“Who’s Pretending to Care For Him?” How the Endless Jail-to-Hospital-to-Street-Repeat Cycle Deprives Persons with Mental Disabilities the Right to Continuity of Care, Part I

• In Event: Legal Services for the Indigent: Representation of Persons with Mental Disabilities

Abstract

There is a well-documented “shuttle process” by which individuals committed to psychiatric institutions (having been charged with minor “nuisance”-type criminal offenses) are often stabilized, returned to jail to await trial, and then returned to the hospital following relapse. Recently, former President Obama noted the existence of a relatively small number of highly vulnerable individuals [who] cycle repeatedly not just through local jails, but also hospital emergency rooms, shelters, and other public systems. This shuttling or cycling is bad for many reasons, not least of which is the way that it deprives the cohort of individuals at risk from any meaningful continuity of care. Without this continuity, it is far less likely that any therapeutic intervention will have any long-lasting ameliorative effect.

As my colleague Naomi Weinstein will demonstrate in her paper, the current system – in addition to being utterly counter-productive (and in many ways, destructive) – also violates the constitutional right to treatment, and the statutory right to non-discrimination as provided in domestic (the Americans with Disabilities Act) and international (the Convention on the Rights of Persons with Disabilities) human rights law. In my talk, I will explain how this also violates every precept of therapeutic jurisprudence, and why it is necessary for lawyers to integrate these teachings– focusing on the prerequisites of “voice, validation and voluntariness” –in their representation of this population in the hopes that the current system can be ameliorated.

Author

• Michael Louis Perlin, New York Law School; Mental Disability Law & Policy Associates