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tv   [untitled]    October 30, 2013 2:00am-2:31am PDT

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behind it and it was like the principle facts behind it refused to let me give you no matter what. even coming home, when my case got accepted. it was like, i'm going home. it still didn't happen. i'm thinking in 60 days the court will, i'm telling everybody i'm going home and there is people all the time up in there educating myself about the law, i know is fast to get in there, but when the wheels are turned to come home, it's slow. i couldn't accept it. people are like they are going to do this to time. i said no, this is clear. this was what was supposed to have been done from the beginning. even my families, my loved wupz ones that lost. that made me fight more. i never gate gave up my
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fate. my hope is restored. >> with that i would like to thank all of our panelist. thank you. [ applause ] and we are now going to move to our second panel. while they take their seats, this idea of forced treatment versus constitutional rights has always been a tension that we've had in our criminal justice system. there is an issue that came up earlier this year that you may have read about involving this implementation of a court that was supposed to treat individuals who were suffering from long-term alcoholism. and the court was set up in a way where individuals were not
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being arrested for a crime but instead were being jailed for contempt of court as long as 120-150 days in jail. my office, when we learned of this, we were not involved in the creation of it, challenged it because we believed that it was unconstitutional because you were not charging people with crimes and you are jailing people for contempt of court when legally they hadn't failed to come to court because in most of these cases they had simply been served with citations. so the legal challenge is filed and the court was found to be unconstitutional by the court of appeals. but it still left a question, one of the colleagues raised this in his column, how do you deal with the tension
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between constitutional rights and wanting to provide treatment to individuals who need it? >> so out of that came the idea for this panel. actually action behind this panel as to what to do. we do have a lot of collaborative court's in san francisco of mental health court, drug court. domestic violence court. but san francisco is at the cuff of considering what measures to take in serving individuals who suffer from mental illness and also individuals who suffer from drugs, substance abuse, chronic conditions. >> i would like to introduce john diaz from the san francisco
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paper, san francisco chronicle. i'm very pleased to introduce him now. john? [ applause ] >> thank you very much, jeff and good morning and welcome to our panel this morning on forced treatment and constitutional rights. can they coexist? i am john diaz, the editorial page editor from the san francisco chronicle and i'm moderating this modern's discussion with our distinguished panel. forced treatment as jeff node is one of the most contentious issues of mental health. as you look at our discussion there are informed and panelled views from both sides. there has been many debates on how to implement lawyer's law which
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consist of outpatient treatment. it was named after laura wilcox, a mental health worker who had been shot to death by a man who refused treatment. the county r remains the only county to implement the law. there have been other counties in los angeles county and other counties who are considering it. >> why have they not adopted the law. what is it about forced treatment and the consequences for an allowing refusing treatment. we have a panel who have a knowledge of this subject in some cases because of their professional endeavors and in some cases
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because of personal experiences and in some cases, both. let me introduce them. karen chen is an attorney manager for the san francisco public defenders office, kathy, whose son battled mental illness, can is a subject treatment expert for the medical center. danny is the associate director for the serial neeb breet program for the city of san diego. and san francisco chief of police. gary is a psychiatrist and laura's law advocate and eduardo vega of the mental health association of san francisco. let me start by opposing a question to karen chen from the public defenders office. karen, can you -- how about if you start by giving us an overview
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of how the city handles this conflict between treatment and civil liberties. >> an involuntary hold starts in san francisco when a peace officer or a clinician makes the determination that the person is due to a mental disorder, is a danger to others or danger to self or gravely disabled. gravely disabled means that person does not have the ability to provide for basic needs such as food, clothing and shelter. and the legal representation starts in most cases the first 3 days of the involuntary hold during the initial psychiatric evaluation and then the legal representation also continues with if the person is asked to be stayed or referred for
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further treatment up to 14 days. during this phase, the attorneys will represent the clients about whether or not they will have to stay on this hold, whether they have to take medications. if a person after at the end of the 14 day hold is found that may need further treatment, the person maybe subject to a conservatorship under the act of the conservator in the california constitution code and representation continues and after an initial established conservatorship such as objection to the conservatorship and also propose medical and psychiatric
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treatment. one of the things that in san francisco that is up to 2012 we are one of the three counties that consistently offers judicial review when there is a recommendation to take away someone's right to refuse medications. the law requires that anyone even in involuntary commit a person the right to refuse psychiatric medication in a non-emergency situation unless there is a judicial find that go this person lacks the capacity or ability to make rational decisions regarding his or her medical treatment. in further response to the need for make sure that treatment is provided and people with psychiatric disability have access to trees and maintain stability in the community, san francisco in 2011, we started a
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pilot project and that pilot project is called independence in the community, pilot project. it's cipp. this is a collaboration among department of public health, office of the public conservator, san francisco district attorney as counsel for the public conservator and the superior court of san francisco and office of the public defender. the key feature of this program is to have someone who has starting a serial hospitalization and the provider identifies this person and receives this person to this program. the program is voluntary. the person agrees not to refuse medication. they come in to check in with the judge on a regular basis and
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attorney is provided to represent this patient in all proceedings. if they feel at some point they don't need the program, they have the right to ask to leave. we have them participating in this program. >> thank you very much. let's continue this discussion. let's go to gary sigh. you have studied this issue from a personal standpoint and you have a family member with mental health issues. as you explained to me in the e-mail, one of the problems here is people with certain mental health problems may not even beware of their condition. give us a sense of what you mean by that? >> yeah. there have been some studies looking at individuals with bipolar disorders as well as skwiz schizophrenia. 40-60
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percent have systems of lacking awareness. what this means is basically there is damage to certain pathways of the brain responsible for self reflection and self awareness. this has been shown in neurology for individuals after they have had strokes with particular areas of the brain that have been damaged, has also been shown for individuals with dementia and in my clinical experience and my personal experience with my family member, it's very clearly an issue in mental health as well. the dilemma is that if there are individuals who are biologically unable to
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self reflect and have an awareness of their illness, they oftentimes very frequently will not want to engage with treatment and do not see themselves as needing treatment. and this is beyond psychological denial, kind of realizing deep down that there is an issue but not wanting to accept it. it's also beyond simple stubbornness. it's a natural inability to realize that there may be something wrong. one particularly pertinent example is a neurology for certain people after strokes where one side of their body is paralyzed. a doctor will ask them to do a task with a paralyzed side and oftentimes these individuals will say that they are actually lifting their arm when clearly they are not or come up with a reason for why they are unable
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to do it. i have arthritis in my shoulder. it's a big problem in mental health and particularly becomes problematic when there are issues of involuntary treatment being considered and all the dell icate sea of that issue. >> you went through a parents nightmare with your son diagnosed with schizophrenia and now held accountable for the death of a man. how is your understanding the need for this law and the need for treatment? >> my experiences that our current mental health system is based on crisis management. from what i have seen with people like my son and people that can't recognize their
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illness and aren't willing to take their medication, it just does not work. too many of our mentally ill end up on the streets and in the criminal justice system. these are pictures of my son and another mother's son. we wanted to share with you so you can have an insight to our lives and our sons lives. my son could have never harmed anybody. the other son has lived on the streets for four years now. this mom told me when he was firstborn how beautiful he was. he was a 4.0 student, he was extremely
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bright and invited to all the top schools. he now lives in city parks and on the street. both of our families tried desperately to help our sons to try to prevent this. we could not. our son first became ill after high school. he was supposed to go to college like many other people's kids an then he had his first psychotic break. we could not get any help for him. when a person is left to decompensate to the point where they can not eat because they fear their food is poison or when they can't go outside because they think people are following them everywhere. when they can't sleep because they are hearing
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voices and the delusions in their mind, we owe it to them and to intervene to help. there is nothing civil about letting somebody without their right mind decompensate to the to point that they lose their lives and sometimes other people lose their lives. our mother recently had called me and said that her son had been on the streets because he also left their house and the police called her first thing in the morning. she hadn't seen him in a long time and he had paranoid schizophrenia. they said your son is in the hospital. we arrested him on a 51/50. he was walking naked in the street in the middle of the
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night talking to himself. the mother and father jumped in the car and went to the emergency room and by the time they got there, the hospital had released him. i don't understand this. it's just, you know, i'm not a lawyer and i wasn't in the mental health field before, i just, i don't understand it. the qualifications and criteria for a holder extreme and they are unrealistic. a person much be imminently danger to self or others or gravely disabled before they are picked up. if your shelter is under a freeway, if he knows of a garbage can that he can frequent, he's not gravely disabled. i'm told. if your son threatens you because his mind
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is telling him that you poisoned him and the police come and take your son to the hospital, it's likely that if he can present himself in a reason manner because many people with mental illness can, they will release him. and this happens over and over and over again. we all know about the revolving doors. it's costly. if you want to look at money, but i'm here because i'm talking about lives. i don't think, i'm just, you know, it's very hard and we knew nothing about mental illness about this, but i will not stop fighting for my son, i won't stop fighting for others and i am going to scream and
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shout and share until somebody hears. that's all. >> [ applause ] >> thank you. let's get another perspective on this from eduardo very big vega. you have been forthright to discussions about treatment and in your chronicle about laura's law that you think the need to help the vast majority of people who do want treatments. but aren't there cases as we are hearing today that force treatment is necessary? >> well, so i have been working in mental health field for
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about 22 years various places across the country. i have worked in crisis programs here and in new york city and pretty much ever phase of program there is. i have been a suicide prevention interventionist, i guess after this, the one thing i want to say that force is not treatment. one thing that we have learned in the community mental health system which was set up in the 60s partly to answer the need for social justice around mental health is that people respond to dignity and fair treatment. and the -- as an example of the -- i think that the psych so physiology is that it's still very coneject ral. that doesn't really matter. the one thing that i
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have realized in working with people in all sorts of states, regardless of what you call their state, they respond to, if you treat them with love, with kindness, and compassion. and unfortunately, whether or not i think that as an example, the mental health association and generally mental health associations across the country we do not advocate against services. i want to point out that what is called outpatient treatment. the part that we have a concern about is what the technical issue of involuntary outpatient commitment, a o c different terms relate to the model of the laws of the program. we feel that we've seen throughout the community mental health movement across the world is that the right kinds of
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services and support can reach the vast majority of people even people that are very ill on an on going basis. there are countries in which there is virtually no involuntary treatment at all or involuntary process and some that are very successful. so we feel that there is a lot to be done. it is true and i totally agree with miss dewint, we do not have what we need. we don't have the range of services, we don't have the range of skilled providers, and we need to do more. but, do we need another process for taking away people's civil liberties when we already have one. there is a process under the act that is set up to protect people's
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civil rights. one of the things in 1421 that hasn't been i am mplemented in the counties, the real issues as a matter of course is what is the process for hospitalization under the enforcement. under this program, if someone misses a doctors appointment, they can call the police to take them to the upon the hospital for an evaluation. you might say there is something about that. but whe we see people's interaction for service, when they see police and someone upfront, as
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a criminal or someone to be weary of or suspicious of or to the fact of a lesser member of society, when people have that experience, and it doesn't matter how many psychotic symptoms they have, they push back. that's our human nature. what i have seen in new york. that's very relevant. other ill leave with you this. i was a social worker working in new york, i was very enthusiastic about my job in the homeless outreach program and our program was specifically to reach out to people who are clearly living on the streets and our program was in the western part of harlem. we would bring people sandwiches
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and we developed relationships with people. one of the things that would happen wins once in a while we would talk to somebody, and we think we know that guy, his name is george. i would say george, how are you doing, would you like a sandwich. he runs the other way because he's had interaction with us before who the sandwich was an entry to getting them locked up for 6 months and whether or not you think that people living on the streets were you consider that a life, those people do consider it their life. so we feel that there absolutely needs to be more services for all levels. we do not feel that we need a coneject ral and problematic
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extra involuntary process in california and certainly not in san francisco. >> thank you. [ applause ] . i know we are going to be -- this hearing and discussing a lot more about outpatient mental health treatment but let's take a moment to hear from danny mcclaegen from san diego. tell us about the program. is it working? >> let me tell you what the program is about. it's a program where people are convicted for drink in public 5 or more times or arrested and held and if they are convicted for the crime in public. if you see it like a drug court model, that's how it works. so if we want to talk about is it successful, we can throw out a
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number of definitions for that. we know that drunk in public arrest are down 77 percent in san diego. that's good for you and we can talk about health care cost have been reduced by $73,000 a month on health care for people picked up by paramedics and drunk in public and hospitals. i think that's good. i know in my program that 70 percent of people that enter the program complete a program and graduate and are 80 percent of employed and housed at the end of the program. we think that's good. and there are serial neeb rate programs across the united states. we have a call from ireland and alaska which begs the question
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how can you be homeless in alaska? but there are. if i were brought to a conference for the police, we'd have a very different point of view. if i was at a conference for the district attorney we might have a different point of view . the nice thing about this program is we are going to have a job. the police are going to arrest these. the attorneys are going to prosecute their cases and the public defenders is going to defend their client and everybody gets to do their job. they are going to do it legally, ethically, but we ask more that they do it morally. so, if i'm walking down the
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street and i'm pulling my dog's chain or i leave my dog outside in the cold and i don't feed it and it has health problems or i kick it and make fun of it and treat it harshly, you can arrest me. but i can do that to a person and you think it's okay. i don't think it's okay. jeff got me on the phone and said i want to know more about the program and i talked to him and said this is how it works and he said what's the biggest barrier? i said we have trouble making people understand how to better treat their clients. i'm a huge fan and knowing what we need to do is to make sure those people that need help get the help they want. our