CO-OCCURRING DISORDERS:DRUG/MENTAL HEALTH COURTS AND OTHER INTERVENTIONS
Stephen S. Goss, Judge Albany , GeorgiaTennessee Drug Courts ConferenceDecember 5, 2012
Largest mental hospital in U.S.?
Los Angeles County Jail with 3,000 MI inmates every day
Earley, Pete
, Crazy: A Father's Search Through America's Mental Health Madness
(Putnam, 2006)
Transinstitutionalization
Olmstead 527 U.S. 581 (1999)
Under ADA Title II, statesare required to providecommunity based MHtreatment whenrecommended and if placement can be reasonablyaccommodated
“They have been
here
Mr.Mulder”
( you deal with the same folks anyway)
Mentally Ill Inmates
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Lack of communitytreatment-ER time police
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Jails de facto treatmentcenters(i.e.LA & Rikers)
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10-15% Inmates onMental HealthRx(
APA;DO.Co. Jail)
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SSI and funding issues
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Human vs. taxcost:jail,legal,child,ER
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Homeless shelters
STIGMA
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Fear- cannot see it; no objective tests
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Fear- what is hard to understand
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TMI( too much info)-not MH issues
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Hushed tones/whispers
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“He’s not right”
SERIOUS MENTAL DISORDERS
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Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,(DSM-IV),
AmericanPsychiatric Association
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Bipolar Disorder (Manic Depression)
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Schizophrenia
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Mood Disorders
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Developmental Disabilities
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Organic/Traumatic Brain Injuries
DSM-IV
Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition
!
Axis I- clinical disorders: mentalillness ( i.e. schizophrenia; bipolardisorder) and substance relateddisorders
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Axis II-Personality Disorders ( ieantisocial; obsessive-compulsive)and mental retardation
DSM-IV
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Axis III- General Medical Issues(diabetes; HIV;hepatitis)
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Axis IV-Psychosocial andEnvironmental Factors(homeless;death of spouse)
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Axis V- Global Assessment of Functioning
Challenges with COD Population
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Diverse and complex problems
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No one clinical approach “fits all”
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Expectation, not exception
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Personality disorders, learningdisabilities and health issues impacttreatment plans
Case Scenario
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Returned to Community
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Outpatient Treatment and Medicines
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Life Stressor(i
.e.
family or job)
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Decompensates- No Rx or Drugs & Alcohol
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Public Safety Call
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Combative or “mercy booking”
!
Importance to Judge- Revolving Door Cases