Saturday, October 25, 2014

What I Learned Part 3

Today I enjoyed the presentation about the role of the Academy and of the American Psychiatric Association in appellate litigation. Both organizations work together to file amicus curiae ("friend of the court") briefs for court cases that have relevance to psychiatry and the care of the mentally ill. The APA has participated in 127 cases since 1962, and AAPL has participated in 16 cases since 1985. Most briefs are written by the APA counsel (all of whom have been former Supreme Court law clerks). Most of the cases were criminal rather than civil cases, and several were cases that went before the U.S. Supreme Court. AAPL wrote briefs for cases involving intellectually disabled defendants facing the death penalty, and in the California prison case regarding overcrowding and access to mental health and other services. The AAPL brief was cited in the appellate opinion in 10 of the 15 cases, so the organization apparently does have some influence.

A panel presentation on the New York Safe Act was interesting, since the work on it was done long before the New York Times story came out on the subject. A group of forensic people tried to obtain data from the New York Office of Mental Health as well as the New York Division of Criminal Justice Services regarding the number of reports made, the professional training of those filing reports, the treatment settings the reports were made from, and the ultimate outcome of the reports. Both agencies refused to release data for a variety of reasons, either because "it was an election year" or because the statute was in litigation. In rare cases, the agency expressed concern over potential privacy issues where a report was filed in a county so small that the individual could easily be identified. Both agencies said that the only way to determine the number of guns actually seized would be to contact each law enforcement agency in every county---not a small feat for the state of New York. The only definitive statements given by OMH was that no reporter had ever been sued to date for making a report, and that there were some cases where reports were made by someone other than a mandated reporter (a psychiatrist, psychologist, social worker, or psychiatric nurse). None of these reports were acted upon or forwarded to local law enforcement. The implication appeared to be that if the information was coming from someone other than a mental health professional it might not meet the standard for requiring that dangerousness be due to a mental illness. This is speculation on my part; still, I'm not sure why a lay assessment of potential dangerousness---regardless of cause---wouldn't be taken seriously by someone. More evidence that common sense and public policy do not always go hand-in-hand.

The final session of the day was a panel presentation on consultation to law enforcement, easily the most testosterone-laden of any talk this week. The presenters were people who provided peer support, counseling and fitness for duty assessments on police officers. There was a lot of emphasis placed upon the need to slowly develop trust both with the department and the individual officer. In addition to post-incident counseling, mental health providers were involved in substance abuse and domestic violence counseling as well as crisis and hostage negotiation. I was impressed by some initial data they presented: that a police officer is two to three times more likely to die by suicide than to be killed in the line of duty, and that the life expectancy for an officer is 10 years less than the rest of the population (average age 66). This seemed like such a dramatic statistic that I figured I should do a little research about it myself, and I did. I found this article which contradicted the ten year number. In this 2013 study I found, the life expectancy of a police officer in Buffalo NY was actually 20 years shorter! Yowza.

Tomorrow's topics: Guns and the mentally ill, and research done on prisoners (ethics and barriers).

And a thank you as well as a shout-out to D.J. Jaffe for taking the time to tweet with me today. I'm trying to encourage the organization to have a more real-time social media presence during future conferences and your input was a great example of how the organization can broaden our discussions.