The WaPo exposes
flaws in Virginia's labyrinthine mental health system, including confusion about the law, spotty enforcement and inadequate funding.Neither the court, the university nor community services officials followed up on the judge's order, according to dozens of interviews. Cho never got the treatment, according to authorities who have seen his medical files. And although state law says the community services board should have made sure Cho got help, a board official said that was "news to us."
At the commencement of the commitment hearing, the district court judge or special justice shall inform the person whose involuntary admission is being sought of his right to apply for voluntary admission and treatment as provided for in -º 37.2-805 and shall afford the person an opportunity for voluntary admission. The judge or special justice shall ascertain if the person is then willing and capable of seeking voluntary admission and treatment. If the judge or special justice finds that the person is capable and willingly accepts voluntary admission and treatment, the judge or special justice shall require him to accept voluntary admission for a minimum period of treatment not to exceed 72 hours.
The reports I read last week stated that Cho had been offered the opportunity to voluntarily commit himself. Contrast this with Section 37.2-817.B., which provides that if a
special justice finds by clear and convincing evidence that (i) the person presents an imminent danger to himself or others as a result of mental illness or has been proven to be so seriously mentally ill as to be substantially unable to care for himself and (ii) alternatives to involuntary inpatient treatment have been investigated and deemed unsuitable and there is no less restrictive alternative to involuntary inpatient treatment, the judge or special justice shall by written order and specific findings so certify and order that the person be admitted involuntarily to a facility for a period of treatment not to exceed 180 days from the date of the court order. Such involuntary admission shall be to a facility designated by the community services board or behavioral health authority that serves the city or county in which the person was examined as provided in -º 37.2-816.However, the following Section, 37.2-817.C., provides that
(ii) less restrictive alternatives to involuntary inpatient treatment have been investigated and are deemed suitable, (iii) the person (a) has the degree of competency necessary to understand the stipulations of his treatment, (b) expresses an interest in living in the community and agrees to abide by his treatment plan, and (c) is deemed to have the capacity to comply with the treatment plan, and (iv) the ordered treatment can be delivered on an outpatient basis and be monitored by the community services board, behavioral health authority or designated provider, the judge or special justice shall order outpatient treatment, which may include day treatment in a hospital, night treatment in a hospital, outpatient involuntary treatment with anti-psychotic medication pursuant to Chapter 11 (-º 37.2-1100 et seq.), or other appropriate course of treatment as may be necessary to meet the needs of the person. The community services board or behavioral health authority that serves the city or county in which the person resides shall recommend a specific course of treatment and programs for the provision of involuntary outpatient treatment. The community services board, behavioral health authority, or designated provider shall monitor the person's compliance with the treatment ordered by the court under this section, and the person's failure to comply with involuntary outpatient treatment as ordered by the court may be admitted into evidence in subsequent hearings held pursuant to the provisions of this section. Upon failure of the person to adhere to the terms of the outpatient treatment order, the judge or special justice may revoke it and, upon notice to the person and after a commitment hearing, order involuntary admission to a facility.
The types of hearings I have been involved in as counsel for the "consumer" have overwhelmingly been brought pursuant to Code Section 37.2-814 rather than 37.2-817. In such instances it is the duty of the attorney to explain to the "consumer" his option to take the voluntary commitment. Frankly, if the "consumer" is not totally nuts without any sense of reality he is going to opt for the voluntary commitment provision. There is no definitive statement in this part of the statute about the duties of the CSB in such cases. The statute referring to followup is Section 37.2-837 and it allows discharge after preparation of a "discharge plan" of
Any consumer in a state hospital who, in his judgment, (a) is recovered, (b) does not have a mental illness, or (c) is impaired or not recovered but whose discharge will not be detrimental to the public welfare or injurious to the consumer
To understand what happened in Cho's case one must keep in mind that the once the detention order was issued on the police report of Cho's bizarre behavior he was probably detained and within 48 hours brought before a "special justice", who is a local attorney appointed to hear such cases. He was probably provided with a court-appointed lawyer who interviewed Cho on the day of the hearing and also read the petition and talked to whomever brought the petition and maybe the CSB doctor who is kept on contract for such things. The attorney would have advised Cho to take the voluntary admission and there would likely have been very little to the hearing. Once Cho was voluntarily admitted he would have been provided medication and probably showed immediate improvement to the point where he was considered "restored" and eligible for discharge with a treatment plan. Once he was discharged there would have been no mandatory followup. He would have been relied upon to do his own followup. Does this sound like a good system to you? I didn't think so. Time to change this system to reflect the realities of the situation, which is that the dangerously mentally ill should never be the ones making the final treatment decision.
I've had criminal court appointments in which trial on the case has been delayed for more than a year while the good people at Western State or Central State Hospital try to "restore" my clients to enough sanity to participate in their defense. It's not uncommon to receive an appointment, file a 169 motion to determine whether he's competent enough to assist in his defense, have a date set for return of the client after he's had time to be evaluated and possibly treated for his condition, then to have him decompensate all over the place between the time he is transported back to Arlington from Western State and goes to trial. Sometimes I find myself talking to a sane, nicely restored, pleasant individual on a Tuesday night and then encounter a raving lunatic at trial the following Wednesday morning. I've seen witnesses and police officers inconvenienced by having to show up for trial, sometimes multiple times, for someone who is so unstable that he can't be restored long enough to be competent enough to assist counsel at trial or to understand the proceedings against him.
Upon return of the competency evaluation, if I am considering a defense of Not Guilty by Reason of Insanity (NGRI) then I have to file an additional 169 motion under another paragraph of the statute requesting a determination of whether he was sane at the time of his offense. That evaluation is set for yet another return date.
Added to this bizarre stew is the fact that as long as the charges exist against this individual and he is going through the process of evaluation and treatment, he is being better served by the system than he would be if we simply dismissed the charges. Once the charges are dismissed there's no way to hold him in the hospital unless he meets the stringent definition of posing an imminent threat of harm to either himself or others under the provisions of Title 37.2-800 et seq. It's a very awkward situation.
I wrote this diary BECAUSE of my distress at our abominable mental health system and with sympathy for people who find themselves ensnared by its inconsistent, confusing, and generally unhelpful provisions. You find the use of the word consumer in quotes to be an insult? I find it an insult not to use a word which truly describes such individuals, such as patient or client, and to treat them as if they're deciding whether to buy apples or oranges at the supermarket.
Before going into your rant you tell me that if Cho had been committed involuntarily he would have been kept for 180 days. Well, no duh. What do you think the point of my diary was? Oh wait, you didn't actually READ the diary, so pumped up were you about some cherry-picked words and your eagerness to go on the attack. You've posted some facts and figures. Too bad I NEVER called mental patients more "dangerous" than the rest of the population, and that I NEVER said anyone with a mental illness could not make his/her own treatment decisions. You make it sound like every mental health sufferer is subjected to an involuntary commitment hearing. On the contrary, the law is so restrictively written, and the behavior alleged or witnessed has to be so abnormal that it raises an inference that the person has to be, upon initial analysis anyway, in imminent danger of harming himself or others. The vast majority of the mentally ill never have an involuntary commitment hearing.
You find it significant that 81% of the subjects of IC hearings either are committed or voluntarily enter treatment? (I'd like to see the link since your work thus far on this issue seems pretty sloppy). I don't. You don't delineate between the voluntary admittees and the involuntarily committed, and I'd be willing to bet the actual involuntary inpatient commitment numbers are quite small. My diary specifically dealt with the difficulty of dealing with the most seriously mentally ill, many of whom are suicidal or so deranged that they commit criminal acts without even realizing what they are doing. I've been there. I've seen people who are not only suffering, but whose families are suffering. No one is helping these people because they're too busy pontificating like you about freedom; never mind how exhausted their families and friends are at having to deal with them, nor how much of a danger they pose to themselves because they are so vulnerable to the predations of criminals and the products of their own diseased minds.
Thanks for telling me the TDO and exam were online. Of course, the documents posted also show that the section directing Cho to outpatient treatment and to "follow all recommended treatments" DO NOT direct any kind of follow up other than his own cooperation. They DO NOT direct the CSB to monitor his case. They DO NOT refer the case back for review by the Court or direct any updates to the Court. They DO NOT impose any duty at all on anyone else at all. In other words, you can call it "involuntary" all you want, but there is no transport order. Cho was "oriented x4" and able to respond to questions, and that was enough to make him outpatient rather than inpatient. Once rendered outpatient Cho was on his own. My case is made.
As for your quibble over my use of the phrase "nuts" to describe someone who is absolutely out of touch with reality, please get over yourself. It's semantics, and I know we should all be all PC, all the time, but you can use whatever term you want and still arrive back at the same point. This is not "hate speech" or prejudice and to chastise me for describing what I have witnessed for twenty years makes you look like a sanctimonious simpleton.
I think it's interesting that the other writer honed in on Catzmaw's role in representing the mentally ill, and claimed that she was guilty of "discrimination" for accurately describing Virginia's revolving door, broken system. Unless they have a mentally ill family member, the general public is woefully ignorant of the dangerous failings of this system. The patient's confidentiality rights serve as a shield to hide the system's mistakes, missteps, and deliberate neglect.
Inevitably, some of those mistakes bubble to the surface, and innocent people are hurt. Only those who have worked in and with the mental health system have the knowledge to detail the daily outrages and failings of that system. With that knowledge comes a duty to speak out in the best interests of patients, their families, and the public.
Those who criticize the system are motivated by care, concern, and loyalty to the true needs of the mentally ill for treatment, not by "discrimination."
Ask any police officer, sheriff's deputy, or judge how the mental health system's abdication of responsibility to provide treatment has affected law enforcement, and you will get a long litany that proves that all this happy talk about freedom, independence, and autonomy is a lie, pure and simple.
I also find it interesting that there is no mention of how many people with mental illness die in our state facilities, the latest being a 30 year old man in a prone restraint, which of course will never make the news. Nor is there any mention of the 25 years cut off folks lifespan who particpate in our national public mental health system--and you can look that up, I don't need to do your research for you. The 81% comes from adding up the figures in the state's 1994 study of the commitment process in Virginia, the last study that has been done state wide. If you don't know about it, you really aren't up on the state wide issues, you are just relaying anecdotes.
I wonder if someone who used the N. word on this blog would get away with saying someone who objected was "quibbling" and being too "P.C.". You can say you are not prejudiced until you are blue in the face, it doesn't make it so lawyer who "represents" people with mental illness in court.
Most violent crime in this country is perpetrated by people with no psychiatric history. Equating mental illness with violence is simply TAC and NAMI propaganda except even NAMI national has now disavowed the connection and come out with a statement saying that people with mental illness should not be targeted because of one person's actions.
What's sad is that I already knew how much prejudice and hatred lurked in the minds and hearts of people who say they work for or advocate for people with mental illness, but now people feel free to express it openly all over the place and the hatred and the fear and the smearing of an entire group is hurting people with mental illness in this state as the number of suicide attempts goes up as does the isolation and the fear of being known to have a mental illness.
But go ahead with your hate speech, why should this blog be any different than the vast majority of ignorant people in this country who would rather scapegoat an entire group than look for complex reasons and answers for tragic events. I know, let's bomb Iraq because Saudi Arabians flew into the Twin Towers, that's a reasoned and responsible response.
I'm not posting anymore on this thread because the ignorance and prejudice is too much for me.