1. 10/28/20151 INVOLUNTARY TREATMENT IN THE 21 ST CENTURY MAKING THE RECOVERY MODEL REAL Honorable Milton L. Mack, Jr. Chief Judge Wayne County Probate Court Detroit, Michigan December 10, 2010

2. 10/28/20152 CURRENT CONDITION Nationally  Over 340,000 with mental illness are incarcerated  2/3 of prisoners with mental illness were off their medication*  25% of prisoners have history of chronic mental illnesses*  Schizophrenia  Bipolar disorder  Depression *The Health and Health Care of U.S. Prisoners: Results of a Nationwide Survey, American Journal of Public Health, 2009. Harvard Medical School

3. 10/28/20153 IN THE BEGINNING... Generally cared for in homes Generally cared for in homes Kept in: Kept in: –Attics –Basements –Backyard iron cages Less fortunate Less fortunate –Jails –Almshouses

4. 10/28/20154 DOROTHEA DIX Believed improving conditions would help Believed improving conditions would help Lobbied legislatures and Congress to establish asylums Lobbied legislatures and Congress to establish asylums Architect of first generation asylums Architect of first generation asylums

5. 10/28/20155 INSTITUTIONAL MODEL Governed Mental Health Care Delivery Across the Country Governed Mental Health Care Delivery Across the Country Mental Illness Mental Illness –Considered Lifelong disability –Little, if any, hope for recovery

6. 10/28/20156 HISTORICALLY – 1950s Institutionalized with Mental Illness Institutionalized with Mental Illness –559,000 people in the United States –Over 20,000 people in Michigan

7. 10/28/20157 HISTORICALLY – 1960s Community Mental Health Act of 1963 Community Mental Health Act of 1963 –Triggering event –New federal role –Agreement to pay for mental health treatment UNLESS an adult patient in a psychiatric hospital

8. 10/28/20158 HISTORICALLY – 1960s Goals Goals –Reduce hospital population by 50% –Within 10 years Incentive Incentive –Federal $$$ for Outpatient Treatment –State funds freed-up

9. 10/28/20159 HISTORICALLY – 1970s Michigan’s Mental Health Code - 1974 Enabled the Conversion of Institutional Model To Community Treatment & Support

10. 10/28/201510 HISTORICALLY – 1970s Barriers to Involuntary Hospitalization Barriers to Involuntary Hospitalization –Due process standards –Civil commitment standards Threat of imminent harm Threat of imminent harm –Most States have similar standards

11. 10/28/201511 RECOVERY MODEL Mental Illness is seen as: Mental Illness is seen as: –Responsive to Specific Treatment –Recoverable Productive Life Productive Life

12. 10/28/201512 RECOVERY MODEL Timely Treatment: Timely Treatment: –Speeds recovery –Promotes wellness –Promotes quality of life –Preserves resiliency –Reduces costs –Reduced need for intensive care

13. 10/28/201513 RECOVERY MODEL Barriers to Timely Treatment Remain Barriers to Timely Treatment Remain –Wait for crisis –Delayed delivery of right care at the right time –Law enforcement knows treatment is not an option, making jail the only option –Common assumption that persons must be homicidal or suicidal to get treatment

14. 10/28/201514 MISALIGNMENT Current Mental Health Code An Inpatient Model in an Outpatient World Or A Community Treatment and Support Model in a Recovery Era

15. 10/28/201515 PERSON REQUIRING TREATMENT MCLA 330.1401 (c) An individual who has mental illness, whose judgment is so impaired that he or she is unable to understand his or her need for treatment to result in significant physical harm to himself, herself, or others. This individual shall receive involuntary mental health treatment initially only under the provisions of sections 434 through 438. on the basis of competent clinical opinion, on the basis of competent clinical opinion, and whose continued behavior as the result of this mental illness can reasonably be expected,

16. 10/28/201516 PERSON REQUIRING TREATMENT MCLA 330.1401 (c) An individual who has mental illness, whose judgment is so impaired that he or she is unable to understand his or her need for treatment on the basis of competent clinical opinion.

17. 10/28/201517 ALIGNING THE SYSTEM Early Treatment Early Treatment –Allows a person to recover from illness –Frees the person from the illness preventing the exercise of free choice –Early treatment supports freedom from the devastating consequences of untreated mental illness –Opportunity to restore capacity before Joblessness Joblessness Homelessness Homelessness Incarceration Incarceration

18. 10/28/201518 ALIGNING THE SYSTEM What is the real fear of early intervention? –Protecting choice? –Stuck in 1974? –Lack of confidence in treatment modalities? –Lack of continuity in the public system?

19. 10/28/201519 WHAT IS WORKING Connecticut Program Connecticut Program –Links Probate Court with CMH –Guardians have help from case workers –Help wards navigate system

20. 10/28/201520 ARRESTS BEFORE & AFTER INVOLVEMENT 16 People Arrested, 46 Arrests12 People Arrested, 22 Arrests N = 54

21. 10/28/201521 INCARCERATION / JAIL DAYS 13 Incarcerated, 985 Total Jail Days4 Incarcerated, 362 Total Jail Days N = 54

22. 10/28/201522 EMERGENCY ROOM 23 People, 322 Total Visits 23 People, 150 Total Visits N = 54

23. 10/28/201523 HOSPITAL EVENTS 30 People, 287 Total Visits 27 People, 240 Total Visits N = 54

24. 10/28/201524 WHAT DOES THIS MEAN? The Right Care at the Right Time The Right Care at the Right Time –Speeds recovery –Reduces Crime