Competent but crazy

Source: pocketfulofginch.blogspot.com

Source: pocketfulofginch.blogspot.com

Before I came to the bench, I spent time as the law member of the Dawson County Mental Health Board. Our job was to determine whether a person should be civilly committed because of a mental illness. See for example here or here.

The person had to be dangerous to himself or others as evidenced by a recent overt act. That’s where I first learned that if you saw a monster, smelled a monster or heard a monster and you took steps to distance yourself from the monster by climbing tall trees you were crazy enough to go to the nut house. If not, you were free to wander the streets and mumble all you want.

Later on, I developed a little speciality in dealing with mental health issues both in the criminal and civil context. I also represented clinical psychologists and had the opportunity to hire some of the best of these brilliant professionals. They taught me a lot.

I was reminded recently of something I learned long ago. You can be crazy as a loon, but competent to stand trial, or reject a plea deal that would get you some help. What does the justice system do with such people? Most of the time, very little. That strikes as both deeply sad and, dare I say, crazy.

I want to learn of the experiences of practitioners who have dealt with clients in this place of darkness and eternal suffering. That is, tell me please of your experiences in dealing with the crazy but competent.

RGK

17 responses

  1. My very first case was less than a week after passing the bar and starting my own law firm. I was appointed to represent M.S. in a civil commitment proceeding. Her “act” was trying to deposit a bottle of wine(Boones Farm as I recall) and a loaf of bread in her checking account in her downtown bank. She was very nice to the teller but insistent about her deposit. I was told the court “referee” did not report the hearings so I brought my own tape-recorded. There was no burden of proof, right to subpoena witness, or standards to guide the referees’ discretion. I mustered at least 30 constitutional violations as I made my record. Totally unimpressed by my upstart constitutional career the referee committed her. She was going to be transferred the next day to a distant county for “treatment.” I went back to my “office” and typed a ex-parte petition for a writ of habeas corpus, called a state court judge at home and asked if I could come over to his house to sign the writ. He did and appointed me to serve process and by 10 that night I had located the Executive Director of the public hospital where she was being held and served him with the writ. At the hearing a few days later I won and she was released. I went on in another case to challenge the constitutionality of Iowa’s civil Commitment procedures and won that, too. M.S. came to my office a few weeks later to give me a sketch she drew for payment of my services and told me she thought it was worth millions. I explained that I was court appointed and could not except her valuable art work but wished he the best. Our paths never crossed after that.

  2. I was a judge of probate for twelve years. In my state, the probate court has primary jurisdiction over commitments of the mentally ill, and over petitions for forced medication. The standard for involuntary commitment was danger to themselves or others. The problem: everyone has a different definition for that standard. The other problem: once admitted, and once medicated, they became stable and rational enough to be released. The other, other problem: poor follow up care, and a patient that stops taking the medication needed to maintain stability. The next step in the process being mental decomposition, a call to the police or the mobile crisis unit maintained by the Department of Mental Health, admission to the emergency room, issuance of a ten day physician’s emergency certificate, and being sent to the state psychiatric ward. Repeat.

    I think what bothered me most, watching this process unfold over and over again, were the looks on the faces of the parents usually in their late forties or early fifties (who always looked ninety years old), and their plea for someone to please help their adult child. Absolutely heartbreaking.

  3. Mark,

    As a side note, my very first case was the “birthday chicken” case cited in my post. As you know, we share more than that similarity but it is good to know that we started off doing the same thing–dealing with crazy people.

    All the best.

    Rich

  4. I am not lawyer but I have been observing this process for the past 15 years and I would agree that in some cases the Iowa Civil Commitment law does protect the civil liberties of the subject but the down side is that some of them commit suicide, die of ether a drug or alcohol overdose and on occasion freeze to death. The main reason for the deaths is that the MH support system is overloaded and the only practical way to keep them alive is to put them in jail (and that is temporary).

  5. Once thrilled with SCOTUS and mental health commitment law, but have become more skeptical. Has turned out to be an excuse for shrinking the mental health care system. Public mental health care is largely delivered by prisons in many States. One of the sad aspects of devil take the hind most version of supposed free market economics.

  6. repentinglawyer,

    With all the talk of sentencing reform, perhaps we can find more money from the savings anticipated by such reforms. I sure hope so. All the best.

    RGK

  7. I’m a permanent (not term) law clerk for a trial court in the mountain west. The case that has troubled me for years involved an older gentleman (early 60s) in a civil commitment. The commitment went off without a hitch, and he was sent off to the state hospital. A month later, the state came back to the trial court to get an order for involuntary administration of medication. The underlying facts would have allowed entry of a clear order for involuntary medication at the outset, but the state didn’t address the issue at the commitment hearing, and the state’s proposed order’s language was unclear on it. During the month the gentleman was at the state hospital, he refused to take his medical health medications, refused to take his physical health medications, refused to eat, and barely drank any water. He had dropped to 90-something pounds, and during the hearing, he continually interrupted the proceedings to make incoherent ramblings. He was suffering greatly from his mental health condition, his delusions were obvious, and it was heartbreaking to see this gentleman’s decompensation over the course of the month when he was in the state hospital, the only place we could place him to keep him safe from himself.

    We ultimately ordered involuntary medication over the gentleman’s attorney’s vigorous objection. The case was appealed to the state supreme court, and the decision was affirmed. But I remain troubled by the system’s failure to care for someone committed to the state for his own safety, the state’s failure to wait a month to step in and ask the court for relief, and the public defender’s failure to look out for the gentleman’s best interests when he was clearly of diminished capacity. These failures undoubtedly had long term effects on the gentleman’s physical health, mental health, and quality of life.

  8. I have so many of these it would be hard to choose one. My career began working in the commitment division of the Probate Court (commonly referred to as “Crazy Court”), where I spent ten years as a clerk. Not a lawyer, just a clerk. I went to law school from there and now specialize in Social Security disability. So, I have seen lots and lots of mental dysfunction.

    My recent favorites are certain of our local mental health centers. I get that these folks are severely underfunded and overworked. What I don’t understand is how they can see someone who is actively hallucinating, delusional and homeless, and the MHC gives them a global assessment of functioning score (GAF) of 70. DO NOT UNDERSTAND the need to minimize a person’s lack of function in this way.

  9. As both prosecutor and defense attorney, I have come across defendants who are clearly competent — they exhibit an understanding of what is happening and can communicate with counsel — but have a mental disease that contributed to their offense (frequently because they went off-medication). Sometimes, the mental disease is just a background fact (e.g. bipolar disorder) to be considered in finding an appropriate sentence that accounts for and deals with that mental disease, but in rare cases it does rise to the level of a valid NGRI defense. In those rare case, those of us in the system have two options — 1) have the defendant enter a guilty plea with appropriate treatment program as a probation condition (a temporary patch that gives them a criminal record); or 2) have them enter an NGRI plea which does result in a commitment to the mental health system which might result in a term of confinement much longer than the maximum criminal penalty. A lifetime commitment to the mental health system for stealing a car that a defendant delusionally thought was his seems inappropriate but so does a conviction when the defendant is clearly NGRI. The “system” would benefit from having a third option that would give an appropriate level of supervision to assure that the defendant receives appropriate treatment and takes his medication, but neither the structure nor the resources are available for such an option.

  10. Riding the rails.

    Crazy competent of you to solicit this input.

    Known perception is and there is known that you frankly know.

    I yield, Welcome Back! This “shame” is ready.

    Is your strength beautiful enough?

    I think it is!

    Being careful might be misunderstood.

    Nice to see you on your recreational mount again.

    Ride on!

    .

  11. In the late 1960s, my first few years in practice, a woman came to my office ( I was then with a small law firm in Colorado) and told me a sad story about her husband. He and his partner had driven cross country on a sales trip. They ended up in Mississippi. One day, they were driving along the shore of a large lake when her husband pulled off into a roadside parking area. He began talking crazy. He claimed he was Jesus. He got out of the car, speaking in tongues to the gathered multitude, shedding his clothes, promising to calm the storm-swept waters, wading into the lake. His partner had to physically restrain him and wrestle him back into the car. Upon returning to Colorado, he was committed to a mental hospital. There was more to her story. Before he left on the trip, her husband bought a brand new Lincoln Continental. The wife told me they couldn’t afford a Lincoln Continental. He had spent all of their savings on the car. That weekend, I was standing near the first tee at an Elks golf outing waiting my turn to tee off. I heard a guy on the tee bragging about a car sale he had made a few weeks before. He told his fellow golfers about a man who wanted to buy a blue Lincoln Continental. The dealer didn’t have a blue Continental in inventory, but the customer was insistent. He kept going on about how it had to be blue. The salesman said the customer looked sharp, like he had money, but he was weird acting. He claimed to be a personal friend of Henry Ford. He told the salesman, “You get Mr. Ford on the phone and let me talk to him. He’ll find a blue Lincoln Continental for me. I know he will.” The salesman claimed he actually dialed Ford in Detroit, but, of course, the customer couldn’t get through to anyone who could get him a car. The salesman finally talked him into buying a new, white Continental for around six thousand dollars. The salesman bragged about how the man was crazy, but loaded with cash. On Monday morning, I called the wife and asked her to bring me the car. When I showed up at the dealership, the salesman saw me and ran like a cockroach. I asked for the manager, showed him the man’s name on the contract of sale, showed him his name on the commitment papers, and told him the story, word for word, just like I heard it from salesman. Then I left the keys on the manager’s desk and asked him to call me the next day about an out-of-court settlement, which he did.

  12. Pingback: Some good advice about representing the competent but crazy « Hercules and the umpire.

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