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May 5, 2013 by Bob Nikkel, MSW

Elusive Justice – America’s Thought Leaders Weigh In at USC Symposium

I made my escape from the glitz of Las Vegas and a national conference on behavioral health this past month and flew into the surprisingly fresh–and relatively boring–air of Los Angeles. I could even see the hills!

The purpose of this personal transformation back to reality was to attend the Third Annual Symposium on Mental Health and the Law at USC’s Gould School of Law. This stimulating forum was organized by Elyn Saks, the director of the Saks Institute for Mental Health Law, Policy, and Ethics.

Because I grew up in the San Joaquin Valley two hours north of L.A., my attention focused quickly on the first speaker, Marvin Southard, D.S.W., if for no other reason than that he was formerly the director of the my home county’s (Kern County) Mental Health Department.  More to the point of the conference, he is now the director of the Los Angeles County Department of Mental Health, an incredibly diverse community where over 100 languages are spoken.  His talk was entitled a little esoterically, “Correcting Category Errors.”  He admitted his first degree was in philosophy but the message he shared was practical — category errors in the context of mental health and the judicial system “impede problem solving, confuse the dialogue, and create false public impressions.”  He described 3 major categories of people with mental health problems who end up in jails and prisons.  Rather than repeat much less articulately his presentation, I would refer you to the video of his talk: Video.  I felt that this laid a thoughtful foundation for all of the speakers who followed.

‘Adversarial Justice’ Not Helpful
David Meyer with USC’s Keck School of Medicine provided an excellent review of Collaborative and Problem-Solving Mental Health Courts, including their operations, some of the sacred cows of both legal and clinical worlds in making them work.  The message he conveyed most powerfully to me was that “adversarial justice” is not a good fit for addressing the needs of people with major mental health challenges who are involved with the criminal justice system.  His reference to recovery and wellness as key objectives for Mental Health Courts placed him well within the Foundation’s goal of seeing the expectation of recovery become the new mainstream in the practice and experience of mental health care.  You can review his presentation here: Video | PowerPoint

PTSD Treatment for Inmates Critical
Henry (Hank) Steadman, Ph.D., President of Policy Research Associates spoke on Reducing the Involvement of Persons with Mental Illness and Co-Occurring Disorder in the Criminal Justice System Through Jail Diversion Programs.  I was particularly interested in hearing his presentation since he is regarded by many as the leading researcher in the world on outcomes from criminal justice systems.  A takeaway message for me was his data showing that the lifetime incidence of trauma from physical abuse among women prisoners with mental disorders is 93% and 77% for sexual abuse.  For men, the parallel figures are nearly 90% for physical abuse and nearly 35% for sexual abuse.  While not completely surprising, these figures argue for nearly universal attention to PTSD in program design.  Much more from Dr. Steadman is here: Video | PowerPoint

How to Really Reduce Recidivism
Jennifer Skeem, Ph.D., UC Irvine, Professor of Psychology and Social Behavior Professor of Criminology, Law and Society spoke on the topic, Reducing the risk of recidivism for offenders with mental illness: What really works? Dr. Skeem challenged many conventional views by showing that effective risk reduction is more complex than is often assumed. For example, symptom reduction and lowered use of substance use don’t necessarily translate to lowered recidivism. She described 8 central risk factors which must be considered in order to have significantly better outcomes: Video | PDF

Making a Difference for Youth
A number of excellent presentations focused on youth who become involved with juvenile justice systems. Rather than summarize these presentations, I will just note them as:

  • Linda A. Teplin, Ph.D. of Northwestern University, Department of Psychiatry and Behavioral Sciences & Feinberg School of Medicine, Psychiatric Disorders in Youth in Detention…and After: Implications for the Criminalization Hypothesis  Video
  • Paul Freese, J.D. Vice President of Public Counsel Law Center, The emergence of the therapeutic and collaborative justice models to help liberate justice involved youth with trauma and mental instability or addictive disorders Video (We were able to tour Paul’s law center and found it to be an inspiring place with inspiring people totally dedicated to helping vulnerable children, adolescents and adults)
  • Anna Yee, LCSW, SPSW, Juvenile Court Consultant, An Update on New Paths in Juvenile Justice and Mental Illness Video | PowerPoint

Community Involvement & Public Relations
We were able to spend some stimulating and entertaining time with Dr. Ralph Aquila, M.D. the Fountain House Chief Psychiatrist, in New York City. His topic was Fountain House and the Baer Center: AKA community helping persons staying out of jail.  His presentation materials are: Video | PowerPoint

For me (and I believe others) the most inspiring session was the one delivered without notes by Judge Steven Leifman, of Miami-Dade County, who almost single-handedly took on a dreadful and frankly abusive non-system of care for prisoners with mental disorders in his community.  I’m not even going to try to say anything about his work.  Watch this: Video

The symposium concluded with a keynote by Richard Bonnie, LL.B. University of Virginia Professor of Law, Psychiatry and Public Policy and Chair, Virginia Commission on Mental Health Law Reform who spoke on Mental Health Law Reform in the Shadow of Tragedy: Is it Possible to Control the Message?” with the Video here.

And two other presentations: Marvin Swartz, M.D. Duke University, Division Head, Social and Community Psychiatry, Assisted Outpatient Treatment: Can it Reduce Criminalization of Persons with Severe Mental Illness?” Video | PDF and Richard Lamb, M.D., Emeritus Professor of Psychiatry and Behavioral Sciences Keck School of Medicine of USC Decarceration of Our Jails and Prisons: What Will the Mental Health System Do?”  Video

Bottom Line
Elyn Saks organized one of the best symposiums possible on this critical topic.  Whether or not one may agree with every speaker, the issues raised and potential solutions discussed are well worth careful consideration–and of course, movement toward systematically solving the problem of the criminalization of people with mental health challenges.

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