10/28/20151 involuntary treatment in the 21 st century making the recovery model real honorable...
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INVOLUNTARY TREATMENTIN THE 21ST CENTURY
MAKING THE RECOVERY MODEL REAL
Honorable Milton L. Mack, Jr.Chief JudgeChief Judge
Wayne County Probate CourtWayne County Probate CourtDetroit, MichiganDetroit, Michigan
December 10, 2010December 10, 2010
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CURRENT CONDITION
NationallyNationally
Over 340,000 with mental illness are Over 340,000 with mental illness are incarceratedincarcerated
2/3 of prisoners with mental illness were 2/3 of prisoners with mental illness were off their medication*off their medication*
25% of prisoners have history of chronic 25% of prisoners have history of chronic mental illnesses*mental illnesses* SchizophreniaSchizophrenia Bipolar disorderBipolar disorder DepressionDepression*The Health and Health Care of U.S. Prisoners: Results of a Nationwide Survey, American Journal *The Health and Health Care of U.S. Prisoners: Results of a Nationwide Survey, American Journal
of Public Health, 2009. Harvard Medical Schoolof Public Health, 2009. Harvard Medical School
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IN THE BEGINNING . . .
Generally cared for in homesGenerally cared for in homes Kept in:Kept in:
– AtticsAttics– BasementsBasements– Backyard iron cagesBackyard iron cages
Less fortunateLess fortunate– Jails Jails – AlmshousesAlmshouses
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DOROTHEA DIXDOROTHEA DIX
Believed improving conditions would Believed improving conditions would helphelp
Lobbied legislatures and Congress to Lobbied legislatures and Congress to establish asylumsestablish asylums
Architect of first generation asylumsArchitect of first generation asylums
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INSTITUTIONAL MODELINSTITUTIONAL MODEL
Governed Mental Health Care Governed Mental Health Care Delivery Across the CountryDelivery Across the Country
Mental IllnessMental Illness
– Considered Lifelong disabilityConsidered Lifelong disability
– Little, if any, hope for recoveryLittle, if any, hope for recovery
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HISTORICALLY – HISTORICALLY – 1950s1950s
Institutionalized with Mental Institutionalized with Mental IllnessIllness
– 559,000 people in the United States559,000 people in the United States
– Over 20,000 people in MichiganOver 20,000 people in Michigan
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HISTORICALLY – HISTORICALLY – 1960s1960s Community Mental Health Act of Community Mental Health Act of
19631963
– Triggering eventTriggering event
– New federal roleNew federal role
– Agreement to pay for mental health Agreement to pay for mental health treatment UNLESStreatment UNLESS an adult patient an adult patient in a psychiatric hospitalin a psychiatric hospital
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HISTORICALLY – HISTORICALLY – 1960s1960s GoalsGoals
– Reduce hospital population by 50%Reduce hospital population by 50%– Within 10 yearsWithin 10 years
IncentiveIncentive– Federal $$$ for Outpatient Federal $$$ for Outpatient
TreatmentTreatment– State funds freed-upState funds freed-up
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HISTORICALLY – HISTORICALLY – 1970s1970s
Michigan’s Mental Health Code - Michigan’s Mental Health Code - 19741974
Enabled the Conversion of Enabled the Conversion of
Institutional ModelInstitutional Model
ToTo
Community Treatment & SupportCommunity Treatment & Support
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HISTORICALLY – HISTORICALLY – 1970s1970s Barriers to Involuntary Barriers to Involuntary
HospitalizationHospitalization
– Due process standardsDue process standards
– Civil commitment standardsCivil commitment standards Threat of imminent harm Threat of imminent harm
– Most States have similar standardsMost States have similar standards
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RECOVERY MODELRECOVERY MODEL
Mental Illness is seen as:Mental Illness is seen as:
– Responsive to Specific TreatmentResponsive to Specific Treatment
– RecoverableRecoverable
Productive LifeProductive Life
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RECOVERY MODELRECOVERY MODEL
Timely Treatment:Timely Treatment:– Speeds recoverySpeeds recovery
– Promotes wellnessPromotes wellness
– Promotes quality of lifePromotes quality of life
– Preserves resiliencyPreserves resiliency
– Reduces costsReduces costs
– Reduced need for intensive careReduced need for intensive care
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RECOVERY MODELRECOVERY MODEL
Barriers to Timely Treatment RemainBarriers to Timely Treatment Remain– Wait for crisis Wait for crisis
– Delayed delivery of right care at the right Delayed delivery of right care at the right timetime
– Law enforcement knows treatment is not Law enforcement knows treatment is not an option, making jail the only optionan option, making jail the only option
– Common assumption that persons must be Common assumption that persons must be homicidal or suicidal to get treatmenthomicidal or suicidal to get treatment
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MISALIGNMENTMISALIGNMENT
Current Mental Health CodeCurrent Mental Health Code
An Inpatient Model in anAn Inpatient Model in an
Outpatient WorldOutpatient World
OrOr
A Community Treatment and A Community Treatment and Support Model in a Recovery EraSupport Model in a Recovery Era
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PERSON PERSON REQUIRING TREATMENTREQUIRING TREATMENT MCLA 330.1401MCLA 330.1401
(c) (c) An individual who has mental illness, whose An individual who has mental illness, whose judgment is so impaired that he or she is unable judgment is so impaired that he or she is unable to understand his or her need for treatmentto understand his or her need for treatment
to result in significant physical harm to himself, to result in significant physical harm to himself, herself, or others. This individual shall receive herself, or others. This individual shall receive involuntary mental health treatment initially only involuntary mental health treatment initially only under the provisions of sections 434 through 438.under the provisions of sections 434 through 438.
on the basis of competent clinical opinion,on the basis of competent clinical opinion,
and whose continued behavior as the result and whose continued behavior as the result of this mental illness can reasonably be of this mental illness can reasonably be expected,expected,
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PERSON PERSON REQUIRING TREATMENTREQUIRING TREATMENT MCLA 330.1401MCLA 330.1401
(c) (c) An individual who has mental illness, whose An individual who has mental illness, whose judgment is so impaired that he or she is judgment is so impaired that he or she is unable unable
to understand his or her need for treatment to understand his or her need for treatment
on the basis of competent clinical opinion. on the basis of competent clinical opinion.
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ALIGNING THE ALIGNING THE SYSTEMSYSTEM
Early TreatmentEarly Treatment– Allows a person to recover from illnessAllows a person to recover from illness– Frees the person from the illness Frees the person from the illness
preventing the exercise of free choicepreventing the exercise of free choice– Early treatment supports freedom from the Early treatment supports freedom from the
devastating consequences of untreated devastating consequences of untreated mental illnessmental illness
– Opportunity to restore capacity beforeOpportunity to restore capacity before JoblessnessJoblessness HomelessnessHomelessness IncarcerationIncarceration
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ALIGNING THE ALIGNING THE SYSTEMSYSTEMWhat is the real fear of early What is the real fear of early
intervention? intervention?
– Protecting choice?Protecting choice?
– Stuck in 1974?Stuck in 1974?
– Lack of confidence in treatment Lack of confidence in treatment modalities?modalities?
– Lack of continuity in the public Lack of continuity in the public system? system?
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WHAT IS WORKINGWHAT IS WORKING
Connecticut ProgramConnecticut Program
– Links Probate Court with CMHLinks Probate Court with CMH
– Guardians have help from case Guardians have help from case workersworkers
– Help wards navigate systemHelp wards navigate system
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ARRESTS BEFORE & AFTER INVOLVEMENT
16 People Arrested, 46 Arrests 12 People Arrested, 22 Arrests
N = 54
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INCARCERATION / JAIL DAYS
13 Incarcerated, 985 Total Jail Days 4 Incarcerated, 362 Total Jail Days
N = 54
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EMERGENCY ROOM
23 People, 322 Total Visits 23 People, 150 Total Visits
N = 54
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HOSPITAL EVENTS
30 People, 287 Total Visits 27 People, 240 Total Visits
N = 54
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WHAT DOES THIS WHAT DOES THIS MEAN?MEAN?
The Right Care at the Right TimeThe Right Care at the Right Time
– Speeds recoverySpeeds recovery
– Reduces CrimeReduces Crime