Public Safety and Mental Illness

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It’s been a year since the tragic shooting in
Tucson that left six people dead and many others injured, including U.S. Representative Gabrielle Giffords. Experts explore the challenges they face when mental health, criminal justice and public safety are intertwined.

Ted Simons: It's been almost one since the horrific shooting rampage in Tucson that left six dead and 13 injured, including Congresswoman Gabrielle Giffords who continues to make a remarkable recovery. Meanwhile, doctors are working to restore the mental health of the suspect, Jared Loughner. The shootings have reunited the issue of how crime is impacted by the availability of mental health services. Asu's morrison institute will hold a forum on that issue tomorrow. Joining us now is mental health advocate and attorney Charles "Chick" Arnold, and Dr. Jack Potts, a forensic psychiatrist who once handled mental health services at the maricopa county jail. Good to see you again and thanks for joining us. Let's talk about how best you balance mental health with public safety. How do you do it?
Charles "Chick" Arnold: Well, indeed, balance is the key word. All of mental health represents a balance of individual rights against community rights, so that every one of us has the right to have a mental illness and remain free from involuntary treatment. But, when the community's rights trump those individual rights, when we are dangerous to ourselves, dangerous to others, or, in our state, persistent and acutely disabled, we are subject to involuntary treatment.

Ted Simons: Does that balance, as we saw there, does it shift over time? Has it evolved over time?
Jack Potts: You know, one of the values of being here for so long is, is chick was instrumental in passing this standard of commitment that you don't have to have someone be dangerous to others, like Mr. Jared Loughner. You, in fact, can have the system, the mental health system evaluate them involuntarily prior to a criminal act deteriorate to get a level that he did. We have a very good system of laws here. They are not being enforced. Some of the places they aren't using them appropriately, which leaves some of the mentally ill out there to have a higher level of incidents.
Ted Simons: Talk about that process. How do you determine if someone is mentally ill and a public safety risk?

Charles "Chick" Arnold: Well, those things don't necessarily go together.

Ted Simons: Yes.

Charles "Chick" Arnold: Our state has adopted a public policy as set by statute that if a person is suffering from severe, emotional, physical, mental stress, that, in itself, is sufficient to subject that person to involuntary treatment. Dangerousness has nothing to do with it, Ted. It's a, a false belief that is based upon statutes in other states, but our state statutes are extraordinary.

Ted Simons: Is that how you see it? Is that a good state statute? Is that a good way to kind of meet this off at the pass?
Jack Potts: It's an excellent way because it gets to someone who needs treatment before they get involved with the criminal justice system, before they harm themselves or harm others. Number one, the Schizophrenics are less prone to violence when they are treated. In fact, Schizophrenics, if you have that diagnosis, you are 12 times more likely than an average person to have violence committed upon you. So, they are not necessarily more violent, which is a myth, mentally ill aren't. No. 2, 52% go untreated. At any one year. So, what we need to do is get those with mental illness into a treatment system, and that will prevent some of the exacerbations and problems that we see. The homelessness, the issues of just, just the survival crimes, get them involved with the criminal justice system and the like.

Ted Simons: Are those systems there? Let's talk follow-up now. We have the person identified, we see the problem, and we evaluated the problem, and what happens next?

Charles "Chick" Arnold: Well, unfortunately, under the cover of the fiscal crisis, the dialogue that has taken place regarding civil discourse and security has pushed aside the discussion about mental health issues. Indeed, as Dr. Potts suggests, our statutes are fabulous, educating our population and the people about what to do when you come across someone who is clearly suffering from a brain disorder is what's necessary.
Ted Simons: What do you do if you come across someone like this? And can it be anyone? Does it have to be family? Does it have to be friends, neighbors? Can anyone see someone and say, that person needs help and assistance. I have got to do something?

Jack Potts: That's an excellent point. I recently was involved in a case that the high school principal and vice principal called in and had their senior in high school, a civil commitment on this person acting goofy, and we don't see enough of that. So anyone can be an applicant.
Ted Simons: So, if the civil commitment, if I'm the parent of the child, and you keep your hands off my kid, no way. If that civil commitment has to occur, it happens?

Jack Potts: It does. Someone has to bring it to the attention of the agency. The urgent care center on 2nd street sees about 20,000 encounters a year. And we have about 2,000 people that go to court, civil commitment hearings in 2011, so, they were court ordered to treatment in maricopa county alone. So, it works a large, for a large percentage of people. Sometimes, the parents don't want to be involved because of the stigma, and the son or daughter will be angry. So, it's good. I've been involved as an applicant, take the burden off the parents, and the neighbors can be, friends' attorneys can be, the applicant can be anyone. Police officers frequently are.

Ted Simons: And I want to bring that up, as well. Often law enforcement is the first responder in some of these types of situations. Talk about the dynamic there, and the challenges with that.

Charles "Chick" Arnold: We've been blessed to have taken advantage of crisis intervention training for police officers. So, police officers throughout our state now have the ability to trained about what to look for and then what to do about it when you see it. And as Dr. Potts suggests again, police officers now take people to the urgent care center, despite the fact that our county jail is the state's largest treatment facility. The intent, the public policy of our state, is to treat people, not incarcerate them.

Tim Simons: And that was, I was going to mention that. The idea of making sure that, that people -- treatment over punishment, for lack of a better phrase. Is that still holding true? Has that evolved over time?

Charles "Chick" Arnold: Well, statutorily, yes, in practice, no. Treatment works, Ted. It's unfortunate that, that, again, under the cover of the fiscal crisis, we have significantly reduced mental health services at a time when awareness and demand is increasing. That's a, a scary dynamic on our state.
Ted Simons: Are you seeing that, as well? How is that dynamic shifting and how is it moving regarding treatment regarding punishment?

Jack Potts: What's happening, first of all, is because of the Phoenix Police Department and other agencies, they are taking the people who are in harm's way, the mentally ill to the urgent care centers, which is good because they are being dealt with professionally and quickly. One of the biggest issues, though, is if you are not title 19, and you're court order for treatment, if you don't get Federal benefits, the court order is meaningless. It's a fiction. So, the people, even though they are committed and say, we need treatment, know you need treatment, they are not going to get it because there is no services out there for them. So, what's happening is they are getting recommitted over and over, and after a while, they will be incarcerated because once they get out of the hospital, there is no follow-up.

Ted Simons: Last question, I think a lot of people were concerned that someone with a history that Jared Loughner had was able to secure firearms, was able to purchase a firearm. And talk about that situation. Has any of that changed? What's going on there?

Jack Potts: The issue is he didn't have a history. He had a history of being strange. He did not have a history of mental commitment or of psychiatric treatment, didn't have a history of being a felon. If you do and are civilly committed now, your rights to possess a firearm are taken away from you, sometimes, probably, inappropriately. But, the reality is he was never in the system, and he could have been and should have been.

Ted Simons: I was going to say, he should have been and could have been by 14 the way of the community college, the antics there?
Charles "Chick" Arnold: Absolutely. Our statute would have permitted and encouraged people who were aware of the behaviors that caused them to suggest that he should not be anywhere near that campus, they could have very well knocked down a domino that would have knocked down other Dominoes that could have gotten him evaluated by mental health professionals to see whether he met the standards of our public policy.

Ted Simons: So, quickly, as Jack mentioned earlier, the laws are there, whether they are being followed is another matter.

Charles "Chick" Arnold: It's an education and training issue.

Ted Simons: All right, very good. Gentlemen, good to have you here and thanks for joining us.

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