INVOLUNTARY TREATMENT ACROSS FLORIDA S PSYCHIATRIC INSTITUTIONS

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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

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