The Daily Record asked people in the legal community who deal with the mentally ill to explain why some people who clearly need help aren’t getting it.
by Liz Daube
Staff Writer
It’s hard not to notice the mentally ill on Downtown’s streets. Some of them have collected vast piles of random items in shopping carts. Some of them eat out of trash cans. Some scream and curse at passersby, to themselves and even the sky.
One day, one of them is no longer seen on the street. And good samaritans are left to wonder where they went – and what, if anything, they could have done to help.
According to attorneys working in mental health issues, there isn’t much an average person can do. Mary K. Brennan, an attorney leading Jacksonville Area Legal Aid’s mental health division, said most people expect the government to take care of the mentally ill. In reality, Brennan said, there are few institutions or hospitals set up to admit mental patients anymore – and with good reason.
“It (the state mental hospital) is a very expensive place, and it’s very restrictive,” said Brennan. “There used to be an idea that (mentally ill) people should just go away, but it’s not set up that way now.”
Before the Baker Act of the 1970s, mentally ill people had few civil rights, according to Cynthia Hunold. She’s an assistant public defender who handles local Baker Act cases.
“What the Baker Act did was give rights to the mentally ill because they were being thrown into institutions,” she said. “It gave them due process rights, like criminal offenders have, because their liberty’s at stake.”
Hunold said the Baker Act is often used when police officers or other concerned parties pick up a mentally ill person who appears incompetent and without family or friends. With three signatures and a judge’s order, the person can be forcefully placed in a facility for up to 72 hours and evaluated by professionals to see whether they need placement in an institution or less restrictive treatment.
After those 72 hours, Hunold said, a mental health facility has to petition the court if they want to involuntarily place the person in an institution. Public defenders like Hunold are assigned to those cases to fight for the person’s right to freedom – but, according to Hunold, “normally, they’re not seeking placement at the state hospital. Normally, they’re looking for stabilization or alternative placements.”
Mental health advocate and attorney Angela Vickers said that trend – toward less hospitalization and more independent treatments – has created more rights for mental health patients, but a far weaker safety net for those who are truly incompetent.
“They let them go,” said Vickers. “There’s a lack of facilities. Most people are in and out in a day and eating out of garbage cans again. There’s no medical care or case management. So that’s how effective it (the Baker Act) is.”
Vickers, Hunold and Brennan agreed that mental health resources – from living and treatment facilities to medical professionals to prescribe and oversee medications – are not sufficient to handle the number of people in need. They do not agree on solutions to the problem.
“The problem in Jacksonville is the whole system is dysfunctional,” said Brennan. “You’ve got a huge number of people who fall through the cracks.”
For example, she said, many nonprofit programs will use nurses to prescribe medications to help stabilize mental health patients – but Social Security won’t qualify a person as disabled and in need of government funds unless the person has been evaluated by a doctor. Without that money, Brennan said, many mentally ill people cannot afford their medications, and some of them lose their homes because their erratic behavior causes them to lose their jobs.
Hunold said the Public Defender’s Office investigates some mental health cases and finds family members who want to take responsibility for helping the mentally ill person. But without that type of person – or more assistance from the nonprofit community, which would need more funding to increase caseworkers – Hunold said some mentally ill people will continue to struggle.
“(To institutionalize someone,) the state has to prove a person manifestly incapable of surviving alone or substantial likelihood of inflicting serious bodily harm on themselves or another person,” said Hunold. “They often fail because you can’t prove that. You can’t just go in based on speculation.
“If they’re not harming anyone, they have the right to be free.”
Vickers said a mental health court could help. It works like a drug court, where a judge follows up on cases over a period of time and, if stipulations that include recuperative efforts are met, misdemeanor charges like trespassing are dropped.
In general, Vickers said, education on mental health issues will help reduce the stigma attached to them and make people more comfortable addressing them. She said early treatment is important and most people don’t know about free support groups and nonprofit services available to them.
On an individual level, Vickers said she didn’t have much advice. She said she’s watched the same homeless man wander over the years, his teeth falling out and skin deteriorating in the sun.
“I’ve seen him go down, and every time I see him, I pray,” said Vickers. “Pray, learn, teach.”
Hunold said she doesn’t encourage people to call the police when they see someone screaming to themselves or eating out of the trash.
“Supposedly the police are trained on how to deal with the mentally ill,” she said. “But unfortunately, a lot of them end up in jail just for doing things like screaming outside a business.
“If I’m ever with my son and we see someone like that, it’s a good opportunity to talk to him about people who have problems and make sure he understands that we don’t treat them differently and we’re not cruel to them.”