There is no question in anyone’s mind but his own that the patient has a mental illness. It has caused him chaos, family dissolution, unemployment. Random paranoid confrontations lead to recurrent arrests. He can rattle off his legal history, full of terms and charges, but cannot acknowledge any responsibility for them. The fault is always with someone else.
Because he has no mental illness in his own mind, he refuses medications. He refuses day treatment. He refuses vocational training programs. These interventions insult his autonomy. Instead, he roams the city, feeling himself threatened and, in response, growing threatening. Then police (who know him well) step in, or he is sent in a rage by ambulance to the emergency room.
Once again, he has been arrested. There will be a hearing. But this time, something is different: The case may be transferred to Mental Health Court, a specialized place, full of unusual understanding and leverage. Instead of sentencing psychiatric patients to jail, Mental Health Court sentences them to probation with stipulations in place: compliance with treatment and medications, therapy, and court follow-up. It is a sensible, creative (and, let it be noted, cost-saving) alternative. But the patient must agree to it.
Of course he does not agree to it. Who needs Mental Health Court? He has no mental illness. He wants the charges dismissed. His lawyer requests evaluation by a forensic psychologist, in order to see whether he is competent to stand trial.
After interviewing him, the psychologist writes her report. His symptoms are manifest, he cannot think clearly enough to collaborate with his lawyer, and does not comprehend how the justice system works. He is not competent to stand trial. In fact, this is his usual state.
It would seem the perfect time and reason to transfer him to Mental Health Court, where, at last, treatment would be possible. Doesn’t that seem logical?
Instead — and this is so confusing that, with or without mental illness, minds twist to comprehend it — the charges are dropped because he was found incompetent to stand trial. There will be no Mental Health Court, no mandated treatment, no chance for change. He will leave the hearing feeling a little vindicated — since, as far as he is concerned, this is proof of innocence. It was someone else’s fault.
A mentally ill person is arrested again and again. As a consequence of his illness, he cannot comprehend the proceedings against him. But instead of being diverted into an arm of the legal system that would require his treatment (and, as a happy by-product, decrease his future legal involvement), he is discharged altogether. What madness is this?Elissa Ely is a psychiatrist.