Get men­tally ill Coloradans the treat­ment they need

The Denver Post - - OPINION - By Krista Kafer

Over the past few weeks, Colorado pub­lic de­fend­ers have filed 64 re­quests to re­move men­tally ill peo­ple from jails around the state. Deemed in­com­pe­tent to stand trial, th­ese in­di­vid­u­als must await treat­ment be­fore their cases can con­tinue. Many are be­ing held for low-level of­fenses and would have had their day in court by now if they were men­tally com­pe­tent. In­stead they are be­ing held in jail with­out a con­vic­tion.

The Colorado De­part­ment of Hu­man Ser­vices is sup­posed to get such in­di­vid­u­als into treat­ment within 28 days of be­ing de­clared in­com­pe­tent to stand trial but of­fi­cials claim there is not enough fa­cil­ity space to take them. One man has spent 270 days in jail await­ing treat­ment. Th­ese men­tally ill men and women need ac­cess to treat­ment not only so their cases can be ad­ju­di­cated but be­cause they need help and can­not help them­selves.

Over the past year, a grow­ing aware­ness of the prob­lem of se­vere men­tal ill­ness has led to leg­isla­tive ac­tion. Dur­ing the 2018 ses­sion, the Colorado Gen­eral As­sem­bly passed a bi­par­ti­san bill to es­tab­lish a statewide pro­gram to help in­di­vid­u­als in cri­sis get treat­ment af­ter a 72 hour in­vol­un­tary men­tal health hold in a hos­pi­tal. In Novem­ber, Den­ver vot­ers passed a .25 cent sales tax for men­tal health and ad­dic­tion treat­ment ser­vices. Th­ese are good steps but more ac­tion is needed be­cause there are peo­ple with se­vere men­tal ill­ness lan­guish­ing in jails and on the streets.

In 2019, the state leg­is­la­ture should more ad­e­quately fund in-pa­tient and other men­tal health ser­vices for men­tally ill Coloradans. Ad­di­tion­ally, leg­is­la­tors should con­sider how to en­sure men­tally ill per­sons in jail re­ceive timely treat­ment to re­store com­pe­tency so their court cases can move for­ward and men­tal health ser­vices are avail­able for those who are con­victed and serv­ing time. Lastly, the Gen­eral As­sem­bly should re­view the le­gal cri­te­ria for in­vol­un­tar­ily com­mit­ment. It may be too dif­fi­cult to get peo­ple into in­pa­tient fa­cil­i­ties in the first place, leav­ing them vul­ner­a­ble to life on the street and in jail.

Un­der cur­rent law, in­di­vid­u­als can be in­vol­un­tar­ily com­mit­ted for up to 72 hours if they are deemed a dan­ger to them­selves or oth­ers.

A per­son deemed “gravely dis­abled” be­cause his men­tal state se­ri­ously ham­pers his abil­ity to care for him­self can also be com­mit­ted. Cer­ti­fi­ca­tion by a court is re­quired for com­mit­ments of three months or longer. The court can also man­date out­pa­tient ser­vices.

Ac­cord­ing to a re­cent 9 News in­ves­ti­ga­tion, some 35,000 peo­ple were placed on a 72 hour in­vol­un­tary men­tal health hold last year. An­other 5,000 ex­pe­ri­enced more than one in­vol­un­tary hos­pi­tal stay and 86 in­di­vid­u­als were held six or more times. This sug­gests that some pa­tients need more than 72 hours of in­pa­tient care.

Some par­ents of schiz­o­phrenic and se­verely bipo­lar adult chil­dren main­tain that it is too dif­fi­cult to get long term in­vol­un­tary com­mit­ment for their loved ones. A se­ries of Supreme Court de­ci­sions in the 1970s be­gin­ning with O’Con­nor v. Don­ald­son made it more dif­fi­cult to in­vol­un­tar­ily com­mit men­tally ill peo­ple who are not a dan­ger to them­selves or oth­ers. The de­ci­sions were meant to curb real abuses and en­sure civil lib­er­ties. There’s a rea­son the words “men­tal asy­lum” evoke scenes from the movie One Flew Over the Cuckoo’s Nest or even grainy pho­to­graphs of Vic­to­rian era in­sti­tu­tions where un­treated men­tally ill peo­ple and in­con­ve­nient spouses were ware­housed. In­ves­ti­ga­tions of abuse in mod­ern in­sti­tu­tions add weight to the be­lief that out­pa­tient ser­vices are al­ways prefer­able to in­sti­tu­tion­al­iza­tion.

This assess­ment ig­nores the im­prove­ments made to men­tal health fa­cil­i­ties since the 1970s and the fact that not ev­ery­one who needs out­pa­tient care will seek it.

While most men­tally ill peo­ple can get the help they need from com­mu­nity sup­port and in­ten­sive out­pa­tient treat­ment, some peo­ple will live their best life in an in­sti­tu­tion. For them, the al­ter­na­tive is a life on the street comb­ing through garbage bins and oc­ca­sion­ally run­ning afoul of the law. Though tech­ni­cally free to live as they please, they are trag­i­cally bound by the chains of delu­sion.

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