STAR SPECIAL REPORT: BARRIERS STAND BETWEEN MENTAL ILLNESS AND HELP

Law supports those who seek aid for others, but it's not easy

Patients needn't be a danger to self or others, but they have right to avoid forced treatment
2011-04-19T00:00:00Z 2014-07-08T17:16:03Z Law supports those who seek aid for others, but it's not easyTim Steller Arizona Daily Star Arizona Daily Star
April 19, 2011 12:00 am  • 

Yes, the 18-year-old man acknowledged, he did turn off his mother's car while she was driving it.

"There was a dog running behind us - that's what I thought," he told a judge in a small Pima County courtroom on the fifth floor of UPH Hospital at Kino.

But no, he said, he is not mentally ill - "just a little bit hyper."

The judge, Court Commissioner K.C. Stanford, disagreed and cited a particularity of Arizona's law - people can be forced into treatment even if they aren't a danger to themselves or others. Stanford ordered him to be treated, against his will, for one year.

Arizona law gives extra leeway to people seeking to have someone evaluated and treated for serious mental illness. Every state allows for involuntary treatment of people who are a "danger to self or others," and about half the states do so for those found to be "gravely disabled," or unable to take care of their basic needs.

But Arizona law also permits involuntary treatment of those who are "persistently or acutely disabled" - that is, likely to suffer severe mental or physical harm because of impaired judgment caused by a mental-health condition. That provision puts Arizona in an elite group of states, said Brian Stettin, policy director at the Virginia-based Treatment Advocacy Center.

"Arizona has one of the best, most-progressive laws," Stettin said. In Arizona, he said, "You're focusing on the fact that the person is suffering as a result of their mental illness and their inability to seek treatment for it."

That can be helpful in cases like that of the 18-year-old man, whose mother filed a petition for him to be involuntarily treated for severe mental illness. The judge denied an argument by a Pima County attorney that he was a danger to himself or others but agreed that the young man is persistently or acutely disabled.

NO PANACEA

Still, the law is no panacea, because the system can be hard for laymen to negotiate, and the patients have the right to fight forced treatment, even if it would likely help them. Since January 2008, only about 54 percent of the petitions to have someone evaluated for serious mental illness have led to petitions for forced treatment.

Cadie McCarthy discovered this, painfully, in the last two months. Her son Eric had been living on the streets in San Francisco for months before calling home the afternoon of Jan. 8, hours after the mass shooting that wounded U.S. Rep. Gabrielle Giffords.

The son, 22, did not acknowledge hearing of the shooting, McCarthy said, but a week later he called again and said he wanted to come home. When he got here in mid-January, McCarthy said, he was like he has been since symptoms of mental illness began emerging at age 17 - angry, anxious, delusional and scared.

On Sunday, March 6, he came into his mother's room and asked her to "euthanize" him, she said.

"Something snapped in me and I decided I couldn't take care of him," she said. "I think he knew what he was doing that night. He wanted help."

McCarthy had her older son call 911, and sheriff's deputies took Eric to Northwest Medical Center on what is known as a prepetition - a legal request to have a person evaluated for severe mental illness.

That first night, McCarthy signed an affidavit that was to be attached to the prepetition, but there was no notary present. A hospital employee called the next day and said she would have to sign a new affidavit with the notary present. Several abortive efforts later, the affidavit was finally signed and notarized on Tuesday, March 8, McCarthy said.

"Just trying to find my way through it all has been difficult," she said.

Upon arriving at the hospital, Eric agreed to stay there voluntarily on the condition he didn't have to take medication, McCarthy said. Evaluators there concluded he was a danger to himself, and he was sent to Sonora Behavioral Health.

But after several days at Sonora, doctors there decided they would not support a petition for involuntary treatment, she said. Her information is limited, because her son is an adult and entitled to privacy under federal law.

But the decision left her wondering: "The fact that he wanted to kill himself wasn't enough?"

PROFESSIONALS HAVE A ROLE

Professionals play a role in the petition process, even if it's initiated by a family member. In particular, social workers at Southern Arizona Mental Health Corp. often join first-responders when officers encounter someone who appears mentally disturbed.

They form the Mental Acute Crisis teams that police call in and which evaluate whether the person needs a mental-illness evaluation. Mental Health Corp. workers also check on people who are in nonemergency situations, to determine if they need evaluation.

After these "prepetitions" are filed, two psychiatrists and other medical workers have 72 hours to evaluate the patient. If they agree that the patient needs to be involuntarily treated, they file a request with the Pima County Attorney's Office, which files a formal petition to the court. These are heard in courtrooms such as the one in Kino hospital.

While Arizona's system gives some leeway to these professionals and the petitioners, it also gives the patient ways to fight forced evaluation and commitment. That, along with other circumstances, can lead to an allegedly mentally ill person avoiding treatment, said Paula Perrera, who heads the health-law unit at the County Attorney's Office.

"The mentally ill have as many rights as you and I," Perrera said.

However, she noted, when her office gets as far in the process as filing a petition for involuntary treatment, it is rare that it is turned down.

Mark Johnson often is the adversary to Perrera's attorneys in the fifth-floor courtroom. Johnson is one of the lawyers who regularly represent patients the county wants put into involuntary medical treatment.

On a recent Monday, Deputy County Attorney Dan Jurkowitz had a problem: He was supposed to call two psychiatrists to testify that another patient needed to be forced into treatment.

Both of them were out sick, so Johnson asked the judge, Court Commissioner Julia Connors, to dismiss the petition. Reluctantly, she did.

"Under the circumstances," she said, "I have no choice."

Contact reporter Tim Steller at 807-8427 or at tsteller@azstarnet.com

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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