I'm An Attorney. This Is What It's Like To Represent Mentally Ill Clients Facing Civil Commitment Proceedings

I'm An Attorney. This Is What It's Like To Represent Mentally Ill Clients Facing Civil Commitment Proceedings
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People with disabilities are part of the spice of life and a great asset to our diverse communities, and perhaps more often than you might realize. According to the National Alliance for the Mentally Ill, 1 in 5 adults in the U.S. (43.8 million, or 18.5%) may experience mental illness in a given year. In addition, nearly 1 in 25 adults in the U.S. (9.8 million, or 4.0%) will experience a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.

People with psychiatric disabilities who receive inadequate care are vulnerable because they may face dire consequences in the community, such as loss of their property, livelihood, and freedom. For this reason, disabled litigants should be entitled to effective and compassionate legal assistance during times of crisis.

Currently I serve as a court appointed attorney for persons with mental illness facing civil commitment proceedings in the state of Massachusetts. All of my clients have a mental and/or physical health problem that, for one reason or another, has evolved into a legal proceeding. Based on my experience, this is what it is like to be an attorney who represents persons who are indigent, mentally ill, and being held in a psychiatric hospital against their will.

All of my clients are human beings who are suffering, and they deserve to be treated with compassion and respect.

The commitment process may start for my client when a care giver or loved one calls an ambulance out of concern for the client’s behavior and/or deteriorated mental health. Maybe the mentally ill person is depressed won’t leave the house, isn’t taking care of themselves, and their conversations have become a rapid string of loosely related topics and incoherent thoughts that put others in fear that they might hurt themselves or someone else. Other times a client might be picked up by police for displaying some sort of anti-social behavior in a public place (nudity, disturbing the peace, etc.). Instead of taking my client to jail, the police might have [mercifully] brought my client into the hospital emergency room for evaluation.

Regardless, it’s not my client’s fault that they are sick. If they had the flu or a broken leg, you might feel sorry for them, but people who are acutely mentally ill rarely get the empathy and sympathy they deserve.

When the client is admitted to the emergency room, the hospital has the authority to temporarily hold the client against their will for up to 72-hours (without a hearing) if the hospital reasonably believes the client’s mental health condition poses an imminent physical threat to themselves or others (suicidal, homicidal, etc.). In particularly severe situations that do not improve after 72 hours, the hospital (or someone else with standing) may petition the court to confine the person to a psychiatric facility for treatment for up to 6 months or a year (depending on the circumstances). Such cases are civil in nature, not criminal.

When a person is temporarily held in a hospital or committed against their will to a psychiatric facility, they are entitled to legal counsel to assist them with understanding their rights and to represent them in the proceedings. If the person cannot afford an attorney, the court will appoint an attorney from the Committee for Public Counsel Services to represent them. That’s me.

From the moment I am assigned a new client, I have 24 hours to go to the hospital and meet with my client. When I get to the hospital, the only information I usually have on my client is their name, maybe some scraps of personal information (if I’m lucky enough to get the medical records right away). When I arrive on the locked psychiatric ward, I usually have no idea what I’m walking into. My client might be in a state of psychosis, they might be depressed or delusional, they might be violent criminals. None of this matters because all of my clients are entitled to a zealous advocate and it’s my job to make sure my clients receive the Constitutional protections of due process that they are entitled to.

In every case, I have to meet alone with my client to preserve attorney-client privilege. This can be difficult if my client is paranoid and suspicious, or if my client is violent and unstable.

My first conversation with my client will usually start in the hallway with me saying “Hi, I’m your lawyer and I’m here to help you protect your rights. Would you like to go somewhere to talk privately?”

Clients also may not be able to understand the nature of the proceeding or my role as an attorney. Consequently, the conversation will often proceed one of two ways:

Client: “Fuck you. I don’t need a lawyer.”

Me: “That’s ok. Here’s my card. I can come back another time.”

OR:

Client: “Finally, my lawyer is here. The hospital is involved in a conspiracy to violate my rights and I need to expose it.”

Me: “I believe you. Let’s go someplace private and talk.”

The emotional stress and anxiety that my clients are experiencing in these acute situations is very real, and so I never take their expressions of fear and frustration personally.

Paranoia is an expression of extreme fear. As an attorney, I would believe my clients if they told me that they feel like the world has conspired against them. In the days leading up to a commitment proceeding, everything a patient does (or doesn’t do) in the hospital is documented and analyzed under a microscope, then later debated amongst professionals in a high stakes court proceedings. Suddenly, expressing fear about the consequences of Donald Trump’s America and overly broad government surveillance programs may be viewed as a symptom of a patient’s mental decline (and not the president’s). It’s also not a good time for a patient to lose their appetite simply because they dislike the taste of hospital food.

There are also many good reasons why a patient might not want to take antipsychotic medications. Is it really unreasonable for a patient to fear that a corporate hospital might unwittingly enroll them in a dangerous clinical trial without their consent or knowledge? Committed or not, it would be unusual for anyone not to be afraid if a hospital provider (who doesn’t know them) were trying to get a court order to force them to take medications with horrifying side effects that may alter or harm their body.

Sometimes I debate in my own head where the line between reasonably sane and dangerously insane may fall in a case, and I am always disappointed at how often pharmaceutical compliance replaces human compassion in the community. Other times sanity boils down to financial condition. Rich people who are mentally ill may be treated as delightfully eccentric while quirky poor people are written off as a public health crisis. Is this really fair?

It may take several meetings for the client to fully understand their situation enough to make informed legal choices. Personally, I don’t think my impaired clients have an affirmative responsibility to hide their existence or drug themselves up to make my job a little easier. To the contrary, it is my job to accommodate my client’s mental state and find a way to communicate effectively with them and the court about their case. As with any other client, I protect my client by keeping our conversations confidential and I follow their instructions to the extent that the law allows.

Since I took this job, many people have told me stories about why the public should fear the mentally ill, but I can honestly say I am more afraid of what could happen to my clients behind closed doors if they did not have a good attorney.

At the end of the day, everyone has a constitutional right to choose to be insane and to exist freely in the community so long as their brand of mental illness does not cause them to pose an imminent physical threat to themselves or others. My clients are not committed to hospitals because they have done something wrong and need to be punished, they are committed because they require a level of treatment that isn’t available to them on the outside and no lesser restrictive environment can keep them safe.

Persons who are mentally ill and dangerously symptomatic need to be seen by compassionate psychiatric professionals, but there just aren’t enough well trained doctors available to address this critical need. Even so, a diagnosis can become a weapon of discrimination that is used to keep mentally ill people separate from their communities and dependent on pharmaceuticals—even when it is debatable whether the drug is effective at improving the way the patient feels, and even when the patient the might be happier to have a bag of groceries instead of those expensive drugs. A client’s crisis will often play out in the context of irregular business hours- nights, weekends, or on holidays when their regular doctor’s offices are closed. For this reason, clients who cannot find or afford care run the risk that a brush with authorities could cause them to be locked up like criminals and denied care.

People who are mentally ill may lead wonderfully colorful and productive lives, but many other will exist in a world of secrets, wracked with shame and a kind of painful scrutiny that ordinary people without mental illness may never be able to relate to. Since the richest countries in the world haven’t found better solutions for my mentally ill client’s problems yet, there’s a good chance that they might walk out of the psychiatric facility worse off than they were admitted. For this reason, I feel good about my work helping mentally ill clients navigate the court system, particularly on the rare occasions when the court system sets them free.

Given that millions of people suffer from mental illness, maybe the solution is for America to become a more inclusive and tolerant towards people with disabilities.

Surely America can do better by my clients.

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