California was the first state allowing judges to take guns away from people whose family members or guardians said show warning signs of violence. No such measure was available in Florida, where school shooter Nikolas Cruz showed many indications he could pose danger.
The warnings about Florida student Nikolas Cruz seemed to flash like neon signs: expulsion from school, fighting with classmates, a fascination with weapons and hurting animals, disturbing images and comments posted to social media, as well as mental health treatment.
In Florida, that wasn’t enough for relatives, authorities or his schools to request a judicial order barring him from possessing guns, the Associated Press reports. Only five states have laws enabling family members, guardians or police to ask judges to strip gun rights temporarily from people who show warning signs of violence. Supporters of these measures, called “red flag laws” or gun-violence restraining orders, say they can save lives by stopping some shootings and suicides.
Florida, where Cruz is accused of using an AR-15 assault weapon to kill 17 people at his former high school, lacks such a law. Cruz was able to own the semi-automatic rifle, even though his mother, classmates and teachers had described him as dangerous and threatening, and despite repeated police visits to his home. Red flag legislation has been introduced by Democratic Florida lawmakers, but it hasn’t been heard during this year’s session. Its fate is uncertain in a legislature controlled by Republicans who generally favor expanding gun rights.
After last Wednesday’s shooting, Republican Gov. Rick Scott said he would work to make sure people with mental illnesses don’t have access to guns, but he offered no specifics. Florida’s GOP Sen. Marco Rubio — facing criticism over accepting $3.3 million in career campaign cash through the National Rifle Association — now says state legislators should “absolutely” consider enacting a law enabling family members or law enforcement to ask a court to remove guns from a person who poses a danger. In 2014, California was the first state to enact such a law. Its legislature acted after a mentally ill man, Elliot Rodger, killed six students and wounded 13 others near the University of California, Santa Barbara, before killing himself.
Gun-rights activists say the laws can be used to take away rights from people who have not been convicted of crimes, nor professionally evaluated for mental illness. The NRA’s lobbying arm said the laws enable courts to remove Second Amendment rights “based on third-party allegations and evidentiary standards” lower than what’s required in criminal proceedings.
Researchers found that almost half of a sample group under community supervision in Washington DC had not been examined by a physician for signs of mental distress. But after testing, some 30 percent tested positive for moderate depression and 21 percent were diagnosed with bipolar disorder.
Opioid users in the justice system are at high risk for depression and other mood disorders and need systematic testing and treatment to prevent them from harming themselves, according to a new study.
Researchers found that almost half of a sample group of individuals under community supervision in Washington DC had not been examined by a physician for signs of mental distress. But after testing, some 30 percent tested positive for moderate depression and 21 percent were diagnosed with bipolar disorder.
The study, published in the Substance Use and Misuse Journal, said the high prevalence of mood disorders among the predominantly black justice-involved populace in Washington D.C. highlights the pressing need to sufficiently identify and care for mood disorders in opioid-dependent correctional populations.
The paper noted that policy changes in the 1960s resulted in the deinstitutionalization of who were once formerly placed in mental health facilities , producing big surges in the U.S. criminal justice system of populations with mental health disorders—the bulk of whom reside in the community
Researchers based their conclusions on a sample of 258 opioid-dependent individuals living in Washington, D.C. who were on probation, parole, or other form of community supervision.
The sample primarily included unmarried African-American men aged 50 and over. Most those who screened positive for mood disorders were also found to face greater family, legal, and medical problems on the Addiction Severity Index-Lite (ASI-Lite) than those who didn’t test positive.
Researchers said their findings made clear that there were major shortcomings in the treatment of opioid-dependent individuals in the justice system.
“Key issues related to screening and assessment of psychological conditions exist universally, “ the paper said, listing for example, “insufficient staff training, the use of ineffective and non-standardized screening/assessment instruments, and the separation of mental health substance use service systems.”
The authors said that proper diagnosis and wider access to treatment could “decrease the incidence of adverse psychosocial outcomes and repeated involvement in the criminal justice system.”
The paper was written by Mary Mbaba of George Washington University; Shan-Estelle Brown, Sandra A. Springer, and Frederick Altice of Yale University School of Medicine; Alese Wooditch of Temple University; Marissa Kiss, Faye Taxman and Amy Murphy of George Mason University; Suneeta Kumari of Howard University; and William B. Lawson of the University of Texas.
An outbreak of hepatitis A in a number of states highlights the vulnerability of individuals suffering from both mental illness and substance abuse. Those most at risk —the homeless and formerly incarcerated—deserve “compassionate, evidence-based solutions,” says a TCR columnist.
Several states are in the midst of hepatitis A virus outbreaks. San Diego and the surrounding region are among the hardest hit, but southeast Michigan has more reported cases and more deaths. Utah, Colorado and Kentucky also have experienced outbreaks.
California had 683 cases as of Jan. 23, with 21 deaths. Michigan recorded 715 cases as of Jan. 24, with 24 deaths. Colorado has had 62 cases, and one reported death.
Understanding these outbreaks requires acknowledging the links between homelessness, addiction and mental illness—and it requires more than a single solution.
Hepatitis A is typically a disease spread by human contact with already-infected individuals or pieces of their stool that are too small to see. High-risk groups include the homeless, the incarcerated (and those released from prison) and drug users—all groups that have some overlap. The homeless and the incarcerated also suffer from mental illness and are drug users, a condition known as a dual diagnosis or co-occurring disorders, and the deficiencies of health care in many prison facilities make incarceration a key risk factor.
According to a 2009 National Coalition for the Homeless (NCH) fact sheet, the Substance Abuse and Mental Health Services Administration found that “20 to 25 percent of the homeless population in the United States suffers from some form of severe mental illness,” compared to only six percent of the population as a whole.
A one-year study of people with serious mental illnesses examined by California’s public mental health system found that 15 percent were homeless at least once in the previous 12 months.
In addition, the NCH fact sheet found that “some mentally ill people self-medicate using street drugs, which can lead not only to addictions, but also to disease transmission from injection drug use.”
The Los Angeles Timescites experts who say that 50 percent to 70 percent of homeless people with severe mental illness (SMI) also have problems with alcohol or drugs.
The likelihood of homelessness also is increased when you have a mental illness, an addiction disorder and a disease such as hepatitis A. None of these conditions is going to go away if you are homeless and have no access to health, substance abuse or mental illness services.
If only one of the three gets treatment, the other two remain, and the third may return because they are all connected.
In 2016, Kevin Fischer, executive director of the National Alliance on Mental Illness (NAMI) of Michigan, suggested on Michigan Public Radio that closing all the state mental hospitals in the 1990s by then-Gov. John Engler resulted in an “explosion in homelessness.”
The mentally ill were supposed to be sent home, but many ended up on the streets because the private mental health system and the patients’ families were not prepared to handle them.
Joel John Roberts, CEO of People Assisting The Homeless (PATH) Partners, says many people in the mental health field put the blame on Ronald Reagan, then governor of California, who they say released more than 50 percent of the state’s mental hospital patients and abolished involuntary hospitalization of people with mental illness.
“This started a national trend of de-institutionalization,” Roberts wrote.
Then, as president, Reagan ended funding for federal community mental health centers. No one expected the mentally ill to wander the streets. The feds thought the states would take care of them. The states thought private insurance or family would take care of them.
Somewhere, somehow, they were wrong.
To get these outbreaks under control, and to prevent future outbreaks, we need more support for mental health and substance abuse treatment, and better harm reduction strategies (including clean needle exchanges and safe injection sites).
Some of that funding could come from Medicaid if the Trump administration eliminates the Institutions for Mental Diseases (IMD) Exclusion, which prohibits Medicaid funds going to mental health providers with more than 16 beds. There’s bipartisan agreement that this rule, which dates back to 1965, needs to go. The executive branch can, has, and does issue exemptions for this rule, and Trump has pledged to speed up the process.
But virtually no one thinks the rule needs to remain.
More than money is needed. Sometimes only one co-occurring disorder is apparent. First responders need to be trained to look for and recognize both.
In 2017, the Michigan Department of Health and Human Services (MDHHS) & Michigan Association of CMH Boards wrote, “Supports and services for persons with co-occurring mental health and substance use disorders must be the norm for all agencies across the network.”
The department added this was because “it is more prevalent than addiction-only or mental illness-only among the people served by MDHHS providers. Practitioners in every program at all levels of care must be competent to address comorbidity in mental health and substance abuse treatment.”
Effective treatment, according to the NAMI, requires not only that both be treated—but preferably at the same time. It’s called integrated intervention, and often involves detoxification, inpatient rehabilitation with psychotherapy, supportive housing, maybe medications (either to treat mental illness symptoms or to control addiction) and self-help/support groups.
The Michigan House of Representatives’ bipartisan House C.A.R.E.S. (Community, Access, Resources, Education, and Safety) Task Force’s final report recommended that crisis intervention training (CIT) for first responders should include “information on signs and symptoms of mental illnesses” and “co-occurring substance use disorders.”
It also recommended that trial and pre-trial practices “should assess defendants to determine whether the person has a serious mental illness, co-occurring substance use disorder” and so benefit from “mental health services.” Better and more consistent efforts must be made to screen for mental illness and co-occurring substance disorders during the booking process, the task force said.
But that’s if the individual ends up in the mental health or criminal justice system. There are harm reduction practices that can save lives even if the person with mental health and substance-use disorder remains out of the system.
One is providing maintenance drugs (medication-assisted treatment or MAT) such as buprenorphine (brand name Suboxone, also available as an implant, Probuphine, that only needs to be replaced every 90 days) or methadone to addicts to prevent withdrawal, and there are drugs for mental illnesses such as depression, bipolar disorder, schizophrenia, and psychosis.
Another—although hep A isn’t as likely to be spread this way—is providing intravenous drug users with a safe injection space. These spaces are also known as safe consumption sites, fix rooms, drug consumption room (DCR), supervised injecting facilities, and shooting galleries. But they share the following characteristics: a clean facility, with clean needles, the availability of testing supplies to make sure the drug is unadulterated, and a nurse to administer naloxone in case of an overdose.
They not only save lives—no deaths have been reported at any such site around the world, including Canada and Australia—they also save money.
A recent study estimated that such strategies could save an average US city $3.5 million per year and that some could save more (Baltimore: $6 million). The American Medical Association likes the idea, as do the Clinton Foundation and the Johns Hopkins Bloomberg School of Public Health.
Some in the anti-drug camp oppose harm reduction in particular, and substance abuse treatment in general. They prefer incarceration to rehab. Their position on the mentally ill is less clear, but maybe they feel that, too, is the result of a poor personal choice.
Maybe paying for these sinners to go to dual diagnosis treatment centers seems like rewarding bad behavior. The result: we have a homeless problem, an opioid epidemic, and hepatitis A outbreaks,
Punishment isn’t working, and science and public opinion now believe addiction is like a disease. It’s time to look for compassionate, evidence-based solutions.
Stephen Bitsoli, a Michigan-based freelancer, writes about addiction, politics and related matters for several blogs. He welcomes readers’ comments.
Wisconsin teenager Morgan Geyser was sent to 40 years of mental health treatment in the Slender Man stabbing case. Geyser, 15, Geyser and another girl were charged three years ago with stabbing a friend 19 times because they feared Slender Man, a fictional internet boogeyman, would kill them or their families if they didn’t carry out the crime.
Wisconsin teenager Morgan Geyser was ordered committed to 40 years of mental health treatment and monitoring in the Slender Man stabbing case and for the foreseeable future will remain at a secure state hospital, the Milwaukee Journal Sentinel reports. Judge Michael Bohren opted for the maximum commitment term after hearing from experts who suggested Geyser, 15, could receive more effective treatment for her schizophrenia somewhere other than the Winnebago Mental Health Institute, where she is housed solely with adult criminals. “We can’t forget what actually happened,” Bohren said. “It was a premeditated murder” that, but for serendipity, didn’t result in death. Geyser’s attorney suggested 25 years of monitoring until Geyser is 40 would be appropriate, given her stabilization and the full remission of mental illness symptoms.
Before the ruling, Geyser tearfully apologized to her victim, whose family was in court, and said she hoped the girl is doing well. Geyser was 12 when she and Anissa Weier were charged as adults in the sensational crime. They had plotted the murder of their friend and sixth-grade classmate Payton Leutner because they feared Slender Man, a fictional internet boogeyman, would kill them or their families if they didn’t carry out the crime. Leutner survived 19 stab wounds and was discovered by a passing bicyclist after she had crawled to the edge of woods at a park where the attack occurred. After unsuccessful efforts to have their cases transferred to juvenile court, both girls struck plea deals in which they were convicted but found not guilty by reason of mental disease or defect.
The high rates of opioid addiction for females in America’s rural and tribal areas are exacerbated by intimate partner violence and the lack of access to treatment, advocates and caregivers told a webinar Thursday.
Native American females and women in rural communities suffer the highest risk of deaths from opioids and other drugs, advocates and caregivers involved in mental health and trauma said Thursday.
The risk is heightened for Native American women, who face a long history of oppression and abuse, turning to opioids as a form of pain management, and for women in rural areas, who have limited access to drug treatment programs, the experts said at a webinar organized by the National Center on Domestic Violence, Trauma & Mental Health.
Researchers found that more than 84 percent of Alaska Native and American Indian women had experienced some form of violence in their lifetimes: 56 percent experienced sexual violence and 55 percent experienced intimate partner violence, according to a study released by the National Institute of Justice in 2016.
In some villages, 100 percent of women experienced sexual assault or domestic violence, the webinar told.
Indigenous women also face a long history of genocide, removal from their land, removal of their children into state custody, and loss of culture and language- all factors that play into the high rates of opioid deaths, said Gwendolyn Packard, a specialist at The National Indigenous Women’s Resource Center (NIWRC).
“We experienced a period of forced removal of our children. [Society] placed them in institutions in an effort to civilize the savage born. Even today we experience the highest rate of children in state custody” she continued.
“This left many families psychologically battered.”
Opioids can also lead Native American women into the grasp of sex traffickers, who prey on their drug dependency to maintain control.
Sarah Deer, attorney and author of “The Beginning and End of Rape: Confronting Sexual Violence in Native America” refers to this vulnerable community as ‘the perfect population.’
“If you’re a trafficker looking for the perfect population of people to violate, Native American women would be a prime target. You have poverty. You have people who have been traumatized. And you have a legal system that doesn’t step in to stop it.”
In an attempt to fight back, the Cherokee Nation has filed a lawsuit against pharmaceuticals companies for negligent conduct. Tribes are seeking monetary damages to pay for treatment programs, which are scarce.
Still, generations of trauma and abuse has left a scar on Native American populations, who are searching for the best way to tackle the epidemic within the tribes.
“There is common agreement that the country is rooted in historical and generational trauma” said a tribe member at an opioid hearing, reported on by the webinar.
“There is also agreement that as a tribe we are strong and resilient and can create and support in order to heal the next generation.”
While women in rural areas suffer from domestic abuse as well, they face unique difficulties accessing treatment due to their geography.
For instance, in some parts of West Virginia, the state with the highest rate of fatal drug overdoses in the nation, there is no cell phone or internet connection. West Virginia is the only state that lies completely within the Appalachian mountain region, which greatly affects telecommunication.
But the biggest issue is the the lack of local treatment or effective treatment close by. It may take opioid users 2 to 3 hours to arrive at a local clinic- that is, if they have access to a car.
There is also no public transportation, leaving some addicts stranded in the countryside.
Often times, for women, the vehicle owner is the batterer who controls where and when his victim takes the car, added Laurie Thompsen, a Mental Health and Behavioral Health Coordinator in West Virginia.
In attempt to maintain power and control, abusers may restrict their partners from getting treatment, and instead fuel their drug addiction by leaving paraphernalia around the house and forcing them to use drugs.
The National Domestic Violence Hotline reported that 60 percent of women said their partner or ex-partner tried to prevent our discourage them from getting help, while 27 percent said they were pressured or forced to use alcohol or other drugs more than they wanted.
If admitted to a treatment center, there is also the possibility the batterer and the victim will be in the same drug program.
“Safety is a big issue” said Thompsen, who recalled a story about a husband who checked himself into a mental health hospital to stalk and follow his wife.
“These situations occur because we don’t have many services.”
Editor’s Note: The Webinar proceedings will be available online. Please check here for update.
Megan Hadley is a staff writer at The Crime Report. Readers’ comments are welcome.
Tulsa spent millions building a facility to house mentally ill jail inmates. “We’re not a mental health hospital,” says the administrator. “We’re still a jail and we can’t change that.”
Arrested after leading Tulsa police on a high-speed chase in 2016, when family members say he was suffering from paranoid delusions, Jeff Welton has been incarcerated for nearly 18 months while waiting for the courts to decide whether he’s mentally competent to stand trial. His mental condition seems to have deteriorated further while he has been in the county jail’s new mental health pod, his mother tells the Tulsa World. “If they can’t deal with psyche-patient issues in jail, they should not put them in jail,” she said bitterly. “That’s basically the crux of the problem.”
Jail officials seem to agree, at least to some extent. The Tulsa Jail doesn’t get to choose its inmates. Administrator David Park has to take whoever law enforcement officers bring in. Tulsa County’s mental health pod is a multimillion-dollar attempt to “make the best of it,” Park said. The pod opened last April after voters approved a 15-year extension of a sales tax increase to fund a $15 million expansion of the jail, part of which is dedicated entirely to housing inmates with diagnosed mental illnesses. The area houses 106 inmates in four levels of security. It stays consistently full. The pod has a psychiatrist and psychologist on staff, along with clinicians who can dispense medications. “But we’re not a mental health hospital,” Park said. “We’re a jail. We’re doing our best to give people the treatment they need, but we’re still a jail, and we can’t change that.”
Riehl was hospitalized at a Veterans Administration psychiatric ward in Wyoming in 2014, and at one point he was placed under a 72-hour mental health hold. It is not yet clear whether his meant health record should have kept him from buying firearms.
Matthew Riehl once was a standout law student and an Army medic in Iraq. By last weekend, he lay dead in a Colorado apartment building, killed by a SWAT team after he gunned down a 29-year-old deputy. Riehl’s six-year descent from a budding attorney to a gunman who live-streamed some of the final violent hours of his life was accompanied by episodes of mental illness, the Associated Press reports. It still is unclear whether Riehl’s problems were grave enough to disqualify him from buying a weapon. Police haven’t released details about what weapons were used or how he obtained them. Federal standards prevent anyone from buying a gun who has been determined to be a danger to themselves or others by a court or other authority. People who have been involuntarily committed to a psychiatric institution also can’t buy from federally licensed gun dealers.
Riehl was hospitalized at a Veterans Administration psychiatric ward in Wyoming in 2014, and at one point he was placed under a 72-hour mental health hold. The VA declined to say whether that treatment meant Riehl should not have been allowed to own a gun. KDVR-TV in Denver reported that Riehl had purchased 11 firearms from a store in Laramie, Wy., between 2010 and 2013, but it wasn’t immediately known whether any of those guns were used in the Colorado shooting. A Laramie Police Department report said David Smith, owner of Dave’s Guns, told police Riehl passed the required background checks.
Colorado is bound by a 2012 federal lawsuit settlement to conduct mental competency evaluations of accused criminals within 28 days of a judge’s order. But demand is outpacing the system’s capacity, and some are waiting four months for the exams.
People with mental illness who are accused of crimes in Colorado are waiting up to four times as long as legally allowed for evaluations and treatment because the system is so overwhelmed, reports the Denver Post. The state is bound by a 2012 lawsuit settlement to conduct mental competency evaluations or begin treatment for people found incompetent to stand trial within 28 days of a judge’s order. But for the second time in six months, the state says it is failing to meet the requirements of the federal settlement. Court orders for mental competency evaluations are outpacing capacity, clogging the system and forcing people to languish longer in lock-up, according to a legal letter written by the Colorado Department of Human Services.
In June 2016, the system received 146 competency evaluation orders and 54 orders for “restoration,” which is mental health treatment to restore people found incompetent so that they can then face charges. A year later, in June, the system received 215 competency orders and 93 restoration orders — increases of 47 percent and 72 percent, respectively. The numbers remain high. State officials would not say how long people are waiting–only that wait times fluctuate depending on bed availability and that some have waited longer than the settlement requires. Colorado plans to spend $20 million to address the backlog, partly by adding dozens more mental health beds in jail and at the state mental hospital.
At age 16, Tyler Haire was accused of assaulting his father’s girlfriend. A Mississippi judge ordered a mental evaluation of the teen. He waited in a county jail for years before the exam happened. ProPublica says that is business as usual in the Magnolia State.
ProPublica takes a close look at the case of Tyler Haire, a Mississippian arrested in 2012 at age 16 for attacking his father’s girlfriend with a knife. A judge ordered a mental examination of the teen, who had a long history of psychological problems. It took years for that to happen. As Haire celebrated his 18th, 19th and 20th birthdays in the jail, the local sheriff, Greg Pollan, served as the young man’s only vigilant advocate. Every month, Pollan called the state hospital in Whitfield for an update on where Tyler stood on the waiting list for one of the 15 beds in the hospital’s forensic unit, which handled psychiatric evaluations in criminal cases.
On Jan. 13, 2014, the state hospital said it should be able to admit Haire “in two weeks,” according to a note in his case file. It would take another two and a half years. Haire didn’t fall through any cracks. Records suggests that Mississippi may well have the worst record of any state for prolonged stays in jail for inmates awaiting the most basic psychiatric evaluation. A copy of the state’s wait list shows that as of August 2017, 102 defendants — accused but not convicted of crimes — were waiting in county jails for forensic evaluations. One had waited 1,249 days. The problem is not limited to Mississippi. In 2014, 31 of 40 states said wait times for forensic services for criminal defendants were worsening, and 19 said they’d been threatened with legal action or found in contempt of court for long delays.
For decades, researchers have mulled a link between childhood exposure to lead and criminal behavior. But a new long-term study of New Zealanders published in a medical journal finds only a modest association in teens that diminished later in life.
Childhood lead exposure is not consistently associated with criminal behavior later in life, according to Courthouse News Service, citing a report published Tuesday in the journal JAMA Pediatrics. The report should ease the minds of parents in areas where children have been exposed to high levels of lead in their drinking water. After adjusting for socioeconomic status, a team of researchers found a weak connection between childhood lead exposure and subsequent criminal offenses. Lead exposure was also not associated with recidivism or violence, according to the study. Childhood lead exposure has been associated with abnormalities in brain structures, childhood behavioral problems and lasting declines in intelligence, the authors write.
“One hypothesized behavioral effect of high levels of lead exposure is increased antisocial and criminal behavior,” they added. To test this theory, the team monitored 553 people born in New Zealand between 1972 and 1973 for more than three decades. After measuring the participants’ blood lead levels (BLL) when they were 11, the team tracked the group’s self-reported criminal offending up to age 38. In the end, 154 participants were convicted of at least one crime. “The variety of self-reported offenses was weakly associated with BLL and only reached statistical significance at ages 15, 18, and 26 years,” the study reads. “After controlling for sex, the association between higher BLL and variety of self-reported offenses remained weak and was statistically significant only at assessment age 15 years.”