A local guide on legal issues for the mentally ill

The Baltimore-area affiliate of the National Alliance on Mental Illness ( NAMI) published a guidebook last month for people assisting mentally ill persons who have legal problems or other interaction with the criminal justice system.

Beyond Punishment: Helping Individuals with Mental Illness in Maryland’s Criminal Justice System is being published with a grant from the Harry and Jeanette Weinberg Foundation and individual contributions. It was edited by Kathryn S. Farinholt, executive director of NAMI–Metropolitan Baltimore.

Exhibit A spoke this week with Ms. Farinholt and also a Baltimore County woman who has been helped by NAMI and uses the book.

Interview with Kathryn S. Farinholt:

Q. Is mental illness common among people who are arrested?

A. Yes. People with mental illness are significantly overrepresented in the criminal justice system. Each year, 10 million people are booked into U.S. jails; studies indicate that rates of serious mental illness among these individuals are at least three to four times higher than the rates of serious mental illness in the general population. In fact, a large number of people with mental illness in prison (and especially in jail) have been incarcerated because they displayed the symptoms of untreated mental illness in public. Experiencing delusions, immobilized by depression, or suffering other consequences of inadequate treatment, many of these individuals have struggled, at times heroically, to fend off symptoms of mental illness. Providers in the mental health system have been either too overwhelmed or have too little financial support to help some of these individuals, who typically have a history of getting inadequate treatment or refusing it altogether.

Q. How might mental illness complicate a person’s situation once they are in the criminal justice system?

A. Many ways. Just some of them: Mental illness symptoms can involve behaviors that make it hard for the person to comply with commands and structure in jail or prison, preventing earlier release. Sometime the person cannot provide full or coherent information to police, defense attorneys or corrections officers. If unidentified, without treatment or if the system does not have complete psychiatric history from community providers or family, the person may not receive appropriate or any psychiatric treatment, exacerbating symptoms.

Q. Is the criminal justice system in Maryland well prepared to deal with the problems of the mentally ill?

A. Maryland has made a lot of progress in this area in the past few years as mental health advocates and agencies and criminal justice advocates and agencies have worked together. But, no, the criminal justice system is just not set up to screen or treat individuals with mental illness. In addition, each local police department, court and jail is different in its capacity.  Although there ARE some good programs, they are often poorly funded or unknown and therefore less accessible to people outside the system itself.

Q. What is the book’s format? Is it written for the general public?

A. We tried to write the book in plain English, and to make practical advice easily accessible. We don’t expect individuals to read the book from start to finish, but to consult it as a resource when specific questions or situations arise. For example, an individual whose family member has been incarcerated can consult the Jail section of the book, which provides practical suggestions about communicating with jail staff to help the family member obtain psychiatric services.

Q. Does the book suggest ways to prevent the mentally ill from getting into legal trouble? If so, what are some of the ways?

A. There is some basic advice on preparing for and avoiding mental health crises. In addition, we indicate those times where there may be options to divert the individual from the criminal justice system to mental health treatment.

Q. Do affordable resources exist for Baltimore-area families hoping to find help for mentally ill relatives?

A. There are some excellent and innovative programs in the Baltimore area. Local public mental health agencies do a lot with very limited funding. If a family or individual is not eligible for public services, private insurance does not tend to pay for many of the services needed to keep someone stable. The nonprofit PLAN of MD-DC provides low-cost case-management services. NAMI provides family education and support. Our services are free, funded through grants and individual donations.

Q. Would the book be useful for people who live outside the Baltimore area? Outside Maryland?

A. We are getting quite a response from outside Baltimore. Several national organizations have sent out the link to the book. Actually, we designed the book to be a template. Much information is generally applicable to all jurisdictions, but certain information is designated as applicable specifically to Maryland or to certain local jurisdictions.  Maryland counties can easily insert their local information. We have been contacted by agencies from Harford, Wicomico, Frederick and other counties to discuss local editions. The book can also be easily revised for other states. We have also received calls from organizations and individuals as far away as California to discuss such revised editions.

Q. How can people get copies of the book? What does it cost?

A. It can be downloaded FREE from our Web site at www.nami.org/sites/namimetrobaltimore and is available in simply copied versions through partner sites (mental health agencies, corrections agencies, etc.)
In February, the book will be available for purchase as a bound trade paperback through Amazon.com.

Q. What other work does NAMI–Metropolitan Baltimore do?

A. We provide education and support for families and individuals living with mental illness, community outreach and education to reduce stigma and advocacy for research, evidence-based treatment, and programs that improve the lives of people with mental illness and their families. NAMI Metropolitan Baltimore is the local affiliate of the National Alliance on Mental Illness and serves the Baltimore City and Baltimore County community.

Q. How can people contact your organization?

A. namimetrobaltimore@yahoo.com or 410-435-2600. There are also excellent resources available on our Web site and that of our national organization at www.nami.org .

Farinholt adds that organizations have sent information, useful for people in other areas and states, that can be found on the Baltimore affiliate’s Web site. She also said that organizations in other areas are welcome to use the book as a template to create their own. When they request permission to do so she can put them in touch with printers familiar with the book.

An appreciative client

A Baltimore County woman who asked that her family not be identified speaks enthusiastically about what NAMI has done for her as she copes with and helps an adult son. He’s served one jail term and is in jail again after being arrested last week. She’s thankful to have the book to rely on.

While the woman says most police officers and the entire staff at the Baltimore County Detention Center have been helpful, she is learning from the book how to better serve as an advocate for her son. For instance, she knew this time that she could share information with the court about her son, whom she adopted at age 2. He’d been physically and emotionally mistreated since being born into a violence-prone family and still suffers from the effects of that trauma.

“This book is wonderful,” she said. Just this week it helped her make a painful decision: to not post bail for her son this time. As a mother, she felt the urge to get him out of jail as fast as possible, but after reading the book she decided to let him stay there, where he at least has the structure he needs right now in his life. The book’s section on bail breaks down the issue for the reader, explaining options and their likely outcomes. Her trust in NAMI allowed her to base the decision on logic, not emotion. She plans to post copies of those pages in her home for reassurance.

The woman praises the book’s organization and its glossary. You don’t have to read the book cover to cover, she said. Instead, checking the table of contents allows you to find what you need with ease.

She is eager to give copies to officers she meets and to relatives of mentally ill persons who’ve run afoul of the law. “It tells us what we can and can’t do,” she said. “It’s in writing,” so rights, rules and contact information can be pointed out to officials. Once, when officers visiting her home were eager to check with another jurisdiction, she reached for her copy and quickly looked up the phone number.

“NAMI teaches us to be survivors of the effects of mental illness,” she said in recommending, in addition to the book, the organization’s support groups for family members.