Jailing Mental Patients in Jail-Crazy Kentucky:An Effort to Resurrect an Old Issue [Not Gone-Away] from a So-Deigned "New" IssueIn the Louisville
Courier-Journal yesterday, July 9, 2006, there ran a story "More State Felons Held in Jails," by Andrew Wolfson,
awolfson@courier-journal.com . The gist of this article was that
jails in Kentucky are horribly overcrowded, lacking basic amenities for human dignity, and are the utter
shame of this state, a back-handed sequel to the War on Crime, which has increased the prison population in Kentucky 700% since 1970.
And I -- a former psychiatric social worker who managed part of a career in a maximum-security correctional-psychiatric facility-- do not take issue with these contentions: rather, what I would like the world-- especially the journalists-- to know, is that an exceedingly high percentage of both the pre-trial and post-conviction institutional population is mentally ill!!! Psychotic people are being held in these inhumane conditions, to the detriment of the social stability of the lock-up facility as well as (especially!) to the mental patients themselves.Thoughtful people in Kentucky have known for some time that our jails have large numbers of the mentally ill as inmates; my experiences-- to be presented after I have summarized what else is known on this subject-- only corroborates this elephant-in-the-closet that correctional administrators are not wont to address publicly. Occasionally a progressive paper like the
C-J will press an article on the subject as it did with "Locked in Suffering: Kentucky's Jails and the Mentally Ill; State Acts to Improve Care," which story by Jim Adams and Sara Shipley appeared on March 3, 2002. The article mentions that in the 30-month period prior to this publication, seventeen (17) people had committed suicide in Kentucky jails. The number taking psychotropic medication (mood-stabilizers or anti-psychotics) is also an empirically-quantifiable statistic, which in prison in this state was estimated by the
Cincinnati Enquirer to be about 15%-- about 1000% higher than in the community-at-large. On February 24, 2002, the
C-J ("Jail System Fails Mentally Ill: Many Troubled Inmates Untreated and Forgotten," again by Jim Adams and Sara Shipley) flatly stated, "No one knows how many times in the course of a year Kentucky jails book mentally ill inmates. A conservative figure, The Courier Journal [sic] concluded, may be
around 25,000" [emphasis mine.]
Now let me go back in time a little, to permit older, yet corroborating research to augment this finding, before marshalling the data from my own vita. Sometime around 1990, the National Alliance for Mental Illness (NAMI) published a 'grading-the-states' monograph on the criminalization-of-the-mentally-ill, and of the 50 states, Kentucky came in
exactly last for its propensity to incarcerate people with chronic mental conditions, and correspondingly, Barren County (Glasgow, Kentucky) came in
exactly last in the entire nation for its facile tendency to put mental patients in the local jail instead of referring them to proper mental health treatment. Then, much further back, in the 1970s, Dr. Dale Farabee, Commissioner of Mental Health, and others investigated health conditions in jails in this state, part of which included mental-health history and screening of inmates. This document
confirmed what is still the case-- that the mentally ill in Kentucky are over-jailed.The people who are in jail with mental illness would largely have been taken off to "asylum" [somehow the term is getting better 'press' of late than in the second-half of the 20th century!!!] at Central State Hospital, where they would have faced "kind-and-usual" [as Jessica Mitford put it] treatment of interminable duration, "out-of-sight, out-of-mind" of society. I have said it previously, but the 19th-century mental health crusader Dorothy Dix would simply reel in her etheral abode of the grave if she knew that -- by some savage round-robin-- again the mentally ill are drifting back into jails as the mainstay of placement/'therapy'/maintenance. This process, however, has been inexorably going on in tandem with the "diaspora from the asylum" after the advent of rather effective medications for treating mental illness (chlorpromazine and amitriptyline in the old days; now such as risperadone and divalporate sodium), the "liberalization" of mental health law making involuntary hospitalization a short-term affair, and-- where it hurts The System the most-- the hyper-expense of maintaining psychiatric hospitals and treating the mentally ill. [Not that it is really any "cheaper" to lock people who are mentally ill up and give them a few anti-pscychotic medications at "pill-call." The actual expense of correctional incarceration rivals-- if one would check this out-- tuition at any ivy-league college.] For a good discussion of this phenomenon, the reader is referred to Henry J. Steadman's
The Mentally Ill In Jail: Planning for Essential Services, Guilford Press, New York, New York, 1989; this is an older publication, yet the problems it enounces are up-to-the-minute with Kentucky's needs.
The mentally ill in jail tend to become "problem inmates": they both cause trouble due to their fantastic preoccupations and are the cause of mischief against them. In Jefferson County, Kentucky, there is some mitigation of the bulge of mental patients in pre-trial lock-up by virtue of the Criminal Justice Liason Unit of Seven Counties Services, and to a lesser-extent by the presence of the Behavioral Unit of Seven Counties at 1512 Crums Lane. This does not obviate the fact that many schizophrenics, schizo-affectives and bipolar-disorder patients manage to get themselves -- for justifiable and unjustifiable reasons-- in jail.
As a person who used to have a hand in doing pre-trial competency evaluations at the old Forensic Psychiatry Services, Grauman Unit, Central State Hospital, I saw a lot of clients who would come into our unit who had mental problems: I am of course aware that a wide gulf in time separates the situation now from the situation then, but I feel confident that -- given all the indicators lined up just as I have now-- and given the intractable nature of mental illness and of American/Kentucky society for dealing with social issues in a head-on way-- I know that the stories of exploitation and under-treatment which abounded among my patients then from local jails must be replicated over and over again today. In those days, almost no patient who was manifestly and floridly psychotice would be likely to get psychiatric treatment: instead the circuitous route of referring a client for pre-trial competency evaluation would often be attempted, and as was almost-never-the-case, the occasional client would be decared incompetent-to-stand trial and channeled to a mental instituion, etc.
The main advantage, in the social sense, of referring a mental patient in pretrial to competency-evaluation would be that such a person could receive TREATMENT including psychotropics and some psychotherapy. This was all-to-the-better for the actual sociological function of pre-trial competency evaluation-- I believe-- IN PREPARING THE MENTAL HEALTH CONSUMER CAUGHT UP IN CRIMINAL JUSTICE TO GO TO PRISON!!!The typical mental health consumer, you see, tends to be empty-of-wallet, unable to get a "good" lawyer (i.e. one who will really advocate, and not just plea-bargain), and whether innocent or guilty will be pressed into saying-- most of the time-- that she/he did some lesser charge in order not to get "maximum time." Do not worry about the "insanity defense" in this instance: that is the plea of those-with-money-caught-red-handed. The sap who like I do from time to time occasionally gets charged with a crime -- mine tends to be "disorderly conduct" but the cops would love to find a pocket-knife on me-- which therefore I never tote-- to bring a "carrying a concealed and deadly weapon" charge. But you do not have to even do that as a mental patient: you can be walking down the street, and suddenly surrounded by police swarming around you trying to get "confessions" from you that you started every unsolved arson case in Metro Louisville. [That is what I call "being a person of many convictions!!!"]
There are, of course, mentally ill people who commit crimes, and for these the correctional-psychiatric/forensic-psychiatric facilities
should be employed. Nevertheless, old K.C.P.C. (Kentucky Correctional Psychiatric Center)-- whatever its new name may be-- was and probably still is in the business overweeningly of treating conduct disorder people, and those whom the wardens believe are likely to cause fights and other law-suit generating disturbances. The mentally ill, instead of being treated in mental health facilities specifically for their needs, were and no doubt still are shuffled off to "the yard" with other inmates-- often to come back naked and abused and intimidated by the thugs who have exploited them in prison-proper.
But the condition in jail is even worse. There one
factually has no right whatsoever to a "speedy trial"; but what is more damning is that they are unlikely to get the barest of medical necessities, including treatment for mental problems.
This is a violation of human rights, exactly in contradiction to the "Universal Declaration of Human Rights" -- unratified by our U.S. Senate but persuasive authority indeed for the country holding itself up as the human rights exemplar of the world.In summary, therefore, we may say that the
Courier-Journal and the world needs to look at the phenomenon of jailing the mentally ill in Kentucky and everywhere. It presents miseries to the jail administrators, the non-psychotic jail inmates, and the mentally ill in jail themselves to be subject to this living lie and malapropism of social services.
Dig a little deeper, World, and find out just what an affront to human dignity are the things to which I refer.--- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV # F31.2
E-Mail:
freethink@bellsouth.net
Manics and Schizophrenics Tend to Lose 20 Years of Average Life-ExpectancyDue to Incautious Use of Medication: Co-Morbid "Metabolic Syndrome" with Psychotropic Rx ComplianceThe worthy publication
Psychiatric News (online) today-- Friday, July 7, 2006-- pressed a feature which should disturb any mental health consumer who is compliant-- i.e. "takes as prescribed"-- psychotropic medication for manic-depression or schizophrenia (and I think we can include schizoaffective disorder and the other maladies which begin with the praenomen "schizo- ".) The feature to which I refer by Jim Rosack is entitled, "Clinicians Urged to Better Monitor Drug-Related Side Effects," and its gist is that a patient who has been compliant with (especially) the newer, second-generation antipsychotics (SGAs) run the risk of cardiovascular disease as a condition comorbid to their mental condition,
to the degree that the Centers for Disease Control estimates that such individuals will have a shorter life-expectancy by a factor of 20 years.The research points up a new clinically-definable condition,
metabolic syndrome, which is confirmed by a positive finding of three of the following five criteria:
1. Obesity as measured by a waistline exceeding 40 inches for males or 35 inches for females.2. Fasting serum triglyceride levels above 150 mg per deciliter.3. Serum high density lipoprotein (HDL) levels below 40 mg per deciliter for males or 50 mg per deciliter for females.4. Hypertension defined by an increase in systolic, diastolic blood pressure, or both, above 130/85.5.Hyperglycemia defined by elevated fasting serum glucose levels greater than 110 mg per deciliter (some use glucose levels above 100 mg/dL).[Source: "Clinical and Research News," Psychiatric News 41:1-34, 2006.]The article cites research from the National Institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) which shows that-- depending on which SGA is used -- compliant patients are more-or-less vulnerable to obesity, hypertension ("high blood pressure"), diabetes, and hyperlipidosis (excess fat in the fluids and blood.) These all complicate the general health picture of the compliant mental health consumer, compounded by the fact that her/his confounding medical conditions going along with medication-usage are less-likely-than-usual to receive the kind of treatment that is known to be beneficial in treating these extremely undesirable medical (what doctors call "iatrogenic" --- from Greek roots meaning "doctor-caused") disturbances.
Weight-gain seems deeply implicated in the overall process of developing the co-morbid conditions. Not every antipsychotic, indeed not every SGA, has the effect of making a client obese, though. The author of this article cites a research project called zODIAC-- the ziprasidone Observational Study of Cardiac Outcomes comparing ziprasidone (Geodon) with a variety of other antipsychotics to determine their potential for cardiac complications associated with these medications. At baseline, of the more than 17,000 patients enrolled in this program, 19 % of patients had hypertension, 16 % had hyperlipidemia, yet less than 3% were taking statins or other antihypertensive medication.
Most in jeopardy are schizophrenics, according to CATIE findings: they run a high risk for cardiovascular disease yet at the same time are not getting "appropriate and necessary treatment." Henry Nasrallah, University of Cincinnati professor of psychiatry involved in this research, cautions that psychiatrists need to "measure and follow their patients' obesity, their hypertension, their hyperglycemia and hyperlipidemia."
This all comes full circle now, to the mental health consumer who -- following "doctor's orders"-- and sometimes a court-order-- takes these "head meds." I think almost all of us who take these chemicals realize that weight gain will come as a result of "being good" and compliant. Fewer would know-- as I now believe from my own medical history-- that these medications predispose the "consumer" to health problems as serious as diabetes, or a heart condition, or a stroke. Most of us are still trying to make some cognitive adjustment to our new, "fatso" bodies, which to the public's eye and mind are eyesores leaving you "high, dry, and dateless." If it really gets out that -- almost through carelessness-- taking these medications like SGAs will foreshorten one's life by some 20 years, then I think the "average stabilized psychotic" (whoever that is) if not the general public will simply
flip out!And why not? From what I read in
Psychiatric News this day, the "side effects" of diabetes and cardiovascular disease in mental health clients taking psychotropics is essentially
preventable. We can thank our clinicians for kindness and genuine help, but for "burying the dust under the carpet" goes no thanks at all.
I give my healers fair grades on trying to keep me bolted down to reality with my meds., yet at the same time paying attention to my blood-sugar level and obesity and hyperlipidosis-- all of which are problems for me. In the past, my beloved psychiatrist would weigh me, and give me good counsel about what sorts of foods to eat-- healthy yet befitting a "tight purse." Nevertheless, to be on the safe side, I think I shall get bloodwork to ascertain whether I have this metabolic syndrome described in
Psychiatric News today, with a view toward making whatever corrections I can.
You-- and yours-- are encouraged to do the same!
--- Vernon Lynn Stephens
E-Mail:
freethink@bellsouth.net
More Words on the Insanity Defense:All the Justice a Mental Health Consumer (Or Criminal Caught Red-Handed) Can BuyI write tonight of the
insanity defense, however it gets defined in any of the 51 jurisdicitions of the USA; my reference-point, however, is decidedly of a former professional-- now a mental health consumer-- who worked in the bleak application of psychiatry known as
forensic psychiatry as it is practised in Kentucky-- part of which includes pretrial evaluations to determine whether individuals with criminal charges are competent to stand trial, as well as whether they are to be regarded as
not-guilty-by-reason-of-insanity for a charge.
I say that this sub-discipline of psychiatry was "bleak"; the following reasons point to my sense of bleakness with regard to forensic psychiatry. First of all, only the very rare case would ever be considered too-psychotic-to-be-held-responsible-for-their-crime (the gist of the "Durham Rule.")
Practically speaking, such an 'insanity plea' is the privilege of the rich, who indeed may profess all manner of psychiatric exotica to avoid going to jail. This is all done with "good lawyers" (i.e. attorneys who will "fight" for you like a gladiator or hired-gun in court, and by the expenditure of tall tall tall money.)But the average mental health consumer specifically lacks money, "the green stuff," "what it takes to get along" in these United States. Over and over I saw quite deranged people compelled to go to prison through the workings of "usual justice," i.e. plea bargaining, being declared guilty after a botched trial wherein the jury-- seeing naught but a crazy person in the defendant's chair-- being declared "guilty."
Nor are services up-to-snuff once the psychiatric client reaches prison. In Kentucky, the mental patient is most-likely to serve her/his time "on the yard," in the general prison population in other words, whereas precious psychiatric beds tend to go for antisocial-personalities, psychopathic-deviates, and behavior-problems that the prison administrators would prefer to see apart from the general prison population, in order to prevent fights and mayhem.
All of this means, as a social process, that the social reforms which were the thrust of Dorothy Dix in the asylum movement during the mid-19th century is becoming completely undone. Jails are filling up with patients who should be in mental hospitals, for whom a
real insanity defense was obviated decades ago. Occasionally, we read of this in "progressive" newspapers, such as our local Louisville
Courier-Journal, which on March 3, 2002 published an article by Jim Adams and Sara Shipley entitled "Locked in Suffering; Kentucky's Jails and the Mentally Ill; State Acts to Improve Care." This article focuses on jails, not on prisons-- but you can take my word as a former mental health professional who worked in the prison system for a time-- many of the matters affecting the jail (pre-trial) mental health consumer also apply to the mentally ill convict.
I would say that in the application of
this kind of "justice," as is so true of everything American, the services one tends to get are predisposed
by one's income. Situated at the very bottom of the income-pyramid, the typical mental health consumer finds it: 1. easy to get into trouble with "the law"; 2. prone to go to prison if in any way insinuated in a criminal charge; 3. given essentially sub-standard and horrifically-expensive institutional treatment in the midst of ordinary criminals once she/he gets to prison.
The rich defendant, on the other hand may use the insanity defense as his sole way to "get out of it" when she/he has been caught "red-handed." The successful effecting of an insanity defense with a jury is inevitably an indication that the defendant had a first-class advocate, not the kind that mental health consumers are likely to receive.
Therefore, I am somewhat jaded in all talk about the insanity defense. When the paranoid schizophrenic man who killed the police officer in Arizona lost his bid for an this plea by the Supreme Court of the United States recently, I was only a little perturbed. Knowing something about the
kind of case this likely was-- a "celebrity" case invoking much yea-and-nay controversy in the community, I know in my heart of hearts that here is an instance of violence that does nothing to rectify the
rabid social injustice of locking-up mental patients in correctional facilities with almost no sense that they are violent or dangerous or anything that should not really require a good, old-fashioned "asylum," or a new-fashioned "personal-care-home" to contain! The existence of the insanity defense "on the books" is like the presence of an unused fire-alarm in a high-fire-risk-zone. It is so much "sound and fury" about mental illness, essentially meaning nothing.
This is why I rather "refuse" to take-up-arms about the insanity-defense, preferring instead to promote realistic services for the mentally ill, and a reversal of the trend-- still going on with great vigor-- of putting the mentally ill in correctional facilities. All my experience and all my sense of justice say that these are the real issues, and not the demogogery of some speculative insanity defense, always for the very, very, few.
--- Vernon Lynn Stephens
E-Mail:
freethink@bellsouth.net
"Life, Liberty and the Pursuit of Happiness" for the Mental Health Consumer:Some Fourth-of-July Thoughts about Our Precarious FreedomsAccording to the Declaration of Independence, signed unanimously by Congress on this date in 1776,
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." Now these are fine words, apart from the sexist rendering of men-only which would never be permitted today, and the fact that they were
unintended apparently at the time for slaves, who could not be equal under the Constitution and would not be so for numerous decades... it taking a Civil War to ascertain that equality! In this piece tonight, with fireworks going off here and there like in the original revolution which set this country toward its process-of-liberating-itself, I would like to devote some time to the real liberties that mental patients have acquired -- historically just in the blink-of-an-eye!!!-- and the very real exigencies which countervene against consumer "Life, Liberty and the pursuit of Happiness."
Not very long ago at all a diagnosis of schizophrenia, schizoaffective-disorder, or manic-depression implied institutional confinement, usually a "life-sentence," in a lock-up hardly any more clement than a prison, which was usually given some euphemistic name like
"asylum." Indeed, one was just a little better off in one sense by going to
prison for a crime, for
sentences by and large were
precise: one knew exactly when one would "serve out" and go home from jail, having hypothetically "served one's debt to society." The mental patient, on the other hand, had and has but one gambit to which to resort in "getting out," and that is the route of
submission and
cooperation. And actually, even for the most-cooperative mental patients, "freedom" even as it lamely existed for the ex-convict was not a possibility in the deepest days of the asylum movement.
From such a place, there was, practically speaking, NO WAY OUT!!!I do not attribute the kindness of human spirit or a charitable elan in society for the great depopulation of mental hospitals, but the advent of
medications that offered a real hope -- albeit imperfect-- of controlling the symptomatology of mental illness. I am referring of course to the first applications of the antihistimine chlorpromazine-- which had been synthesized in the 1940s but first used in psychiatry about 1956-- and thereafter the derivation of amitriptyline (closely related to chlorpromazine chemically) for depression-- as well as a host of other chemicals ushering in a genuine age of psychopharmacology. These drugs, and in my opinion these drugs almost exclusively, set the stage for depopulating mental hospitals, the phenomenon generally called "Deinstitutionalization."
I would say the "new accomodation" of the mental patient with the community is going about as smoothly as could be expected, which is to say one would have to consider the initial expectations of society, and in fact, the nature of mental illness itelf.
Given that there is a super-abundance of "Halloween," mad-slasher, mental-patient-gets-out-of-the-asylum-and-commits-mayhem media prevailing, and given that landlords are not wont to rent to "crazies" because neighbors are not wont to live next to "crazies," the housing market for the mental health consumer can be "iffy" and challenging. If she/he for
any reason decides not to make use of outpatient treatment resources-- in this town being the Community Mental Health Center (CMHC) Seven Counties Services, especially if self-medication or no medication is attempted instead of cooperation with "the system"-- which after all is only in place to help in such cases-- then I think it likely that conditions are rife for losing-Life-Liberty-the-pursuit-of-Happiness so dear to the mental health client.
Here follow a few cases to illustrate my point. According to a
Washington Times story by Matthew Cella and Gary Emerling, datelined May 12, 2006, "Gunman Was Free to Escape Therapy,"
http://www.washingtontimes.com/functions/print.php?StoryID=20060511-110539-6536r, a mental health consumer Potomac Ridge Behavioral Health Center at Rockville in Virginia was permitted to sign himself out without restraint, whereupon he went out, reportedly operating under the delusion that he was Jesus Christ and that the world is being invaded by zombies, and then carjacked a sport utility vehicle, and had a gunfire-fight with Fairfax County (Virginia) police. According to the previously treating behavioral health facility, the client did not meet the prior-restraint criteria for involuntary hospitalization.
More recently, the United States Supreme Court-- see "Court Upholds Law Limiting Insanity Defense," by James Vicini, Reuters, Thursday, June 29, 2006,
http://today.reuters.com/-- has upheld curtailment of the insanity-defense rights of a man -- a paranoid schizophrenic who had on June 21, 2000, slain a Flagstaff, Arizona police officer-- apparently blaring a "boom-box" in a truck from some logic having connection with the belief that the town had been taken over by space aliens and that he was being tortured. Arizona is one of several states which have placed restrictions on the insanity defense; others, including Kentucky, have responded by adding an option of "Guilty-but-Mentally-Ill" to the options available in a crimial trial. Clearly, though, "the public," if there is such a thing, singly, is fed-up with outrages against the civil dignity which occur when mental patients -- invariably unmedicated or medicating themselves with "street drugs" or alcohol, do mayhem. I suppose the sort of crime that a mental health consumer does at such a time is likely to be more-bizarre than that of the typical criminal, and at any rate, for a reporter interested in a "story," this would inevitably seem to make better "copy" than a usual fray-with-the-law-by-a-thug.
But on this July 4, the day of freedom, it is well to note that in certain quarters there are those who definitely would like to see more in the way of total-institutionalization of the mentally ill. On Tuesday, June 27, 2006, the
Kennebec Journal Online of Augusta, Maine, issued an editorial "Civil Liberties Must Not Block Mental Treatment,"
http://kennebecjournal.mainetoday.com/view/columns/2875185.shtml; in this position-piece, the editor argues that while in general it is to the good that mental patients have the liberty to live in the community these days, there are times when the needs of the patient -- and the needs of the community-- require that the mental health consumer receive (involuntary) institutionalization. This position reminds me of that of the renowned psychiatrist-mental-patient-advocate E. Fuller Torrey, who in his
Out of the Shadows (John Wiley & Sons, Inc., New York, New York, 1997, pp.81-90) delimns the need for occasional use of involuntary hospitalization and long-term 'asylum' for mental patients who truly need such service. Torrey is of the opinion-- and he justifies his opinion with solid research-- that a substantial fraction of the mentally ill
are dangerous-- at least toward others-- and need to be confined.
To me, this is not, by any stretch of the imagination, a recipe for "going back to the old days," with each-and-every mental health client in confinement. The actual percentage of violent and self-violent mental patients-- from what I have read-- subtends about one-part-in-one-hundred-of-the-total-mix-of-mental-health-consumers. If this small fraction needs an "asylum," then the Fathers of this Society/Community need to get their heads together to see such a lock-up exist. For the great bulk-and-main of the mental-patient-populace, however, simple outpatient treatment-- by which I mean maintenance chemotherapy + psychotherapy + occasional social supports --- should do ably to see that such an individual -- without the stigma that she/he "has some horrible affliction" might prosper.
I do not see the "Fathers" to whom I allude in the last paragraph making even that preliminary step toward institution-building. In all candor, I doubt that what has not happen readily will happen even if it is
very necessary for the decorum of the community. What I see, instead, is a tendency to tighten the purse-strings in all of governance and health-care, to the extent that what the mental patient living in the community is now expected to do is rather to treat-herself/himself with
minimum recourse to "the system." This
laissez-faire approach in the end can only imply that a lot of mental patients will die-- not in "asylums," not in jails, but in the "gutter," on "skid-row."
"Life, Liberty, and the pursuit of Happiness" are only imperfectly obtainable for the mental health consumer, therefore. The mental hospital itself affords almost none of these things, and one entering even the "nicest" mental hospital should anticipate humiliations unlike those other patients in other hospital settings have to experience. One's shoelaces and belts and-- if one is a man of girth-- one's suspenders-- are taken-- leaving to initial nudity and submission the client for "care." All activities, of course, are supervised, particularly things that may involve "sharps" as for example is the case in shaving. Treatment-- even when it is boring and silly-- can be enforced by court order and thus have the force-of-law. Yet there are some folks who without such humiliating places to make their decisions would be out having gunfights with police.
The mental health consumer needs to recognize that liberty is precious, but not everyone in our cohort can "handle" liberty. For the one-percent who need total institutionalization,
provably, the truth-based mental health advocate should take no quarrel. But for the rest of us-- the overweening large majority of mental patients who can live in the community and take "meds." and pay-the-rent and even be-times hold-down-a-job and yea!!! be leaders in town, such "jail" definitely is not the answer. For these, "let freedom ring!"
--- Vernon Lynn Stephens
E-Mail:
freethink@bellsouth.net
