Law Commons^™

Addressing Stigma And False Beliefs About Mental Health: A New Direction For Mental Health Parity Advocacy, Claire Sontheimer, Michael Ulrich

Faculty Scholarship

Despite laws designed to protect mental health and substance use parity in the United States, real parity remains an aspiration. Under the current system, insurance companies use multiple tactics to deny coverage for or delay the provision of mental health and substance use disorder (MH/SUD) treatment. The difficulty of enforcing parity creates a barrier to achieving the goal of accessible behavioral health services. Rather than a continued effort to legislate our way out of this conundrum, it may be useful to look further upstream. Critical impediments to achieving such parity include the basic attitudes and beliefs about mental and behavioral …

A Model For Defunding: An Evidence-Based Statute For Behavioral Health Crisis Response, Taleed El-Sabawi, Jennifer J. Carroll

Faculty Publications

Too many Black persons and other persons of color are dying at the hands of law enforcement, leading many to call for the defunding of police. These deaths were directly caused by excessive use of force by police officers, but were also driven by upstream and institutional factors that include structural racism, institutional bias, and a historic culture of racialized violence. Public outcry against racial inequities has increased as the authority of police departments has expanded to include not only the authority to respond to and investigate criminal activity, but also to respond to calls regarding behavioral health issues and …

Kicked Out, Kicked Again: The Discharge Review Boards’ Illiberal Application Of Liberal Consideration For Veterans With Post-Traumatic Stress Disorder, Jessica Lynn Wherry

Georgetown Law Faculty Publications and Other Works

In recent years, the Department of Defense (DoD) has responded to the growing awareness of mental health issues for military servicemembers during and after service. This Article focuses on veterans who have already been discharged from service, and specifically those who have been discharged under other-than-honorable conditions for misconduct that is likely the result of a mental health condition, including post-traumatic stress disorder (PTSD), traumatic brain injury, sexual assault, or sexual harassment. Thousands of former servicemembers have been kicked out of the military for misconduct rather than treated for mental health conditions they experienced due to their military service. When …

Olmstead V. L.C.: The Supreme Court Case, Samuel R. Bagenstos, Irv Gornstein, Michael Gottesman, Jennifer Mathis

Articles

You have an incredible luxury here at Georgetown Law. You have faculty who are engaged in the world like two of my colleagues on this panel. To my immediate left is Professor Michael Gottesman (Georgetown University Law Center) who argued the case on behalf of Lois and Elaine, and to my next far left, Professor Irv Gornstein (Georgetown University Law Center) who argued the case on behalf of the United States. Between them is Jennifer Mathis (The Bazelon Center for Mental Health Law) who has spent, I think, most of her career at the Bazelon Center litigating, and organizing, and …

Covid-19 And Individuals With Developmental Disabilities: Tragic Realities And Cautious Hope, Samuel J. Levine

Scholarly Works

The COVID-19 pandemic has cast the United States, along with the rest of the world, into a time of crisis and uncertainty unlike any other in recent memory. Months into the pandemic, there is scant agreement among scientists, government officials, and large segments of the public, both domestic and abroad, as to determining the causes and workings of the virus, designing appropriate and effective responses to the outbreak, and constructing accurate assessments of the future—or even of the present. Indeed, the availability of concrete information about the virus and its effects is grossly inadequate and often replaced by anecdotal or …

Pandemic As Opportunity For Competence Restoration Decarceration, Susan A. Mcmahon

Georgetown Law Faculty Publications and Other Works

Before the pandemic, a defendant found incompetent to stand trial was often stranded in jail for weeks or months as she waited for an inpatient bed to open at a psychiatric facility. While there, she usually received no treatment, her mental health deteriorated, and she was astonishingly likely to be abused and neglected. She almost certainly came out of jail in a worse state than she was when she went in.

The pandemic has made this desperate situation even worse. Now that wait in jail is both longer, as many psychiatric facilities stopped accepting new patients as they dealt with …

About A Revolution: Toward Integrated Treatment In Drug And Mental Health Courts, Sara Gordon

Scholarly Works

This Article examines specialty courts, including drug, alcohol, and mental health courts, which proponents claim created a revolution in criminal justice. Defendants whose underlying crime is the result of a substance use disorder or a mental health disorder can choose to be diverted into a specialty court, where they receive treatment instead of punishment. Many of these individuals, however, do not just suffer from a substance use disorder or a mental health disorder; instead, many have a “co-occurring disorder.” Approximately 8.9 million American adults have co-occurring mental health and substance use disorders, and almost half of individuals who meet diagnostic …

Addiction As Disease, Teneille R. Brown

Utah Law Faculty Scholarship

The opioid addiction epidemic is the most overwhelming public health crisis our country has faced. It is now creating a legal crisis, as the its poisonous fruits spill over into the criminal, tort, and family courts. The epidemic costs the U.S. economy about $500 billion every year, and the pressure is crippling our legal systems. This Article is an attempt to relieve some of that pressure, by advocating for a comprehensive public health campaign based upon a new model of addiction. Research shows that the prevalent “moral choice” model of addiction has facilitated stigma and discouraged treatment, by viewing affected …

The Moderating Relationship Of Comorbid Psychopathology And Treatment Outcome For Young Adult Offenders In Drug Court, Patrick Mcgonigal, Kathleen A. Moore, Matthew Scott Young

Mental Health Law & Policy Faculty Publications

Title: The moderating relationship of comorbid psychopathology and treatment outcome for young adult offenders in drug court.

Background: The drug court system is an alternative to incarceration that provides offenders with non-violent, substance motivated crimes with an opportunity to dismiss their charges and undergo a rigorous substance abuse treatment program. It is unknown whether drug court is effective for young adult clients and the role of co-occurring psychopathology within this context.

Methods: This study evaluated the overall effectiveness of a drug court system applied to young adult offenders ages 18-26, and additionally explored the moderating relationship of psychiatric symptoms on …

The Nypd And The Mentally Ill, Randolph M. Mclaughlin, Debra S. Cohen

Elisabeth Haub School of Law Faculty Publications

Recently, a federal court judge cleared the way for a trial in the case of Mohamed Bah, a 28-year-old student killed in his home by NYPD officers after his mother, Hawa Bah, called 911 for assistance to take him to a hospital. Southern District Judge P. Kevin Castel's ruling denied New York City's motion seeking to dismiss claims of unlawful entry and excessive force against the police officers who responded to Mr. Bah's apartment, breached his door and then shot and killed him. Mr. Bah's family alleges that the final and fatal shot to Mr. Bah's head was inflicted at …

Police Contact And Mental Health, Amanda Geller, Jeffrey Fagan, Tom R. Tyler

Faculty Scholarship

Although an effective police presence is widely regarded as critical to public safety, less is known about the effects of police practices on mental health and community wellbeing. Adolescents and young adults in specific neighborhoods of urban areas are likely to experience assertive contemporary police practices. This study goes beyond research on policing effects on legal socialization to assess the effects of police contact on the mental health of those stopped by the police. We collected and analyzed data in a two wave survey of young men in New York City (N=717) clustered in the neighborhoods with the highest rates …

A Mental Health Checkup For Children At The Doctor’S Office: Lessons From The Medical-Legal Partnership Movement To Fulfill Medicaid’S Promise, Yael Cannon

Georgetown Law Faculty Publications and Other Works

Traumatic childhood events and the stress they cause can negatively affect health over a lifetime. For children with Medicaid coverage, visits to the doctor’s office present an opportunity to improve this trajectory. Medicaid’s Early Periodic Screening Diagnostic and Treatment (EPSDT) mandate requires that children receive more than a basic physical when they see a doctor for regular “well-child checks.” As part of a comprehensive look at their development, they should receive mental health check-ups that could identify childhood trauma, its impacts, and the interventions that could help improve health and mental health. Data suggests that many children do not receive …

Resource Guide For Addiction And Mental Health Care Consumers: Answering Questions About Insurance Coverage And Parity For Addiction And Mental Health Care Services, Lucy C. Hodder, Michele D. Merritt, Margaret H. Schmidt, Jacqueline Botchman, Caitlyn Ebert, Marguerite Corvini, Kate Crary, Bridget Drake

Law Faculty Scholarship

Navigating the maze of health insurance coverage can be difficult. For individuals with addiction or mental illness, the process of getting treatment approved and paid for by health insurance can be overwhelming. As a result, many people give up when their health insurance company denies coverage for needed services. This Guide can help people learn how to access health insurance and use their coverage to pay for treatment. This Guide also provides a basic explanation of consumers’ rights under the federal Mental Health Parity and Addiction Equity Act.

Prevalence And Predictors Of Substance-Related Emergency Psychiatry Admissions, M. Scott Young, Kathleen A. Moore

Mental Health Law & Policy Faculty Publications

Background: Individuals commonly present for emergency psychiatry services for reasons related to their use of alcohol or illicit drugs. This study assessed the prevalence of these phenomena and explored characteristics distinguishing emergency psychiatry admissions with versus without presenting problems related to substance use. Methods: Data included standardized emergency psychiatry intake interviews from 2,161 consecutive admissions to three hospital-based emergency psychiatry departments in Florida’s Tampa Bay area. Admissions were classified as substanceinvolved if substance use was ascertained to be related to the presenting problem(s). Cases with only substance-related presenting problems were classified as substance-only admissions. Descriptive statistics compared substance-involved admissions to …

Crossing The Line: Daubert, Dual Roles, And The Admissibility Of Forensic Mental Health Testimony, Sara Gordon

Scholarly Works

Psychiatrists and other mental health professionals often testify as forensic experts in civil commitment and criminal competency proceedings. When an individual clinician assumes both a treatment and a forensic role in the context of a single case, however, that clinician forms a dual relationship with the patient—a practice that creates a conflict of interest and violates professional ethical guidelines. The court, the parties, and the patient are all affected by this conflict and the biased testimony that may result from dual relationships. When providing forensic testimony, the mental health professional’s primary duty is to the court, not to the patient, …

Rethinking The Childhood-Adult Divide: Meeting The Mental Health Needs Of Emerging Adults, Barbara L. Atwell

Elisabeth Haub School of Law Faculty Publications

Part I of this article describes ADHD and explores the extent of ADHD medication abuse, especially among young adults. Part II discusses the characteristics of emerging adults, who may be more likely than their older counterparts to make unwise decisions about medications and other life choices.34 While we protect minors by requiring parental consent for their medical treatments, emerging adults are effectively able to obtain any drug on the market if they convince the doctor that they have the requisite diagnosis. Part III explores HIPAA, the medical malpractice standard of care and the challenges associated with a society that is …

Diagnosis Dangerous: Why State Licensing Boards Should Step In To Prevent Mental Health Practitioners From Speculating Beyond The Scope Of Professional Standards, Jennifer S. Bard

UF Law Faculty Publications

This Article reviews the use of mental health experts to provide testimony on the future dangerousness of individuals who have already been convicted of a crime that qualifies them for the death penalty. Although this practice is common in many states that still retain the death penalty, it most frequently occurs in Texas because of a statute that makes it mandatory for juries to determine the future dangerousness of the defendant they have just found guilty. Both the American Psychiatric Association and the American Psychological Association have protested the use of mental health professionals in this setting because there are …

Not All Women Are Mothers: Addressing The Invisibility Of Women Under The Control Of The Criminal Justice System Who Do Not Have Children, Venezia Michalsen, Jeanne Flavin

Department of Justice Studies Faculty Scholarship and Creative Works

Research has consistently shown that most women under the control of the criminal justice system are mothers. The robustness of this finding has been accompanied by a failure to consider the characteristics and needs of women without children. In this study, we examine data on 1,334 formerly incarcerated women. Findings indicate that while mothers and non-mothers share some characteristics, they differ on several others, most notably demographic profile, mental health, and timing of contacts with the criminal justice system. These results suggest a need to recognize the diversity among women offender groups, particularly when developing policies and programs need.

Aggressive Policing And The Mental Health Of Young Urban Men, Amanda Geller, Jeffrey Fagan, Tom Tyler, Bruce Link

Faculty Scholarship

Objectives: We provide the first population-based analysis of the health implications of contemporary policing. Many cities have adopted “proactive” policing models, which engage citizens – often aggressively – at low levels of suspicion. We survey young men on their experiences of police encounters and subsequent mental health. Methods: We conducted a population-based phone survey of 1,261 young men in New York City. Respondents reported how many times they were approached by New York Police Department (NYPD) officers, what these encounters entailed, any trauma they attributed to the stops, and their overall anxiety. Data were analyzed using cross-sectional regression. Results: Respondents …

All Roads Lead From Vietnam To Your Home Town: How Veterans Have Become Casualties Of The War On Drugs, Susan Stuart

Law Faculty Publications

No abstract provided.

Legitimacy Of Corrections As A Mental Health Care Provider: Perspectives From U.S. And European Systems, Daniela Peterka-Benton, Brian Paul Masciadrelli

Department of Justice Studies Faculty Scholarship and Creative Works

Large numbers of seriously mentally ill persons are being incarcerated because their disturbed behavior is criminalized. The criminal justice system is struggling to manage the needs of these mentally ill persons in correctional settings. This article examines the problem of the incarcerated mentally ill in terms of whether or not the correctional setting is an ethically legitimate place to house and treat these persons. First, it briefly summarizes how we arrived at this problem in the U.S. Then, it examines the problem today in the U.S. and comparatively in European nations. Finally, it closes with recommendations for establishing treatment outside …

"Sell's" Conundrums: The Right Of Incompetent Defendants To Refuse Anti-Psychotic Medication, Christopher Slobogin

Vanderbilt Law School Faculty Publications

The Supreme Court's 2003 decision in Sell v. United States declared that situations in which the state is authorized to forcibly medicate a criminal defendant to restore competency to stand trial "may be rare." Experience since Sell indicates that this prediction was wrong. In fact, wittingly or not, Sell created three exceptions to its holding (the dangerousness, treatment incompetency, and serious crime exceptions) that virtually swallow the right to refuse. Using the still-on-going case of Jared Loughner as an illustration, this essay explores the scope of these exceptions and the dispositions available in those rare circumstances when none of them …

Law & Health Care Newsletter, V. 19, No. 1, Fall 2011

Law & Health Care Newsletter

No abstract provided.

An Institutionalization Effect: The Impact Of Mental Hospitalization And Imprisonment On Homicide In The United States, 1934-2001, Bernard E. Harcourt

Faculty Scholarship

Previous research suggests that mass incarceration in the United States may have contributed to lower rates of violent crime since the 1990s but, surprisingly, finds no evidence of an effect of imprisonment on violent crime prior to 1991. This raises what Steven Levitt has called “a real puzzle.” This study offers the solution to the puzzle: the error in all prior studies is that they focus exclusively on rates of imprisonment, rather than using a measure that combines institutionalization in both prisons and mental hospitals. Using state-level panel-data regressions over the 68-year period from 1934 to 2001 and controlling for …

Reducing Mass Incarceration: Lessons From The Deinstitutionalization Of Mental Hospitals In The 1960s, Bernard Harcourt

Faculty Scholarship

In a message to Congress in 1963, President John F. Kennedy outlined a federal program designed to reduce by half the number of persons in custody. The institutions at issue were state hospitals and asylums for the mentally ill, and the number of such persons in custody was staggeringly large, in fact comparable to contemporary levels of mass incarceration in prisons and jails. President Kennedy's message to Congress – the first and perhaps only presidential message to Congress that dealt exclusively with the issue of institutionalization in this country – proposed replacing state mental hospitals with community mental health centers, …

Benumbed, Carl E. Schneider

Articles

I originally intended to write a column on tort liability and research ethics, and I still plan to do so. But this column is a cri de coeur as I finish another semester teaching law and bioethics. This year, I asked with growing frequency, urgency, and exasperation, "Must law's reverence for autonomy squeeze out the impulse to kindness? Where is the beneficence in bioethics?" These questions assail me every term. Why? Consider Steele v. Hamilton County Community Mental Health Board. Mr. Steele was involuntarily "hospitalized after his family reported that he was 'seeing things and trying to fight imaginary …

Looking Backward: The Twentieth Century Revolutions In Psychiatry, Law And Public Mental Health, Sheldon Gelman

Law Faculty Articles and Essays

Do histories of psychiatry make a difference--or have legal implications--in the present? Does our current situation help explain what historians say about psychiatry's past? Focusing on the past half century--the era of medications-- this paper explores the reciprocal relationship between the present and the past in psychiatry. Part II sketches the medical developments that constitute the subjects of any history of psychiatry. This Part also examines related developments in law. Part III introduces some problems of psychiatric historiography and examines some historians' attempts to deal with them. Part IV analyzes the account of psychiatry's past contained in Edward Shorter's well-regarded …

Doubts About Daubert: Psychiatric Anecdata As A Case Study, Christopher Slobogin

Vanderbilt Law School Faculty Publications

In Daubert v. Merrell Dow Pharmaceuticals Inc., the Supreme Court sensibly held that testimony purporting to be scientific is admissible only if it possesses sufficient indicia of scientific validity. In Kumho Tire Co. v. Carmichael, the Court more questionably held that opinion evidence based on "technical" and "specialized" knowledge must meet the same admissibility threshold as scientific testimony. This Article addresses the implications of these two decisions for opinion evidence presented by mental health professionals in criminal trials.

What's Competence Got To Do With It: The Right Not To Be Acquitted By Reason Of Insanity, Justine A. Dunlap

Faculty Publications

An acquittal by reason of insanity is sufficiently adverse and is in many ways more akin to a conviction than to an outright acquittal. Although not technically punishment, it involves substantial infringement of rights. The legal literature has devoted significant space to the issue of a criminal defendant’s competence to stand trial and to the issue of the insanity plea. The problem of a pretrial insanity acquittal of an incompetent defendant, on the other hand, has not been extensively examined. In undertaking that task, this article will, in Part II, review the law and practice of competency determinations. Part III …

The Authority Of A Guardian To Commit An Adult Ward, David M. English

Faculty Publications

Placement in a mental health facility may be made through either a voluntary or involuntary commitment. Involuntary commitment usually requires a number of protective safeguards, including a court hearing, the appointment of counsel, and the meeting of a statutory criterion such as danger to self or others. Voluntary commitment is much more informal, with a written application and clinical assessment being all that is normally required. Most voluntary commitments are made upon application.of a patient who has the ability to give informed consent. But in a substantial number of states an individual also may be committed by his or her …