Introduction: mental illness and addiction don't respect party boundaries.

AuthorOrnstein, Norman
PositionSpecial Report on Mental Health

On January 3, 2015, my brilliant, funny, sweet, and immensely talented thirty-four-year-old son Matthew died in Delaware, an accident caused by inadvertent carbon monoxide poisoning. Sixteen months later, the pain is even greater than it was when we found out. While an accident, Matthew's death was shaped by a lack of judgment itself driven by a ten-year struggle with serious mental illness. In the midst of a successful career in Hollywood, he had a psychotic episode at twenty-four that brought his vibrant life to a grinding halt. Most likely, Matthew suffered from bipolar disorder. There was never a definitive diagnosis, which is not uncommon, but in his case it did not matter. Different diagnoses can lead to different drug combinations or therapies, but a core part of Matthew's illness was anosognosia--an inability to recognize that he suffered from a mental illness, and an unwillingness to accept any treatment. For ten years, we struggled with him and a system that made it impossible to intervene or help; of course, our frustration and pain paled next to the pain he felt and the stigma he suffered despite the fact that he was never a danger to anyone.

In the United States, if an individual is over eighteen, both federal and state laws in most cases give the individual enormous autonomy. Parents and other loved ones, not to mention most medical professionals, are unable to learn about their conditions or to influence treatment in any way. The autonomy flows mostly from an understandable concern about civil liberties, but for those with deep-seated psychoses and/ or with anosognosia, the result is not freedom but more often tragedy, from homelessness to bullying to arrest and worse.

For loved ones of those with serious mental illnesses, sometimes the only realistic hope of getting treatment for their conditions is to have them arrested--and have a judge who has both the sensitivity and power to provide an alternative to prison or jail, including assisted outpatient treatment (AOT). That is what happened to the journalist Pete Earley, who recounted, in his 2006 book Crazy, the happier ending to the journey he had with his own bipolar son.

One judge who is making a dramatic difference is Miami-Dade's Steve Leifman, who has transformed the way the county deals with mentally ill patients who come through the criminal justice system by developing partnerships with police and 911 responders to get them crisis intervention training (CIT). The...

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