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In The News

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The police have a tremendous amount of discretion how to handle a situation. In Boston, Massachusetts some are saying police need more training in how to deal with the mentally ill. Worcester Telegram

Montgomery County, Texas is starting an indigent defense program for the mentally ill. The program seeks to establish a support system for those with established mental illnesses and are convicted of crimes to reduce both costs and recidivism rates. Houston Community Newspapers

The mentally ill comprise a significant amount of the prison population. Jeff Gerritt, a columnist for the Detroit Free Press examines what can happen when the retributivist theory is applied to those who suffer from mental illness. Detroit Free Press

Proposed Arizona Legislation – Relating to Accountable Health Plans

The proposed legislation Arizona HB 2302 deals with mental health parity for insurance plans within the state. This is not brand new legislation, but rather it seeks to rewrite current law, Title 20 Section 2322.

Arizona Appellate Court Case – IN RE PIMA COUNTY MENTAL HEALTH NO. MH 3079-4-11

In re PIMA COUNTY MENTAL HEALTH NO. MH 3079–4–11

Facts of the case:

The defendant’s mother feared for the safety of her son and for others. She applied for an emergency medical evaluation of her son, and based on the findings the trial court issued a psychiatric evaluation for him. After the evaluation the psychiatrist suggested court-ordered treatment. During the hearing to set the treatment at the trial court, the son told the court he did not need legal representation. The court determined he “was not capable of representing himself,” despite the defendant’s wishes. The trial court reconvened the hearing two weeks later. The date of the hearing which was determined later was never relayed to either the defendant, nor his counsel. The trial court determined because of his absence he waived his right to a voluntary hearing. The trial court then ordered the defendant to undergo inpatient treatment. The defendant appealed the ruling of the trial court.

Issue: Whether an individual with suspected mental health problems waived his right to be present at an involuntary treatment hearing

Rules: The rule used by the court was if due process given to the defendant.

  • The court said that involuntary treatment is such “a serious deprivation of liberty” that due process must be served by, but is not limited to “a full and fair adversarial proceeding.”
  • The Arizona Legislature defines a patient’s due process rights to include: a “patient and the patient’s attorney shall be present at all hearings.”
  • “The right to be present, however, may be waived if done so voluntarily and intelligently.”

Reasoning: The defendant, nor his attorney were notified when the hearing would take place. Even though it is the defendant’s duty to keep in touch with his attorney, the appellate court cannot fault them for something they were not told.

Holding (ruling): Since the defendant did not know about the hearing he cannot be held responsible for his attendance at it. Furthermore, even if he did know about it, the trial court was wrong to conclude the defendant’s absence was voluntary without any supporting evidence.

Disposition: The appellate court cancelled the trial court’s order for the defendant to undergo inpatient treatment and sent the case back to the trial court to be re-decided while using the standards in decision.

Court of Appeals, State of Arizona, Division Two

Decided: November, 30, 2011

Read the entire case here.

Arizona Appellate Court Case – In re MH2010–002637

In re MH2010-002637, 228 Ariz. 74, 263 P.3d 82 (Ct. App. 2011)

Facts of the Case:

The Appellant (the party who appeals to an appellate court) is a diagnosed schizophrenic who suffered a dramatic weight loss in the preceding weeks and appeared ill when admitted to the hospital. The Appellant refused to accept treatment, and was transferred hospitals were his mental and physical health was evaluated. For the civil commitment hearing Appellant was appointed a public defender.

Appellant was not able to attend the civil hearing, nor have it brought to him because of a dangerously low white blood cell count. Instead, he was quarantined where only a medical staff would be around him. According to A.R.S. §36-535(B) the hearing must be held within six days of when the petition is filed. Appellant’s health would not improve before the deadline of the statute.

Affidavits submitted to the trial court by doctors “indicated that Appellant was persistently or acutely disabled and in need of involuntary commitment.”

The trial court ruled Appellant was “acutely disabled and in need of court-ordered mental health treatment.”

Issues:

1. Whether a court may proceed with a hearing when a patient is absent from the evidentiary hearing, required by the A.R.S. §36-539(C), without first finding that the patient cannot appear through any other means.

2. Whether “a person facing civil commitment have the right to effective assistance of counsel, and if so, how is a claim of ineffective assistance of counsel to be resolved.”

Rules:

1. Involuntary treatment involves a massive curtailment of liberty, “a patient facing civil commitment must be afforded due-process protection.”

2. In determining whether due process has been afforded in a civil commitment case, we look to the three-factor test set forth Mathews v. Eldridge, 424 U.S. 319, 96 S. Ct. 893, 47 L. Ed. 2d 18, 1976 U.S. LEXIS 141, 41 Cal. Comp. Cas 920 (U.S. 1976).

First, the private interest that will be affected by the official action; second, the risk of an erroneous deprivation of such interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguards; and finally, the Government’s interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail. – Id.

Reasoning:

Alternative Means of Appearance

1. First, the court said: One’s liberty is reduced during confinement. To protect against unjust loss of liberty one of the procedural safeguards needed is the opportunity to be heard at civil commitments.

2. Second, it can be very difficult in the eyes of the law to come to a definite psychiatric diagnosis. Thus the procedures above must be used otherwise there is a high degree of erroneous deprivation of an individual’s liberty. In this case, the plaintiff asks the court to allow patients to appear telephonically before the court, which would give the proceedings a greater degree of accuracy.

3. The court cannot find a reason why to bar a patient from defending himself telephonically. Even though A.R.S. §36-539(c) allows the court to render a decision without the plaintiff, the court views that the patient should have every opportunity to defend himself. In the chance that he cannot be physically present other methods should be considered, like telephonically.

Effective Assistance of Counsel

The plaintiff argues his attorney was not effective in representing him. Among the list of things his lawyer did not do: “interviewed him (the plaintiff), did not seek to have him participate at the hearing, offered no evidence at the hearing to oppose the petition, cross-examined only one witness (which permitted that witness to testify about the need for mental health treatment) and made no closing argument.” In re MH2010-002637, 228 Ariz. 74, 263 P.3d 82 (Ct. App. 2011).

The court says that an effective attorney is a due process issue,and without a competent attorney there is a much higher chance that errors can be made in the process and decision.

Ruling:

The appellate court sent the case back to the trial court for it to be retried using the standards in this opinion.

Court of Appeals, State of Arizona, Division One

Decided: Sept. 27, 2011

A First-Rate Madness – Book Review

nassir ghaemi

The book A First-Rate Madness by Dr. Nassir Ghaemi registered on my radar was one night while watching The Colbert Report, a current events based, satirical television show. The host, Stephen Colbert, is known for lampooning his guests and at times can make them the brunt of the jokes, which is why it surprised me that someone who wanted to have a serious discussion about mental illness would choose this particular venue to hype his book. The interview was not only informative, but it was also charmingly funny. At the bottom of the page is a link to the video clip of Dr. Ghaemi on The Colbert Report talking about his book.

Around the Web:

In the News

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Mental health care for immigrants is getting attention as critics say immigrants have less meaningful protections in place when in court. L.A. Times

Less money in public coffers, means less money for mental health treatment in New Orleans. The Times-Picayune

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is preparing its fifth edition. The DSM is the gold standard desktop reference for Psychiatrists and Physicians alike when it comes to mental disorders. That is why it is raising some eyebrows that “Internet addictions” may be listed in the book as a possible future diagnosis. New York Daily News