Hope Happens Here. I didn’t truly understand the meaning of this slogan until I first stepped into the Bronx Adolescent Skills Center (ASC) of Vibrant Emotional Health. Vibrant provides services to support all people who experience mental and emotional stress in every aspect of life. In addition to Vibrant’s various programs to emotionally support the community, this organization runs the largest national suicide lifeline promoted through the song “1-800-273-8255” by Logic, a famous and talented rapper.
Underneath the umbrella of Vibrant, the Adolescent Skills Center is a home base for students ages 16-21 with emotional or behavioral issues that prevent their educational or vocational success. The clinically-trained staff at the ASC provides numerous resources to support students emotionally, mentally, and academically.
In the few weeks that I have spent as an intern at the ASC so far, my entire perception of mental health has changed. I began my journey by reading through the charts of all the current students either pursuing their high school equivalency diploma or utilizing the vocational services at the ASC in order to get a job. I learned about what seem to be the infinite diagnoses of the DSM-5, as well as the emotional distress and disadvantages of so many people my age.
Within my first week at Vibrant, I shadowed an intake interview with a young girl–almost two years younger than me–who is battling PTSD from being stabbed in what she described as a “gang retaliation” incident. There is no experience more harrowing than learning about the trauma of someone that is so similar to you, and yet, so different.
Though mental health is a concept that is difficult for anyone to master, you can imagine how difficult it must be for a young student from a low-income, high-crime neighborhood to manage their emotional trauma, academics, and career paths simultaneously. On the most basic level, students in low-income areas of New York City are not provided the same educational or vocational opportunities as students in other areas. Vibrant’s ASC battles this social injustice head-on every day.
With each morning that I step into the ASC office, I am stepping outside of my comfort zone just the right amount to encourage and inspire the ASC students as a role model, a friendly face, and a support system as a peer. My personal contribution to the fight for the prosperity of our students is advising three specific students as a peer advocate. I look forward to spending my summer learning the stories of my students and understanding how I can best encourage them to continue on their paths to success.
Mental health, as I understood previously, is a complicated concept. However, since I started my journey at the ASC, I am learning that mental illness comes in all shapes and sizes and that it can completely control–and in some instances damage–a person’s entire life. In tackling the overwhelming concept of mental health, I expect to have many uncomfortable yet inspiring experiences, and I can’t wait to share them with you.
The mission statement of To Write Love On Her Arms, the organization with which I am interning, does as much justice to its mission as two short sentences can:
“To Write Love on Her Arms is a nonprofit movement dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury, and suicide. TWLOHA exists to encourage, inform, inspire, and invest directly into treatment and recovery.”
There are many different ways that TWLOHA addresses these goals. One of the most important of these ways is the blog on the TWLOHA website. Twice a week, a post is published on the blog. These posts often directly discuss the four issues referred to in the mission statement, but also discuss abuse, eating disorders, bullying, anxiety, self-care, and recovery, among other topics. The posts bring these issues to light in an attempt to humanize the people who suffer from them, and to provide encouragement and hope to people struggling. They are also an effort to reach people who are not struggling and convince them to care about those who are, as well as an effort to reach people who are struggling and remind them that recovery is possible, and it’s okay to have a mental illness even in a society that tells you it isn’t.
Another important way TWLOHA addresses its goals is by serving as a bridge between treatment and people struggling. The “Find Help” page contains a constantly updating list of carefully selected treatment services for locations around the United States and even in other countries. It also features a list of national resources that can be accessed by anyone in each of the countries listed. TWLOHA also offers counseling scholarships to help pay for treatment for those who can’t afford it, and invests money directly into places like suicide hotlines and foundations for advocacy and the funding of research. To date, TWLOHA has invested over $1.5 million into organizations that directly and indirectly help people who struggle with mental illness.
As an intern this summer, I have a few different responsibilities that I’ll be tackling along with my fellow interns. All seven of the interns answer emails for the first half of the day. This is more important than it sounds. The emails include everything from partnership requests, to expressions of gratitude to the organization, to telling stories of one’s struggles. Often there are emails that ask for help because the senders have no where else to turn. My job as an intern is to respond to all of these emails thoughtfully, with compassion and encouragement, and in a way that shows the sender that we care about them. This is one of the things we do that has the most impact on individual lives. We receive so many emails from people who say this organization helped them find their reasons to keep living, or that a reply email we sent to them was exactly what they needed to hear. I had no idea sending a simple email could make such an impact on someone’s life.
Another one of my responsibilities is to seek out more resources for the website, especially in the few states and many countries that don’t have any listed yet. I also help go through the applications for the next intern term, and I have been organizing our blog archive. Last weekend, I got to run the TWLOHA booth at Firefly Music Festival in Dover, Delaware. After reading so many emails thanking us for the work we do, I had an even deeper appreciation for the organization than I did before I arrived. However, running the booth at Firefly made me know how incredibly worthwhile this work is. So many people came up to the booth and told us that TWLOHA helped them get through an extremely dark time in their life. Some people hadn’t heard of us, but struggle themselves, or had lost a loved one to mental illness. Their thanks for doing the important work we do was so touching and meaningful. After witnessing this and hearing these stories, my main goal for the summer is to help as many people as possible, directly or indirectly, and to do everything in my power to make life better for people who struggle with mental illness.
The Truth about “Not Guilty By Reason of Insanity.”
People have always been fascinated by individuals with mental illness. Legal movies have especially glamorized mentally ill criminals who plead not guilty by reason of insanity. They are portrayed to do the crime and not do the time. But in real life, it appears that NGI clients are doing anything but “getting away with it.”
The truth is, NGI clients have it bad. But before I get into the details, here’s a brief summary of how it works. When someone is brought to criminal court, they have the option to plead not guilty by reason of insanity. This means that if the court finds them not guilty by reason of insanity (NGI), it opens a mental health case. Subsequently, NGI clients are committed to a hospital for psychiatric treatment. This commitment is indefinite.
Let me clarify what “indefinite” means; the patient stays in the hospital for an undefined amount of time, meaning that for the foreseeable future they are given a sentence without an expiration date. The point of this type of commitment is the treatment for the defendant’s illness, as opposed to punishment for a crime.
The minute this happens, the legal rights of the mentally ill shrink to a mere opportunity to petition the court for release every 6 months. In reality, this petition rarely works for the advantage of the NGI patient. One of my mentors informed me that in the Public Defender Service for the past 30 years there have been 2-3 NGI patients that won through petitioning. So the chances of an NGI patient being released because of one of these hearings are minute.
The “Other” Death Row
Committing people who are not dangerous for a week or a month seems unjust. So then what do you call it when people are committed for what is practically a life sentence without even knowing it? During my training at the Public Defender Service , my supervisor Carolyn Slenska, Investigations coordinator at the Mental Health Division, informed me that the average stay for an NGI client is 30 years. Throughout my internship, I have read about and even met NGI clients who have been committed for 30 years and counting.
Last week, there was a film showing on NGI patients in the D.C. Superior Court. In the documentary, “Voices from Within,” Joy Haynes follows the commitments of four NGI patients at St. Elizabeth’s Hospital. She and her crew gave cameras to patients at St. E’s who volunteered to participate in a video diary project. They trained them and asked them to record their stories. The documentary presented the real lives of 4 mental health patients who collectively spent 160 years in commitment after being found NGI.
When you sit down and watch the documentary, you forget that you’re following the lives of patients who are supposed to be dangers to themselves or others. You see four high functioning, coherent, cooperative, funny, and relatable human beings. You see men that don’t belong in the hospital. So why are they there? And until when do they have to stay?
Lew, one of the NGI patients, said, “I’m sitting on death row, I just don’t know it.” Tragically, after 47 years of commitment, Lew passed away at 71 years of age. In fact, three of the four men featured in the 2010 documentary have since passed while still in commitment.
Lew also shared a disturbing conversation he had with one of the staff members at the hospital. He states that a staff member told him, “You just stay crazy, you’re putting my kid through school.” All four men featured in the film wanted their freedom. The commitment in the psychiatric hospital is supposed to be about treatment. But after these men get better, after they no longer pose a danger to themselves or other, why are they still there?
Which Side Are You On?
The other day I noticed there is a quotation framed on the walls of the Psychiatric Institute of Washington (PIW). It reads: “Take my will and my life. Guide me in my recovery. Show me how to live.” (Note: Coincidentally, I recently visited PIW and after certain renovations, the plaque is off their walls!)
Then I read the quotation in the back of our business cards: “The mission of the Public Defender Service for the District of Columbia is to provide and promote quality legal representation to indigent adults and children facing a loss of liberty…and thereby protect society’s interest in the fair administration of justice.”
It then became so clear that the mental health system has not escaped the grasp of the adversarial system. There is a clear application of the adversarial process in mental health cases – as in any type of case. On one side, we have the Public Defender Service who tries to get its clients out of the hospital, and on the other side, we have the hospitals that detain and commit people as psychiatric patients. One fights against the loss of individuals’ liberties and the other fights because they know what’s good for the patient. It’s the ultimate battle of lawyers vs. doctors.
An Impossible Burden — Michael Jones v. United States (1983)
Attorneys around the office often bring up this monumental court case, Michael Jones v. US According to this Jones v. US, a patient “has the burden of proving by a preponderance of the evidence that he is no longer mentally ill or dangerous.” (Source: http://www.law.cornell.edu/supremecourt/text/463/354). The significance of this case, however, lies in the decision that the length of the commitment to a psychiatric hospital is not related to the length of time that the defendant would have spent if he were convicted.
Here’s an example: John Doe steals bubblegum from a candy store and the court finds him not guilty be reason of insanity. He gets an indefinite sentence at a psychiatric ward. In an alternate reality, Mr. Doe would have been found guilty for the misdemeanor. Let’s say Mr. Doe is a repeat offender and gets jail time for 2 years. Regardless of the fact that his criminal conviction would have yielded a 2 year sentence, the psychiatric commitment can “until such time as he has regained his sanity or is no longer a danger to himself or society.” (Jones v. US, 1983). This decision makes sense — the whole process sounds fair enough on paper. Well, in reality the burden that is placed on the patients is immense and nearly impossible to meet.
I see the process as having 3 stages. First, an NGI patient has to be examined by his or her treatment team. If the treatment team recommends the patient’s release, we move onto the second stage. On the second stage, the clinical board reviews the patient’s case and makes a determination. If the clinical review is for the release, we move to the last stage. On the third stage, the clinical review board submits the petition to the court asking for the patient’s release.
Here’s where things get complicated: NGI patients have committed crimes. This means that the government is involved in their case. On the third stage, the government can agree or disagree with the hospital’s recommendation to release the NGI patient. If they agree, then it’s up to the court to decide whether the patient can be released or not. If they disagree, it’s still up to the court, but it’s practically impossible to win release. In other words, the government’s agreement is integral for a real chance at NGI patients’ release.
A Necessary Battle
It would be easy to see the situation as a black and white, good vs. bad, where what we do at PDS is good and what the doctors do is bad. But that’s simply not the case. In the real life of mental health cases, lawyers vs. doctors is a necessary “battle.” PDS has developed strong relationships with the majority of psychiatric and medical doctors in D.C. mental health hospitals and psychiatric wards. The adversarial process is set so that each side fights for the client’s best interest. The attorneys at PDS are assigned to represent the clients. Many patients want to be free, many of them want to get out no matter what. So the attorneys do the best they can to advocate for the clients’ decisions. On the other side of the system, if the patients are in risk or hurting themselves or others, someone has to fight to keep them in the hospital until they get better. So medical staff members do the best they can for the clients’ well being.
In conclusion, when an individual with a mental illness is in court, the judge or jury should be deciding between the two best alternatives for the client – that’s what the adversarial system is supposed to accomplish anyway. Sometimes the court deems it necessary to detain a patient until their mental illness is not a danger. Other times, there is no danger and the court honors the patients’ choices and freedom.
Even so, it seems that NGI patients are giving up their entire lives just waiting to “get better.” There also seems to be no standard for what “better” looks like — it’s a very subjective evaluation with very little accountability attached to the evaluators. In NGI cases, the necessity of a vigorous advocate is evident. After a month at the Mental Health Division of PDS, I have come to appreciate the attorneys’ ability to advocate for exactly what a client asks for, without the insertion of their personal beliefs, the doctors’ recommendations, or a subjective bias. In order for the system to work, I guess each player must do what he or she does best – lawyers fight to get clients out, and doctors fight to keep them in – in the hope that the adversarial process is saving more lives than it condemns.
This summer I have the pleasure of working for two defenders at the Mental Health Division of the Public Defender Service, Sheryl Jones and Hadley Truettner, in Washington D.C.. As an intern investigator, it is my responsibility to travel to different mental health facilities, interview our clients, inform them of their legal rights, and help them meet their needs. When I first came across the internship listing on B.hired, I knew that I had my top choice for a summer job.
Both Sheryl and Hadley are wonderful mentors; they have shared numerous stories about their background and experience as attorneys. Even with just a week’s worth of experience, I know that my time at PDS will be invaluable for determining my interest in law school or a potential career at an attorney in the public sector.
Unlike most legal internships, PDS intern investigators are active “field agents” for their clients’ defense. We interview clients, family members, eye witnesses, collect relevant information, request record releases from psychiatric hospitals, review and summarize medical records, attend hearings and sometimes we even get to testify on behalf of our clients!
Sheryl and Hadley both have numerous cases that they are working on and they receive new ones from the U.S Superior District Court every week. I have learned that the mental health system proceedings are very complex. Essentially, patients can get emergencied to psychiatric wards against their will, if certain certified agents determine that they are a danger to themselves or others as a result of their mental illness. Once in the hospital, the court assigns one of the PDS attorneys to represent the clients because they need our help to get out.
I am always impressed by Sheryl and Hadley’s ability to champion their clients’ desires — and it’s not always easy. Many clients refuse to speak to us, others don’t trust us. However, years of experience have given the PDS attorneys a tough skin. Sheryl has informed me that she doesn’t take it personally anymore. It is clear that through this internship you learn to respect a client’s decision, no matter what that decision is. What happens to the cases where the clients refuse to speak with their attorney? Well, attorneys prepare as best they can without the client’s cooperation, and they show up to court hearings to channel the client’s decisions.
I have had two remarkable experiences following PDS attorneys to court hearings. Regardless of the outcome of the hearings, both attorneys gave powerful and confident performances; they exhibited a thorough knowledge of case law and rules of evidence, clear grasp of their client’s case, and respect towards client’s wishes. They are models for how to build rapport with clients and how to fight for client’s wishes. The longer I stay in this internship, the deeper into the cases I get and the more fieldwork I do. I believe that by the end of the summer, I’ll be on my way learning how to play defense.
Over 100 years ago, there was a mental health hospital called the “Government Hospital for the Insane.” Deep within the walls of this gothic facility lied psychiatrists and their patients…Looking at old pictures of the historic hospital easily evokes the first words of a scary story. Today, this mental health institution is called St. Elizabeth’s Hospital; it’s gone a long way from where it first started 100 years ago, but the hospital’s “moral treatment” policies still prevail.
While medicine has evolved and many mental health patients experience tremendous progress with regard to their symptoms, there is a stigma against them in contemporary society. The mentally ill are defined by their illness. Investigations coordinator at the Mental Health Division of the Public Defender Service, Carolyn Slenska, stated that “when you’re mentally ill, you’re never the person they listen to…People find ways to use [the mental illness] against you, that’s not fair.”
In many cases this stigma leads to a suppression of human rights. When we consider mental health patients, we must always remember to respect their liberties, their rights, and by extension, their decisions — no matter what those decisions are.
Life as an Intern Investigator
The main lesson we learn from Ms. Slenska is that mental health patients have the same rights as any individual.