IT’S A GRAY AREA: Grappling with mental illness

IT’S A GRAY AREA: Grappling with mental illness - by Judge Jim Gray

Mental illness has been a part of the human experience for as long as mankind has walked the face of the earth. But within the last several years, medical and legal professionals have come a long way in understanding and being able to grapple successfully with these issues. In fact, there are some really good things that are happening in this area here in Orange County.

Today the largest mental health facility in most counties, including ours, is the local jail. This is mostly not intentional. But when mentally ill and often homeless people congregate and loiter in front of someone’s home or business playing their boom boxes too loudly, urinating in the flower beds or on the sidewalk, sleeping in doorways, or chasing people’s visitors and customers away, residents and business people have no recourse other than to call the police. On the first occasion the police usually take the offenders to a shelter or similar venue. If they keep returning, sometimes the police still drive these people to the city limits and tell them “not to come back.” It is illegal to do this, but it still happens. Otherwise, the police have no other viable choice than to take them to jail.

That is unfortunate because jail is not only the most expensive option, but also often inflicts untold damage upon these emotionally fragile people. But now when they are brought to jail in Orange County, they will be screened and, if the offenses are not particularly serious and they otherwise qualify, the mentally ill will be brought to the team at the Community Court.

Although Chief Justice George made the opening comments at the dedication ceremony at the new Community Court at 909 N. Main St. in Santa Ana on Friday, my dedicated and caring colleague Judge Wendy Lindley has been the leader behind this effort. She has gathered together people from the District Attorney’s Office, public defenders, Probation Department, Social Security, Health-care Agency, and Social Services, and they will work together to diagnose the problems of the homeless, mentally ill, and other people with a “dual diagnosis” of both mental disorders and illicit drug offenses who are generally “self-medicating” their symptoms. Then this team of professionals will pool their ideas and talents in putting together treatment plans backed by the powers of the courts, so that all of these defendants will have a chance to obtain and live at their highest performance level. This is a positive development that we can all be proud of! Thank you, Judge Lindley!

In addition, you should be aware of other resources in our county that are available to help with the problems of the mentally ill. If you need immediate help with a psychiatric emergency, you should call (714) 834-6900 and request assistance from the Centralized Assessment Team. Otherwise, if you need more generalized but non-emergency assistance, you should call Social Services’ Behavior Clinic at (714) 440-6767, or for dual-diagnosis patients you can call (714) 480-6660.

Studies show that only about one-third of the people with mental disorders in our country receive even “minimally adequate” care, and that percentage is far lower for those who are incarcerated or homeless. But it is not any more a crime to be mentally ill and need some psychotropic medication than it is to be diabetic and need insulin. It is often a chemical imbalance in a person’s brain that causes the problems, and medication can often be amazingly successful in helping people to live mostly normal lives.

That is not to say that there should not be safeguards to protect people from being forced unnecessarily to take psychotropic medications. Sometimes lazy medical doctors over-prescribe medications simply to keep their wards more “under control.” But in my years presiding over the Mental Health Calendar in the Superior Court, after hearing expert testimony and witnessing some truly unstable people, I have ordered that they take these medications, involuntarily if need be. And I have seen changes within seven to 10 days that were little short of amazing.

For example, the only time I have ever felt in physical danger as a judge was an occasion in which a man was testifying in my court in one of those hearings. And he was acting in such a truly bizarre and threatening fashion that I physically moved farther away from him. The experts said his records showed that he was a teaching tennis professional from another county who had stopped taking his “meds” while visiting relatives in Orange County. So I ordered that his medications be resumed, involuntarily if necessary.

Within about a week this man was back in my courtroom, and appeared to be perfectly fine. In his testimony he acknowledged that he had a mental disorder, and had forgotten to continue with his medications. And then once he had stopped, he fell into the mindset that he didn’t need them, and that led directly to his mental deterioration. But now that the meds were back in his system, things were fine, and we were joking about how I would never win Wimbledon, etc. And this instance was not at all unusual.

Without governmental and public support of programs like these, the mentally ill by default will hang out in public libraries, receive their medical treatment only in hospital emergency rooms, and be warehoused in county jails. So as you can see, ignoring mental health problems is much more expensive both in human as well as financial terms than addressing them directly. But we are doing pretty well here in Orange County, and I thought that you would like to know.

JAMES P. GRAY is a judge of the Orange County Superior Court, the author of Wearing the Robe – the Art and Responsibilities of Judging in Today’s Courts (Square One Press, 2008), and can be contacted at http://www.judgejimgray.com/ or at his blog at http://judgejamesgray.blogspot.com/