT OF JUDGE STEVE LEIFMAN Chair, Supreme Court of Florida Task Force on Substance Abuse and Mental Health Issues in the Courts before the Subcommittee on Oversight and Investigations of the Energy
Trends in Juvenile Justice State Legislation 2001 2011 Trends in Juvenile Justice State Legislation: 2001-2011 By Sarah Alice Brown William T. Pound, Executive Director 7700 East First Place Denver, Colorado
Three Strikes Project When did prisons become acceptable mental healthcare facilities? Co-Published by: California State Senate pro Tem, Darrell Steinberg Stanford Law School Professor, David Mills Stanford
BASIC CRIMINAL LAW Overview of a criminal case Presented by: Joe Bodiford Board Certified Criminal Trial Lawyer www.floridacriminaldefense.com www.blawgger.com THE FLORIDA CRIMINAL PROCESS Source: http://www.fsu.edu/~crimdo/cj-flowchart.html
One Strike and You re Out How We Can Eliminate Barriers to Economic Security and Mobility for People with Criminal Records By Rebecca Vallas and Sharon Dietrich December 2014 WWW.AMERICANPROGRESS.ORG One
Mental Health Courts and the Complex Issue of Mentally Ill Offenders Amy Watson, M.A. Patricia Hanrahan, Ph.D. Daniel Luchins, M.D. Arthur Lurigio, Ph.D. Mental health courts are emerging in communities
Baker Act Consent for Admission & Treatment of Minors Myers Workgroup June 8, 2009 Minors & the Baker Act A variety of state laws, case law, and court rules of juvenile procedures governing the admission
1 Mandated Community Treatment: Beyond Outpatient Commitment John Monahan, Ph.D. Richard J. Bonnie, LL.B. Paul S. Appelbaum, M.D. Pamela S. Hyde, J.D. Henry J. Steadman, Ph.D. Marvin S. Swartz, M.D. Dr.
Understanding the Civil Involuntary Commitment Process About the Author By D. Renée Hildebrant http://www.okbar.org/obj/articles_05/021205.htm Oklahoma Bar Journal D. Renée Hildebrant is the trial court
February 14, 2007 Mayor Carlos Alvarez: On behalf of the Miami-Dade County Mayor s Mental Health Task Force, we are pleased to submit this Final Report reflecting our responses to the recommendations contained
Navigating the Juvenile Justice System A Handbook for Families Developed by the Maryland Coalition of Families for Children s Mental Health Maryland Coalition of Families for Children s Mental Health ACKNOWLEDGEMENTS
Advocacy Handbook A Guide to helping loved ones in Georgia Prisons 5th Edition 1 2009 Southern Center for Human Rights 83 Poplar St., NW Atlanta, GA 30303 404-688-1202 www.schr.org 2 The Southern Center
The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey (abridged) APRIL 8, 2014 Research from the Treatment Advocacy Center Visit TACReports.org/treatment-behind-bars to read
SANTA ROSA OFFICE 131 A STONY CIRCLE SUITE 500 SANTA ROSA, CA. 95401 TELEPHONE: (707) 433-2060 firstname.lastname@example.org www.youradvocate.net KEROSKY PURVES & BOGUE ATTORNEYS AT LAW AN ASSOCIATION OF ATTORNEYS
Minors (See also Involuntary Examination) (See also bakeracttraining.org for course on Consent for Minors) Q. How is a minor defined? Minority Defined A minor is any person under 18 years old who has not