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Ask the Mental Health Expert Archives 2001-2004

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Mental Health Laws

Q. What solutions are there for people who refuse treatment and continue to get worse? Are there any laws in America to help and protect people with mental illness?

My brother has been sick for 17 years and is continually getting picked up and thrown into jail. Jail is not where he belongs. He needs help and medication. Why isn't there a place for him to go and get the help he needs? My family and I are at our wits end. It is an issue that is ignored too often and it seems like no one cares enough to try and change it. Who do I contact to start the ball rolling with this issue?

A. Your family's struggles--and those of your brother--are all too common in this country, unfortunately. Very often, the criminal justice system does not extend its justice to those who suffer from mental illness, and whose illegal acts may sometimes stem from such illness. (Of course, this isn't always the case).

Much of what happens to those with mental illness accused of a crime depends on local attitudes, sophistication, and facilities. For example, I used to act as a consultant to a local court. Sometimes, the person accused of a crime had a lawyer who recognized that his client had a psychiatric problem, and asked the judge to seek a psychiatric opinion as to the individual's mental state.

In some cases, this resulted in transfer of the individual from a holding cell to a psychiatric facility, for a period of evaluation. But the whole process seemed to depend on whether somebody asked the judge for such an evaluation--there was no automatic referral to the mental health system. Once incarcerated, mentally ill individuals do have a constitutionally-protected right to treatment--but probably only a fraction of these individuals actually receive it (Teplin et al, Am J Public Health. 1997 Apr;87(4):604-9.)

My strong recommendation is that you get in touch with your local chapter of the National Alliance for the Mentally Ill (NAMI; 800-950-NAMI). Their position on your brother's situation is very clear: "NAMI believes that persons who have committed offenses due to states of mind or behavior caused by a brain disorder do not belong in penal or correctional institutions. Such persons require treatment, not punishment. A prison or jail is never an optimal therapeutic setting. NAMI supports a variety of approaches to diverting individuals from unnecessary incarceration into appropriate treatment, including pre-booking (police-based) diversion, post-booking (court-based) diversion, alternative sentencing programs, and post-adjudication diversion (conditional release). You can find this at the website www.nami.org/update/platform/criminal.htm.

Another resource for information on the legal rights of the mentally ill is the Bazelon Center for Mental Health Law (202-467-5730). I hope that you are able to find the right kind of help for your brother--and yes, there are people out there who do care about this!

Other Resources:

October 2003

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