"I've heard family members say that the police told them, 'If you want treatment for this guy, press charges. This is the only way they'll get treatment.'"
One of the best things about getting together the NAMI community for a convention is that in the course of a conversation someone can share a story that gets right to the heart of the matter. Such was the case with the quote above from Dr. Robert Keisling, a psychiatrist with Pathways to Housing DC. He was part of one of several workshops dealing with one of the most difficult questions many of us will ever face—what to do when people don't want help? Or to put it another way, what would we want done for us when we are so sick that we don't feel we need help?
Assisted outpatient treatment (AOT) and mental health courts, two approaches for reaching people in the throes of a mental illness who do not believe they need treatment, are often divisive issues in our community. At a standing-room-only session about anosognosia (the condition when someone is sick but doesn't know that they're sick), AOT, and advanced directives, panelist Jonathan Stanley drew upon his 10 years of experience as a lawyer and advocate as well as his own journey with bipolar disorder. "I've been to Lansing, Mich., to Newark, N.J., and I've been to anosognosia—and I have no desire to return to any of them," he said of the year when his illness was at its worst. "At my most psychotic was when I was most sure I wasn't sick."
The problem is that the treatment system in America in many communities has failed. The system that is meant to fix the people itself desperately needs to be fixed.
"Is this a mental health problem or a criminal justice problem? It will be handled one way or the other," noted Dr. Keisling in a subsequent workshop. A mental health system that leaves no recourse other than calling the police for a mental health crisis has been likened to "calling a plumber to fix a light bulb"— seeking the wrong expert for the problem. Crisis Intervention Teams or CIT has made great strides in educating the officers who are often the first line of defense for people in acute psychiatric distress. "In some areas 20 percent of 911 calls are about people with mentally illness," according to Keisling, who asserted, "It's really unfair to ask the criminal justice system to manage this problem because they're not trained to enforce compliance with treatment. The mental health system has fallen down on the job."
Other sources have reported family members, and individuals, turning to the criminal justice system to get their loved ones the help they didn't get through the mental health care system. "Some parents have resorted to filing criminal charges against their children in order to change out-of-control behaviors," the Child and Adolescent Bipolar Foundation confirms, cautioning, "once in the juvenile justice system, they are more likely to receive punishment than treatment."
No matter who answers that call for help, there is an obvious conflict about making it. Workshop participants who had been on the receiving end of help they didn't want said they were now thankful that someone intervened when they were very ill. Others have had experiences that drive them to take a strong stand in opposition to imposed treatment or interventions. NAMI community members who have been on either side of the issue—those who have resisted treatment while ill or who have tried to get a resistant family member help—what has been your experience? Have you been able to get help without entering the criminal justice system?
Read more about the criminal justice and mental health systems:
The many state budgets in crisis may be one factor leading to the criminal justice system picking up the pieces for an underfunded mental health system.
Fact Sheet: Mental Illnesses – Treatment Saves Money and Makes Sense (2007)
Crazy: A Father's Search Through America's Mental Health Madness by Peter Earley
Learn more about what is happening to address legal and law enforcement issues, including successful strategies, and register to receive NAMI's CIT In Action newsletter.