Tuesday, June 5, 2007

Mental illness: When magistrates intervene

With all the discussion and interest about mental illness recently, here is some information about involuntary commitments that will be useful to anyone who is concerned that a relative or a friend needs assistance.

First, in the event of an emergency, law enforcement officers always have the ability to detain and transport a person directly to a medical facility without any direction from magistrates.

In non-emergencies, the criteria that magistrates use in determining whether or not to issue the necessary paperwork involve two requirements determined by the answers to these questions:

Does the person have a mental condition?
Is that person a danger to others or to himself or herself?
Both have to be present or magistrates do not have the authority to issue an order to require that an evaluation take place.

Please notice that I said an evaluation — not an involuntary commitment.

Technically, a magistrate does not involuntarily commit anyone. Only a doctor can do that. What magistrates do is determine if a person’s conduct meets the standards set for us to consider. If so, magistrates authorize law enforcement officials to pick up that person and transport the patient to the nearest medical facility.

And yes, the person to be evaluated is put in handcuffs when transported. If an individual is already at a medical facility, then regardless of how the person arrived there, magistrates will not issue any further paperwork since the goal is to get them to the evaluation. In the majority of cases, magistrates do not issue any orders for children under the age of 18. A parent already has the authority to seek treatment for a child, and does not need documentation from a magistrate.

Choices vs. illness
When an adult’s choices concern friends and family members — he or she is drinking heavily, taking illegal drugs, refusing to take necessary medication (such as insulin) or even refusing to undergo medical treatment for life-threatening illnesses — magistrates do not act.

These decisions, however distressing to family members, are not justifications in and of themselves for the legal system to intervene.

Adults have a right to make decisions about their health and conduct, even bad decisions. Magistrates will not step in unless mental illness is the underlying reason for these poor choices, such as a heavy drinker hearing voices instructing him to drink.

While we are all sympathetic to the problems of drug abuse, magistrates will not initiate the paperwork simply because a person is using drugs such as heroin or cocaine. Of course, there are some exceptions to every rule, based on circumstances. Magistrates try to balance the requirements of the law with compassion and concern.

Released too soon?
The real problem comes in if a person is taken in to be evaluated and, no matter how bizarre the actions have been, the medical facility decides to quickly release the patient.

One reason is that a person who is frequently taken in for an evaluation learns what to say to the doctor in order to be released as quickly as possible.

Or the person is hospitalized and stabilizes, then is released. And then the cycle of behavior begins again and again.

In those cases, family members should investigate the possibility of filing an incompetency proceeding. A guardian could be appointed to manage the patient’s affairs and make necessary long-term health care decisions. For that, families should consult an attorney or the Department of Social Services Adult Protective Services.

Threatened harm
Clearly, there are times when family members threaten to harm themselves or their relatives. Magistrates then have to make a determination as to whether that person’s conduct is criminal as opposed to its being the result of a psychotic episode.

This is why magistrates have to answer that first question about the mental condition. The more information that family members and friends can provide, the better able magistrates will be to determine the necessity of their involvement. But a threat made to family members is generally not enough for us to determine that a person should be evaluated without additional information as to the person’s state of mind or history of mental problems.

If there is no evidence (or not enough evidence) for magistrates to consider, then it might be determined that the individual has committed a crime, but is not ordered to be taken in for an evaluation. The case for being evaluated is much stronger when a person is threatening suicide or has made attempts to do so in the past.

Again, the two factors that must be present before magistrates will consider authorizing an evaluation are a mental condition and behavior that indicates that a person is a danger to himself or others.

Should the latter occur, you should immediately take the information to that person’s doctor, since the doctor is in a much better position to determine the need for treatment.

In the event of an emergency, come to the magistrate’s office in the Cumberland County Detention Center, 204 Gillespie St.

Renee Rothrock has been a magistrate for Cumberland County for two years and has worked as a divorce lawyer for 20 years.

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