Civil Commitment and Criminality


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Civil Commitment and Criminality

  1. 1. CIVIL COMMITMENT AND CRIMINALITY THE FINE LINE BETWEEN INPATIENT TREATMENT FOR DANGEROUSNESS AND CRIMINALITY Adam M. Weisman, Ph.D., Sanjay M. Sahgal, MD and Kaushal K. Sharma, MD USC Institute of Psychiatry, Law and Behavioral Science
  2. 2. Civil Commitment in California <ul><li>Lanterman-Petris-Short Act (LPS): Involuntary commitment statute for indeterminate commitment </li></ul><ul><li>Three key time periods </li></ul><ul><ul><li>Initial 72-hour hold for observation & treatment </li></ul></ul><ul><ul><li>Additional 14-day hold, following certification, to allow intensive treatment </li></ul></ul><ul><ul><li>Additional 180-day hold (danger to others) for additional treatment; conservatorship option </li></ul></ul>
  3. 3. Involuntary Admission <ul><li>Criteria for 72-hour hold: probable cause </li></ul><ul><ul><li>A danger to others </li></ul></ul><ul><ul><li>A danger to himself or herself </li></ul></ul><ul><ul><li>Grave disability (unable to provide for basic personal needs than endangers self) without intent of harm </li></ul></ul><ul><li>Criteria for 14-day hold (review hearing) </li></ul><ul><ul><li>Danger to self, others or gravely disabled </li></ul></ul>
  4. 4. Danger to Others <ul><li>Dangerousness and Mental Illness </li></ul><ul><ul><li>Threats or Acts: Historical Context </li></ul></ul><ul><ul><li>Clear and Present Danger: Imminent Threat </li></ul></ul><ul><ul><li>Pre-hold violence: Hold and Release to Police </li></ul></ul><ul><ul><li>Post-hold violence: Facility Options </li></ul></ul><ul><ul><ul><li>Release to jail forensic unit for prosecution </li></ul></ul></ul><ul><ul><ul><li>Hold for extended commitment without prosecution </li></ul></ul></ul><ul><ul><ul><li>Extended commitment then prosecution </li></ul></ul></ul>
  5. 5. Inpatient Facility Options <ul><li>Public Facility (state hospital) </li></ul><ul><ul><li>Medication </li></ul></ul><ul><ul><li>Seclusion and/or Restraint </li></ul></ul><ul><ul><li>Intensive treatment </li></ul></ul><ul><ul><li>Extended Commitment </li></ul></ul><ul><li>Private Facility (private hospital) </li></ul><ul><ul><li>Seclusion and/or Restraint </li></ul></ul><ul><ul><li>Discharge to Law Enforcement </li></ul></ul>
  6. 6. Research Questions <ul><li>Is a person legally culpable for violent acts when civilly committed for dangerousness to others? </li></ul><ul><li>To what degree do such violent acts represent a treatment and containment responsibility on the part of the psychiatric inpatient facility? </li></ul>
  7. 7. Case Presentations <ul><li>Two cases presented of violence within private psychiatric facility </li></ul><ul><ul><li>Violence toward other patient </li></ul></ul><ul><ul><li>Violence toward treating staff </li></ul></ul><ul><li>Cases referred for criminal prosecution </li></ul><ul><li>Forensic evaluations for defense counsel </li></ul>
  8. 8. Case A: Flashing Lights <ul><li>29-y-o, single, disabled (SSI), Hispanic male </li></ul><ul><li>6/30/05: self-admitted for suicidal ideation </li></ul><ul><li>7/3/05: assaults male patient in med line for causing “flickering lights” in bedroom </li></ul><ul><li>Victim: facial lacerations & cranial contusions; treated & released back to psychiatric unit </li></ul><ul><li>Defendant: seclusion & release to police on 7/6/05 (liability issues?) </li></ul>
  9. 9. Family History <ul><li>Born in Los Angeles, parents & siblings (1 brother, 2 sisters) gainfully employed </li></ul><ul><ul><li>Family criminal history (father, brother-DUI) </li></ul></ul><ul><ul><li>Family substance use history (father, brother-alcohol, cannabis, cocaine) </li></ul></ul><ul><ul><li>Family psychiatric history (aunt/uncle-psychoses, depression) </li></ul></ul><ul><ul><li>Child abuse history (mother-stabbing; brother-fondling) </li></ul></ul>
  10. 10. Background History <ul><li>Education: 8 th grade; GED 1994 </li></ul><ul><li>Lifestyle: transient </li></ul><ul><ul><li>1998-1999 in Seattle with sister; fish processor, warehouse work </li></ul></ul><ul><ul><li>2002: board & care homes < 2 years; SSI </li></ul></ul><ul><ul><li>2005: living on own with parental assistance; self-payee </li></ul></ul>
  11. 11. Background History <ul><li>Medical History: 1995 drive-by shooting, stomach & left hip surgery </li></ul><ul><li>Substance Use History </li></ul><ul><ul><li>Cannabis & Cocaine: age 14-15 to 1999 </li></ul></ul><ul><ul><li>Beer: age 12 to 2005 </li></ul></ul><ul><ul><li>Rehabilitation programs: 2002-2004: 3 programs </li></ul></ul>
  12. 12. Criminal History <ul><li>Juvenile: vandalism, receiving stolen property, assault, grand theft person </li></ul><ul><li>Adult: second-degree robbery, inmate assault (stabbing), cocaine possession, battery (father) </li></ul><ul><ul><li>1999-2002: Dangerous Mentally-Ill Offender (2684 PC), parole hold at Atascadero </li></ul></ul>
  13. 13. Psychiatric History <ul><li>Juvenile: outpatient family therapy, no medications </li></ul><ul><li>Adult </li></ul><ul><ul><li>1997: Prison; paranoia toward cellmate & guards </li></ul></ul><ul><ul><ul><li>Belief: being hypnotized or poisoned </li></ul></ul></ul><ul><ul><ul><li>Dx: paranoid schizophrenia; enhanced outpatient (EOP) </li></ul></ul></ul><ul><ul><li>1999: Prison </li></ul></ul><ul><ul><ul><li>Belief: raped in his sleep; hypnotized by guards </li></ul></ul></ul><ul><ul><ul><ul><li>Suicide attempt (hanging): moved to Atascadero </li></ul></ul></ul></ul><ul><ul><ul><li>Dx: schizoaffective disorder </li></ul></ul></ul><ul><ul><ul><ul><li>Rx: Loxitane, Remeron & Zyprexa </li></ul></ul></ul></ul><ul><ul><li>2000: Region III Parole Outpatient Clinic: follow-up 5 months </li></ul></ul><ul><ul><li>2001: Prison; suicide attempt (wrist cutting) </li></ul></ul><ul><ul><ul><li>Belief: girlfriend murdered & he was a suspect; raped in his sleep, others could read his thoughts </li></ul></ul></ul><ul><ul><ul><ul><li>Moved to Atascadero as dangerous mentally ill offender, held until 2002 </li></ul></ul></ul></ul>
  14. 14. Psychiatric History continued <ul><li>2002: three outpatient mental health centers </li></ul><ul><li>2003: suicidal attempt (pills) </li></ul><ul><li>2003-2005: treatment noncompliance, decompensation, hospitalization </li></ul><ul><ul><li>High Utilization Patient (> 10 involuntary hospitalizations) </li></ul></ul>
  15. 15. Preoffense Events <ul><li>Proceeding Events </li></ul><ul><ul><li>1/7/05: Crime Scene hospital-danger to others (roommate) with delusion of sexual assault, released with medications </li></ul></ul><ul><ul><li>4/18/05: found in El Paso, Texas in underwear </li></ul></ul><ul><ul><ul><li>refused medication & returned to California </li></ul></ul></ul><ul><ul><ul><li>5/17/05: crime scene hospital-danger to self: released with Zyprexa & Effexor </li></ul></ul></ul><ul><ul><ul><li>6/13/05: danger to others & self (hanging, wrist cutting) </li></ul></ul></ul><ul><ul><ul><li>6/14/05: released to area hospital until 6/20/05 with follow-up appointment scheduled for 6/28/05 at mental health center </li></ul></ul></ul>
  16. 16. Disposition <ul><li>Charge: Assault with deadly weapon </li></ul><ul><li>10/10/05: Forensic report issued </li></ul><ul><li>07/31/06: No contest plea </li></ul><ul><li>11/6/06: Four year state prison, 753 days credit; term suspended. Formal probation 3 years, $200 restitution; locked forensic inpatient facility for probation </li></ul>
  17. 17. Case B: A Nurse’s Nightmare <ul><li>19-year old male </li></ul><ul><li>Emergency Room: disorganized thoughts, persecutory delusions > 2 weeks </li></ul><ul><li>No mental health history </li></ul><ul><li>No medical history </li></ul><ul><li>No drug history </li></ul><ul><li>No criminal history </li></ul>
  18. 18. Background History <ul><li>Danger to others: threatening parents for “harassing him” and he would “get them soon!” </li></ul><ul><li>Nurse administers Haldol, Ativan & Benadryl for agitation during processing </li></ul><ul><li>During injection, subject hits nurse in face </li></ul><ul><li>Nurse: bruised but continues work shift </li></ul>
  19. 19. Background History <ul><li>Nurse & supervisor calls police </li></ul><ul><li>Subject charged with assault, held 72 hours and then sent to jail </li></ul><ul><li>Jail: Risperdal and general population module </li></ul><ul><li>Subject assaulted by other inmates, moved to psychiatric module </li></ul>
  20. 20. Background History <ul><li>Adjudicated as incompetent to stand trial (1368 P.C.) </li></ul><ul><li>Sent to Patton State Hospital; status pending </li></ul><ul><li>Review of hospital records: labor dispute among nurses due to understaffing; case used as negotiation ploy </li></ul>
  21. 21. Summary <ul><li>Dangerousness to self or others can include fellow patients and support staff after admission </li></ul><ul><li>Complete social history is essential in managing such patients </li></ul><ul><li>Forensic evaluations: Durham (product) Rule (New Hampshire) or GBMI is helpful in addressing disposition “not criminally responsible if unlawful act is the product of a mental disease or defect” </li></ul><ul><li>Liability and labor issues influence criminal prosecution </li></ul>