Revamping Our Approach to Mental Illness

Cape Cod Times column, September 18, 2015

by Brian R. Merrick

In a very thoughtful Aug. 27 column, Cynthia Stead asks whether it’s time to reopen state mental hospitals. The answer must be an emphatic “yes.”

Reviewing the history of deinstitutionalization of the mentally ill, Stead notes that over the past half-century a perfect storm of well-meaning mental health advocates and financial cost-cutters dumped a large mentally ill population onto the streets of our communities without resources or services to deal with them.

The local symptom of which, Stead writes, is the conflict between advocates for “affordable housing” and the homeless on one side and Hyannis Main Street merchants and their tourist customers on the other — as if the issue were simply the location of a shelter or a shortage of rent money. Alas, the problem is not that simple, nor is it only local.

One national consequence of the collapse of the mental health system is the seemingly unending stream of mass homicides in schools, theaters and workplaces. While political opportunists try to exploit these tragedies by proclaiming them a rational result of racism or the Second Amendment, the causation that runs through all of them is the untreated mental illness of the perpetrators.

The crisis is closely related to the epidemic of alcohol and drug addiction, of which the Cape Cod Times has written extensively in these pages. According to the Barnstable County Department of Human Services, about 15 percent of the Cape’s population, or around 31,161 people, have a substance-dependence problem. At a conference this spring in Harwich, professionals in the medical, law enforcement and addiction fields unanimously concurred that the challenges of the mentally ill and addicted and their treatment solutions are inextricably linked.

Apart from the human misery they create directly, addiction and mental illness are indirectly linked to nearly all violent and property crime on Cape Cod.

Barnstable County Sheriff James Cummings has joined corrections officials around the country in noting the high percentage of the mentally ill and addicted now housed in our prisons. While he has instituted widely admired programs to treat those in his custody, requiring an assault or a robbery as a prerequisite to inpatient treatment is surely not the answer.

Other Cape Cod officials have led efforts in the state to combat addiction with measures short of incarceration. District judges John Julian and Christopher D. Welch run drug court sessions in the Barnstable and Fall River district courts. The sessions use probation as a means to promote treatment and recovery.

State Rep. Randy Hunt of the 5th Barnstable District sponsored and passed legislation to form a special commission to examine more substance abuse treatment options for court-involved nonviolent offenders with addictions. He has also pushed for more funding for the drug courts.

Cape and Islands District Attorney Michael O’Keefe serves on a Regional Substance Abuse Council committee to design an action plan to deal with addiction. He recently unveiled a confidential mental health concern notification form his office developed in conjunction with the Cape Cod chiefs of police. The form gives police a chance to flag cases for the district attorney where mental health issues may be involved.

However, families seeking temporary civil commitment and treatment of the mentally ill or addicted must too often be turned away by the courts. While the law once permitted temporary commitment of persons on a finding of “reasonable need,” the standard was changed by the Legislature to require proof “beyond a reasonable doubt” that the prospective patient is a danger to himself or others.

The Court Clinic is responsible for performing initial mental health evaluations in criminal cases where an issue is raised as to the defendant’s competence to stand trial and criminal responsibility for the offense itself. The Court Clinic also meets with police or families who file mental health petitions; interviews the respondent (with a court-appointed attorney present); reviews medical records and police reports; testifies before the court to an opinion and recommendation; and, if the commitment is granted, must find a bed in a treatment facility.

In all of Southeastern Massachusetts there is one single individual employed by the Court Clinic to do all of this.

Relaxation of the standard of proof for a civil commitment of the addicted and mentally ill who are reasonably seen to require treatment is desperately needed.

The Court Clinic must be funded and staffed at a level where in can actually be helpful to families urgently in need of practical help.

And state mental hospitals must be reopened. Oh, we couldn’t call them that. Too grim. They would have to be called something like “regional treatment centers.”

It will be expensive, but it will be cheaper than arresting, prosecuting and incarcerating the mentally ill and addicted as we do now.

— Brian R. Merrick is a retired justice of the Orleans District Court.

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