Transcript It’s All About Relationship! - NAMI: National Alliance

It’s All About
Relationship!
REDUCING FORCE AND COERCION IN MENTAL
HEALTH CARE
Presenters

Robert Ward, J.D., Assistant Public Defender,
Public Defenders Office, Charlotte, NC

Lt. Ken Schul, Charlotte-Mecklenburg Police
Department, Charlotte, NC

Sarah Greene, L.C.S.W., Program
Administrator, Trauma and Justice
Partnerships, Mecklenburg County
Government, Charlotte, NC

Mike Weaver, M.S. Ed, CPSS, Consumer Affairs
Specialist, Cardinal Innovations, Mecklenburg
County Operations Center, Charlotte, NC
Applying a Therapeutic Jurisprudence Perspective in
the Practice of Criminal Law and Civil
Commitment Law to Promote Better Results and
Improved Attorney-Client Relationships
Panel Presentation
2014 NAMI National Convention
Washington , DC
Robert L. Ward
Assistant Public Defender
Charlotte, North Carolina, USA
September 5, 2014
“The greatest wealth is health”
~ Virgil
The Public Defender’s Office
Representing People we Might Know and Love
• Criminal Trials, Appeals and Proceedings
• Civil Involuntary Commitment Proceedings
Key Questions We Need to Answer:
• What happened?
• Why did it happen?
• What are the present and long-term options?
• What are we going to do about it?
.
If someone you loved had an alcohol or drug problem
(or any other debilitating behavioral condition) would
you rather send them to treatment - or to jail?
Opportunities Found: Referring a client to an
appropriate resource creates a win/win result
1. Providing the client with the opportunity for
rehabilitation and recovery;
2. Providing the Prosecutor, Judge, and Corrections
with a perspective and plan for a successful case
disposition and community outcome.
Opportunities Lost: Fragmentation of treatment
other services is a barrier to everyone’s success
By relying on an out-dated understanding of human
behavior in the criminal justice system could we have been
–
“…digging at the wrong site?”*
*From the Movie, Raiders of the Lost Ark:
Recent Civil Commitment and Criminal Law
Resources that can help with a Recovery Model
Approach to Initiation, Representation, Adjudication
and Enforcement:
Back to the Future
Four Convergent Movements in Law Regarding Behavioral Heath,
Individuals, Families and Our Communities
1. Therapeutic Jurisprudence: Late ’70s - Two Law Professors Begin a Conversation
David Wexler
Bruce Winnick
2. Drug Treatment Courts: Late ’80s - Seeking Legitimacy in Legal Theory
Judge Peggy Hora
Judge Bill Schma
3. Structured Sentencing and Alternatives to Incarceration: Late 80’s – They’re
coming home
Civil Commitments – Competency, Commitment and Supportive Services
Mitigation Plans
Prison Reform and Alternatives to Incarceration
4. Legal Ethics, Lawyer Assistance Programs, and Lawyer Competency: Late 80’s –
Addressing Visible and Invisible Disabilities of Clients and Colleagues
Representing Clients with Legally Relevant Disabilities*
•
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•
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Understand your clients, their abilities and disabilities
Communicate with clients
Promote Self-Determination for clients
How Lawyers and clients may view rights and remedies
differently
Ethical obligations representing clients with disabilities
The Legal duty to provide reasonable accommodations
* From ABA Publication - Disability Discrimination Law, Evidence and
Testimony: A Comprehensive Reference Manual for Lawyers, Judges and
Disability Professionals, by John Parry2008, www.abanet.org/disability
The Lawyer as a First-Responder for
Clients who are Veterans:
“Lawyers who represent combat veterans (or clients who
have suffered traumatic experiences) must acknowledge the
possibility that these clients suffer from undiagnosed PTSD.
While this may occur due to the client‘s own effort to
conceal symptoms or their delayed onset, PTSD symptoms
often lurk in the police reports or factual circumstances
surrounding the client‘s presenting legal problem.”
The Relationship-Centered Lawyering Perspective in Legal Services for Active and
Separated Military Personnel who Suffer from Posttraumatic Stress Disorder, Captain
Evan R. Seamone, J.D., M.P.P.
U. S. Supreme Court Justice Anthony Kennedy
wrote in the Garrett decision that Prejudice
rises not from malice…*
“…it may result from some instinctive mechanism to
guard against people who appear to be different in some
respect from ourselves…”; and that,
“...knowledge of our own instincts teaches that persons
who find it difficult to perform routine function might
seem unsettling to us - unless we’re guided by the better
angels of our nature.”
*From the Report from the American Bar Association for the Legal Profession, 2nd
National Conference on the Employment of Lawyers with Disabilities (2009)
Self-Regulating Professional Organizations already have long
established Recovery Model Approaches
We might all be able to benefit from NC LAP or other Professional Health
Programs, or groups such as the National Alliance of the Mentally Ill
(N.A.M.I.) about improving simple every day interaction and decision-making
improved skills on how to:
•
Understand and apply
interpersonal boundaries
•
Be honest, but not argumentative
•
Trust yourself
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Provide structure but avoid
having to “control”
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Understand and clarify
expectations along the way
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Focus on the present, or one item
at a time
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Discover (or improve) the skill of
being professionally detached yet
caring
“Facts are Stubborn Things”
John Adams, Lawyer and 2nd U.S. President
The current reality right now is that like it or not, we are all de facto
mental health care first responders and long term community support
providers without truly realizing it, and without reasonably comprehensive
adequate training, or support - with these results:
A Proactive Legal Instrument:
Advance Directives & Health Care Power of Attorney
for Mental Health Issues:
A potential, proactive legal tool for current and future clients, for
general education regarding Mental Illness, Health and Wellness, and
for practicing preventative law and policy consistent with the Social
Model (versus disability, medical or criminal) of Care and Recovery.
http://www.ncdhhs.gov/dma/medicaid/AdvancedDirectCondensed.pdf
http://pad.duhs.duke.edu/templates.html
“If I had my way I‘d make health catching
instead of disease...”
Robert Ingersoll
CIT: CRISIS INTERVENTION TEAMS
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Divert to treatment rather than jail whenever it’s safe and
appropriate
•
Reducing harm to everyone (consumers, family members,
officers)
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Increasing officer skills for responding to individuals
experiencing a MH crisis
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De-escalate, take the time needed, and build relationships
that promote recovery
A PEER-FOCUSED CIT PROGRAM
 Peer involvement throughout
 Program development & planning
 Instruction
 Consumer dialogues at site visits
 Role play actors
 CIT implementation within police departments
 Evaluation of program
 Start with a strong Recovery presentation on the
first day of training
A TRAUMA-INFORMED CIT PROGRAM

Training includes a good PTSD lecture that incorporates
information on trauma exposure of officers
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Includes veterans component, including veteran speaker
with PTSD
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Includes panel members who have experienced trauma
Make sure each speaker speaks with knowledge of
trauma and intervening without re-traumatizing
FROM A POLICE OFFICER’S
PERSPECTIVE
• How we respond is important to the needs of the
caller
• Officers are taught to take the call and clear-CIT
training teaches you to slow down and listen to the
needs of the caller
• Assess the subject’s needs-what type of signs is he or
she showing
• Pull in resources-in Charlotte-Example: Mobile Crisis
Team
• Gain intelligence-family, friends, prescriptions drugs or
illegal drugs and alcohol
• Body language is so important- too much smiling, eye
contact and command voice issues for cops is always
something police have to watch-crossing of the arms
• Don’t join in on their delusion-If you make a
promise and don’t keep it the trust is broken
• Safety is paramount!
• Can the cop work to prevent this from
happening again? This is a goal set that we
always have
MY SON CAMERON
• Call for Service 911 from my home
• I have Chest Pains
• I ask for Public Safety to respond
• Phone is dropped
• Cameron is up in the play room with me
• He has been watching videos on the TV
• I am unconscious and the door is locked
• CIT officer is one of the officers that responds
• Exigent circumstances dictate that the officers kick
in the door
• Cameron encounters the officer and Cameron is
severely Autistic!
• What happens?
A Peer Perspective
“Consumers of legal services
often find their dealings with
the judicial system to be
painful, an invasion of their
privacy, and out of their
control.” (Weinstein, 1997)
Changing the Dynamic through TJ
• With TJ, clients are able to exercise
self-determination and retain control
over the legal actions taken on their
behalf
• Often the social work or MH
intervention in such situations is to
restore a sense of control to the
people in crisis. Interactions with the
legal system also should work to
increase the individual’s sense of
control.
A Change in Philosophy
• Use a strength-based, asset based
approach toward those experiencing
difficulty.
• The usual axiom is “future behavior is
based on past behavior”
• Another axiom is “people can change and
recover a sense of self, dignity and a life,
no matter how difficult the diagnosis or
issue”.
Learned Hopelessness and
Shame
• Peers learn a sense of shame associated
with their diagnosis-it has a mark of
bad reputation or humiliation.
• “We live in an atmosphere of shame.
We are ashamed of everything that is
real about us; ashamed of ourselves, of
our relationships, f our incomes of our
accents, of our opinions, of our
experiences, just as if we are ashamed
of our naked skins.”
George Bernard Shaw
Learned Optimism
• Individuals with pervasively and
personal pessimism can learn to be
more hopeful.
• We can hold the hope for them.
• “Treat people as if they were what
they ought to be and help them
become what they are capable of
being.” Goethe
• Don’t be “prophets of doom.”
• (from P. Deegan)
We Begin by Changing Language
• Language has a powerful effect on
society
• Language affects our expectations of
people
• Use hopeful language
• Use empowering language
• Use language that emphasizes the peer
becoming the decision maker
• Use empathic language-peers may
present difficult behavior due to lives of
difficulty
Develop and Maintain Hope
• “For those of us diagnosed with a
mental illness, hope is not just a
nice-sounding euphemism. It is a
matter of life and death.” Dr. Pat
Deegan
• “I know how difficult it is to push
when the outcome is so uncertain.
Hope is so fragile, a difficult thing to
keep, but I am consistently amazed
at how powerful it is.” C Reeves
Recovery is:
• “Knowing who you are and using your strengths
to become all that you were meant to be.”
Recovery Innovations
• It is not the total absence of symptoms
• It is being able to manage symptoms and
having them become less troublesome
• It is getting in touch with one’s hopes and
dreams. Taking ownership of one’s life.
• Not all achieve recovery, some lose hope or
are never exposed consistently to ideas about
recovery.
Recovery is:
It is a personalized journey-not a destination
It is an up and down journey of healing
It doesn’t mean the illness never existed
It recognizes the “dignity of risk”, making
mistake as the portal of discovery while
balancing that with safety
• It can happen with our without professional
intervention, with or without medications
• It recognizes the inherent wisdom of each peer
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It’s about developing confidence
“The development of self-confidence starts with
the elimination of this demon called fear, which
sits on a person’s shoulder and whispers into
their ear: ‘You can’t do it, you are going to fail,
you don’t have the ability.”
In the new system-peers will
increasingly recover from:
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Low expectations and little hope
Lack of choice, power and work
Alienation from friends and family
Stigma, shame and de-humanization
Poverty, homelessness and lack of home ownership
Trauma from treatment, effects of medications, obesity
Failed education attempts
Lack of important social roles
Isolation, failed relationships
Lack of choices, suicidal thoughts and other serious
symptoms
We must change the “system”
• “A new philosophy, a way of life, is not given for nothing.
It has to be paid for dearly, and only acquired with much
patience and great effort.” Dostovesky
• “The mediocre resist change, the successful embrace
it.” Erik Olesen
• “Change often comes from the edges.” Mark Twain
• “I cannot do everything, but I can do something. I must
not fail to do the something that I can do.” Helen Keller
• A recovery oriented system of care which maintains high
expectations and hope for everyone will be more
humane, have better outcomes and save the system
financially and lessen the burden on the judicial system.
How are we doing as a society?
“If there is any secret in the
management of the insane, it is this:
respect them and they will respect
themselves; treat them as reasonable
beings, and they will take every
possible pain to show you that they are
such: give them your confidence, and
they will rightly appreciate it, and
rarely abuse it.” Dr. Woodward,
Worcester Asylum 1848
Questions?