Saturday, October 07, 2006

you know what they say about opinions...

So, I've been engaged over on Jack Bog's Blog in some back and forth comments regarding mental health services in Portland. The discussions have come about in the wake of an incident in which a man died in police custody under suspicious circumstances. He was unarmed, schizophrenic and according to the medical examiner's report, didn't have any drugs or alcohol in his system. He died from blunt force trauma to the chest, which occurred after cops chased him, caught him, knocked him to the ground and (according to some eye-witnesses) kicked him and tasered him. The cops pursued him because of public urination and otherwise looking shady.

The people posting comments on Jack Bog's Blog have some basic misunderstandings about how the mental health system works here in Portland and, because I work in mental health, I've been posting comments to try and explain things. The gyst of the attitude is similar to my thoughts in my Poor Joshua post of a few days ago: everyone wants to blame someone for the bad thing that happened. Understandable. However, when people are misinformed and willy-nilly pointing fingers, it doesn't help anybody and it exposes a huge flaw in our idea of citizenship (in the true sense of that word, ie: civic responsibility). People enjoy having opinions and vigorously defending them (sometimes obnoxiously airing them) but they don't always spend time informing themselves. We wind up with people who are just standing on top of problems and bleating out opinions like ignorant goats, without ever bothering to nose around inside those problems to try and understand them better.

Case in point: people want to blame, in addition to the cops, the mental health system that they believe "failed" this guy who died. How was he failed? He was failed because he hadn't been institutionalized. Why, people ask, didn't the big mental health provider "do something" (ie: hospitalize) this guy if they knew he was sick? As though its the job of the mental health providers to protect mentally ill people from the police by locking them all up in hospitals, ignoring the reality that the police are part of a community matrix which often first engages (or re-engages) mentally ill people and directs them into services if they need them. People are also ignoring the law in Oregon which establishes when a person's liberty can be taken (ie: when they can be hospitalized against their will). It is not easy to deprive someone in Oregon of their liberty and that's often a really good thing.

It is very hard for mental health professionals to put someone on a "hold" (a temporary psychiatric committment). Usually the person has to be demonstrably dangerous to himself or others before he is holdable. Then he is only holdable for a short time until a judge can hear evidence and determine whether he should be released or held longer. It is not enough for a mental health worker to recognize that a person is decompensating (that his mental health is declining along an often predictable arc), even if that worker knows that client well and knows that he will probably become dangerous once he has decompensated to a certain point. He is not holdable *until* he hits that point. Unfortunately, even though mental health providers are aware of and tracking a person's decompensation, it is often some kind of engagement with police that finally lands the person in a holdable situation. Often, public urination and indecent exposure are the types of behaviors in decompensated individuals that draw police attention. Police arrest, recognize mental illness and, if the person is then "sick" enough, he is taken to the hospital for psychiatric care.

An unarmed, mentally ill man died in police custody. We should investigate the police. We should investigate the mental health treatment he had been recieving. We should take long, close looks at the way the system actually works. We should look at budgets and ask where the money is. We should, above all, make ourselves aware of these elements of our community. If we are so excited to share our opinions with the world, we should channel some of that passion into actually learning about the problems we're opining over. What use is your uninformed opinion to the community? It is no use. Only hot air.

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