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Chicago law professor Mark Heyrman discusses how mental health courts in Illinois and nationwide help keep the mentally ill out of prison and in treatment.


Defining dangerous: Navigating mental illness and mental health courts

by Megan Pauly and Matthew Ross Gelfand
Jun 12, 2013


Chicago lawyer Mark Epstein says that a lot of our mental health is getting criminalized, and it’s hard to disagree.

Lack of early intervention, silent suffering, stigma and a lack of funding for clinics and care head up the list of suspects that make it likelier untreated mental illness will lead to a crime. 

As mental health wards of last resort, United States prisons house an estimated 350,000 inmates who are mentally ill. Some 6,000 of those inmates are incarcerated in Illinois.

And psychosis – one of the characteristic features of mental illness - has been associated with a nearly 50 percent increased risk for violence. So, if left untreated, the odds of a mentally ill individual acting violent are high.

And then there’s the Illinois mental health law itself, with a history of flip-flopping involuntary commitment language and redefining dangerous.

The line is a fine one, as is the health of a mentally ill individual, both for those who are diagnosed and the many who are not.

Wendy Sparrow is an author and mother of two autistic children.

“While the autism community would like to pretend otherwise, a decent percentage of kids with Asperger’s have aggressive or violent reactions,” Sparrow said.

Every time Sparrow’s son- the younger of her two children - starts to act violent, she has the talk.

“We have a discussion with him about how Asperger’s has a violent stereotype and that he’ll have to work harder to prove he’s not like nearly every school shooter or sadistic killer,” Sparrow said. “We have THAT discussion. I bet most parents don’t have to have that discussion.”

Parents of children can make the decisions for medications and treatements that help avert problems but when children become adults, parents can no longer require treatment without the legal authority to do so.

And then – as if mental illness isn’t enough – comes the gun conversation.

Liza Long wrote an article entitled “I Am Adam Lanza’s Mother” in the wake of the Newtown shootings perpetrated by her son.

“How do you decide where to draw the line? Like most things, it’s complicated. I personally do not believe that legislation will ‘fix’ the problem of gun violence in America,” Long said. “Still waiting to hear whether mental illness was a factor in the latest Santa Monica shootings.”

Stigmatization adds to the aura of violence associated with mental illness, especially when it comes to laws and policymaking.

“Gun violence is a serious problem that needs to be addressed by rational lawmaking,” said Dr. Steven Hoge, director at the Columbia-Cornell Forensic Psychiatry Fellowship Program. “It is easy to target those with mental illness rather than to take on the hard decision-making necessary to reduce the availability of guns in our society."

Hoge also points out that there is no evidence that individuals with mental illness are more likely to commit gun-related violence than those without a mental illness.

"The laws attempt to prevent gun ownership by certain classes of mentally ill people: those with a history of being committed,” Hoge said. “It is not clear that these laws have had an effect.”

What is clear is the effect that Karen Gherardini, an Illinois woman with two relatives diagnosed with schizophrenia, has had on changing mental health law in Illinois.

“She is a very strong advocate,” Epstein said. “She was able to tell a narrative that very few people could tell, a lot of it because a lot of these things are confidential. So they never come to see the light of day but to see how the laws and the system affects family members who are trying to do the right thing for their relatives.”

The timeline below details her journey.

2000

Karen Gherardini had had enough with the mental health system’s handling of a mentally ill family member. She decided to set out to change the mental health law in Illinois to enable families to get help for adult relatives who are sick and in need of involuntary commitment. 

“It was out of ignorance that I finally started doing this on my own,” Gherardini said. “I couldn’t convince anyone else to tackle the job and I thought,…I have two people in my family who suffer with mental illness, I know what I’m talking about and I know what needs to be changed in these laws.”

2002

Illinois Sen. Frank Watson (R-Greenville) formed a task force for Gherardini and included Epstein and 28 others to start tackling mental health law. The chair of the first state senate committee she spoke to was Barack Obama.

“I wish so much that I could get him to listen now,” Gherardini said. “If I could just jog his memory…it would sure be nice to gain Federal recognition and support for my not-for-profit charitable foundation, MIRFA,”  the Mental Illness Research Foundation of America.

2003

Bills SB199 and SB200 were passed into Illinois law with the hard work of Gherardini's committee. A paragraph detailing the court's power to consider evidence of the person’s repeated past pattern of specific behavior and actions related to the person’s illness was added. The following language specified criteria for involuntary commitment: those “unable to provide for his/her basic physical needs so as to guard himself or herself from serious harm without the assistance of family or outside help” and “which may include threatening behavior or conduct that places another individual in reasonable expectation of being harmed.”

SB200 required everyone involved in an involuntary admission to be trained and reviewed on the involuntary admission standard and how to properly interpret it to help people but not to be a roadblock to treatment.

2004

Gherardini founded MIRFA, the non-profit Mental Illness Research Foundation of America, dedicated to raising money for ongoing mental illness research. Her vision for the organization is for it to become a St. Jude’s for mental illness.

In September 2004, Derek Potts, a man with bipolar disorder and schizophrenia, drove up to the main entrance of the Illinois Capitol’s north doors, walked in, shot unarmed security guard William Wozniak in the chest, walked out, put his gun in the trunk of his car and drove away. This proved to be a critical event in the passing of future mental health bills.

Summer 2005

Another bill, SB1983, “was tailored to help people who suffer from a confounding physiological symptom known as anasognosia, which can render some of those most affected completely unaware that they are, in fact, overcome by a severe psychiatric disorder,” Gherardini said.

SB1983 defined “dangerous conduct.” It took out “inflict serious physical harm upon himself or herself or another in the near future,” and added a third prong: “because of the nature of his or her illness, is unable to understand his or her need for treatment and who, if not treated, is at risk of suffering or continuing to suffer mental deterioration or emotional deterioration, or both, to the point that the person is at risk of engaging in dangerous conduct.”

Only a portion of this legislation was adopted but passage of SB234 two years later addressed the remaining needs advocates had sought.

Present

The prior language of "dangerous conduct which may include threatening behavior or conduct that places that person or another individual in reasonable expectation of being harmed" has been replaced with "conduct placing such person or another in physical harm or in reasonable expectation of being physically harmed."

The language is also changed regarding someone who "because of the nature of his or her illness, is unable to understand his or her need for treatment and who, if not treated, is at risk of suffering or continuing to suffer mental deterioration or emotional deterioration." A three-pronged description now covers someone who "refuses treatment or is not adhering adequately to prescribed treatment, because of the nature of his or her illness is unable to understand his or her need for treatment, and if not treated on an inpatient basis is reasonably expected, based on his or her behavioral history, to suffer mental or emotional deterioration."

Gherardini is hoping mental health law will stay on the right track in the future.

“The improved legislation allows for earlier intervention. My hope is that no one will ever again be forced to deteriorate and suffer before being given the opportunity to receive treatment.  Early intervention and treatment works. It allows the person suffering from mental illness to lead a more normal life. Society needs to understand that having mental illness (a brain disease) is no different than having cancer, Parkinson’s, or diabetes,” Gherardini said. “It’s something that you cannot help and medication can help. If we can get people to understand that and not be so ashamed the world will be a much better place.”