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  #51  
Old 09-13-2017, 11:27 AM
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Do NOT tell me you are holding yourself responsible for his actions.

You do what you do and make decisions based on the information you have at hand. And you do it with the resources you have. If you are stressed beyond belief, you cannot make good in hindsight before hindsight is necessary type decisions. If you do not have information because he's keeping information from you, you cannot make good in hindsight decisions.

From my understanding, nobody was killed as a result of his actions. Very scary, and yes he needs to be locked up (you'd probably agree to that one), but nobody was killed. And even if somebody was, it was still his decision. It may have been his decision based on mental illness, but if he doesn't share everything with you, you can't help, and you can't prevent, and you can't be responsible.
Yes to all of that.

No, he isn't a murderer (attempted, but not successful). Charges of attempted murder, home invasion, kidnap, torture, aggravated assault. Yes, but nobody actually died. Thankfully. But still pretty bad. And very, very scary. Absolutely terrifying.

Yes, I do have regrets. Intellectually, I know that I had very little control and couldn't have anticipated the outcome. Emotionally, I feel differently. Emotions do not necessarily adhere to logic and reason.
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  #52  
Old 09-14-2017, 06:35 AM
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Yes to all of that.

No, he isn't a murderer (attempted, but not successful). Charges of attempted murder, home invasion, kidnap, torture, aggravated assault. Yes, but nobody actually died. Thankfully. But still pretty bad. And very, very scary. Absolutely terrifying.

Yes, I do have regrets. Intellectually, I know that I had very little control and couldn't have anticipated the outcome. Emotionally, I feel differently. Emotions do not necessarily adhere to logic and reason.
Thought I should add that the charges in his plea bargain dropped/reduced anything that required motive, intent, or premeditation. There was no rational motive that made any sense at all.
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  #53  
Old 09-14-2017, 11:17 AM
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IF he willingly agreed to treatment and demonstrated a willingness to comply with court orders, IF his disorder could be managed with routine medications, I would absolutely support bailing him out of that awful jail.

In fact, I did just that on 2 occasions in the previous 10 weeks. Sadly, with disastrous results. In hindsight, I should have refused and he would not have faced nearly as many serious charges. I'm sure the victims wish I hadn't as well. A major regret.
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He did experience painful and dangerous side effects. Hence reluctance to mandate this treatment outside of a hospital setting.

He had no desire to comply with treatment, or the law. He did then, and still does, regard the law as irrelevant since it's based on "primitive morality". The difference now is we can discuss and debate the topic, without devolving into a disorganized, semi-coherent rant. That's an improvement.
This is what scares me about the US system, especially prisons there are much more modern antipsychotics with better side effect profiles than Proloxin or Largactil.

If that were the way out you have to weigh up the short and potentially long term side effect profiles (sometimes permanent) issues as a result of taking these drugs with the possibility of long term harm.

I am always about the minimum harm for the best long-term results. Of course this depends on what is feasible and what is suggested for his long term care in the community.

If it were possible to have him released and have a full review of his medication by a psychiatrist with a more modern treatment regime I'd work towards doing that. His long term care plan notwithstanding of course, but to sum it up...

Here in the rest of the world there was a doctor who tried to give me Largactil (Chlorpromazine) to quell my anxiety once when I was just about ready to flip someones lid. I couldn't find a single drug store (chemist) that stocked it and when I did ask around a bit more they told me exactly why is because of its unfavourable side effect profile. Proloxin goes in that same basket also.

I'd be looking at Risperidone or Ziprasidone treatment among others. Quetiapine also has a superior side effect profile but requires elevated dosages to treat psychosis rather than anxiety in my case which may decrease the side effect profile advantage. I'm on 25 or 50mg as PRN care. A person who is psychotic would require dosages in the many hundreds of miligrams. Zyprexa (Olanzapine) is also another broadly available modern antipsychotic with good proven results.

Last edited by Roumelio; 09-14-2017 at 11:38 AM..
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Old 09-14-2017, 11:37 AM
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This is what scares me about the US system, especially prisons there are much more modern antipsychotics with better side effect profiles than Proloxin or Largactil.

If that were the way out you have to weigh up the short and potentially long term side effect profiles (sometimes permanent) issues as a result of taking these drugs with the possibility of long term harm.

I am always about the minimum harm for the best long-term results. Of course this depends on what is feasible and what is suggested for his long term care in the community.

If it were possible to have him released and have a full review of his medication by a psychiatrist with a more modern treatment regime I'd work towards doing that. His long term care plan notwithstanding of course, but to sum it up...

Here in the rest of the world there was a doctor who tried to give me largactil once, I couldn't find a single drug store (chemist) that stocked it and when I did ask around a bit more they told me exactly why is because of its unfavourable side effect profile. Proloxin goes in that same basket also. I'd be looking at risperidone and ziprasidone treatment among others. Quetiapine also has a superior side effect profile but requires elevated dosages to treat psychosis rather than anxiety in my case which may decrease the side effect profile advantage. I'm on 25 or 50mg as PRN care. A person who is psychotic would require dosages in the many hundreds of miligrams. Zyprexa (Olanzapine) is also another broadly available modern antipsychotic with good proven results.
He did receive far better care at the specialized psych facility, after sentencing. Including a full review of his medications.

The county jail was horrible, constantly bouncing from the dorm, to segregation, to the hospital. Just awful. They were not well equipped to deal with him.
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Old 09-14-2017, 11:46 AM
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A psych facility would be preferable but I don't know what his status is now, bouncing around facilities with these kinds of conditions is far from ideal. Ideally you want the most settling environment possible which means staying put in one facility and on one treatment regime, and talking to one team of therapists otherwise thing can get a bit nuts.

I know when I'm not stable and everything is up in the air I get extremely bad anxiety. I like to have all my ducks in a row when it comes to treatment. Most people with psychosis aren't much different. You create enough stress and upheaval in their environment and they're likely to have a psychotic episode.

Some intervention so he at least stays put for a while really would be favourable.
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Old 09-14-2017, 09:08 PM
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The problem is that the criminal courts need to adjudicate his case.

Here's what happens with a psychotic prisoner from my perspective:

1. He comes into jail and quickly becomes a behavior issue, sometimes before he's assigned an attorney

2. Jail psych sees him, treats him with medication according to their formulary. Their formulary does not include the current crop of antipsychotics as they are too expensive. Too expensive means treating one person with medication instead of being able to treat ten of more people with medication

3. He calms down enough to meet with his attorney and go to arraignment. At that time, the attorney notices that he's still not with it enough to meet the requirements of competence to stand trial. A petition is made to get the guy sent to the forensic psych unit until competent to stand trial.

4. The guy goes to the forensic psych hospital. They treat him according to their formulary, placing him on another psych drug and stopping the jail psych drug. It is still not necessarily the best for the person, but the best for the person with the consideration that others also need to be treated and such treatment costs money on a dire budget. The guy becomes competent, aka understands his charges and can assist in his defense

5 he comes back to county. The psychiatrist there treats him according to their formulary, taking him off the drugs from the forensic hospital, and placing him on yet another drug. This drug may or may not be the same as the drug that he was treated with when he came in. The attorney realizes there is a limited time of lucidity to get things done.

6. Insanity is on the table as a defense, and a notice of affirmative defense is entered in jurisdictions requiring it. The guy goes to a different unit of the forensic hospital so that he can be examined over the next 90 days to ascertain if he was psychotic at the time of the crime and if he was, whether that psychosis resulted in intellectual impairment that would rise to the level of insanity. He is also removed from the jail drug and placed on yet another antipsychotic that is still the best they can do considering the budget.

7. Invariably, during those 90 days, his treating psychiatrist leaves or is otherwise replaced with a new psychiatrist (there can be heavy turnover in state forensic hospitals, usually around the time that board results come out and about the time of residency graduations). The new psychiatrist again changes the meds because that's how he treats such people.

8. The person comes back to county, psych reports in hand along with treatment notes and the full file from the state hospital - about a banker's box worth of material. Again, the jail takes him off the meds from the hospital and puts him on cheaper drugs, according to that particular shrink's predilictions and preferences. The more shrinks at the jail, the more different cocktails for the same condition and without the input of the person.

9. The attorney digests the bankers box worth of notes, motions for a second, independent psych eval. The person goes to another hospital willing to take payment from the courts and with a criminal lock-up in the facility. Again, the person's meds are switched.

10. He comes back, again his meds are switched. Hopefully, he stays competent for his trial. His trial happens, and he goes to prison. The prison again switches his meds.

In the criminal system, the concern is with justice, not the best interests of the patient. Eventually, he could find himself in a state forensic hospital for the duration, and until he's been properly treated long term, but first the criminal justice system has to take its bite. The victims demand it. The community demands it. And everybody wants to be safe from somebody clearly out of control and unable to go to a hospital when becoming floridly mentally ill.

It's usually a matter of budget and the preferences of the psychiatrist that determine the drugs used and the switch from one drug to the next. They are not gentle about it. They will coerce a person into taking drugs - take them or you're in solitary, it's one or the other. The power of the person as a patient is subborned to the prison system and the need to resolve the criminal matter.

Sometimes a guy comes out better than when he went in to prison. They never come out of jail better than when they went in, but prisons with a mental health unit can result in good, long term treatment. But the emphasis in the criminal justice system is anything but the best interests of the person, or the most appropriate drug. Considering the huge percentage of people in prison taking psych drugs, taking the latest greatest is just not cost effective and they will terminate a particular treatment from the outside with little notice.

A person and his family have to be great advocates. They have to use HIPAA and POAs and even conservatorship s for long term disability to make sure that a person is treated with the most appropriate drug for him whether it's in the formulary or not. And even then, if there's a risk that the drug may be abused, the person's not going to get it (think benzos where the drug is abused and patients become targets of inmate violence as a result).

Prison is not a hospital. The goals of the two are very different. Since we went "tough on crime" nobody wants anything that could be considered "mollycoddling " and frequently a treatment team that includes therapy and anything other than drugs like Prolixin is considered "mollycoddling criminals".

Considering, too, that a person has to be able to afford those drugs on his own on the outside, putting together a drug regimen that costs more than $3k a month is also just asking for trouble. We don't have universal health, and we don't have psych parity. This is not the country to be mentally ill and charged with a crime.
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  #57  
Old 09-15-2017, 07:24 AM
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Yourself, your description is 100% spot on. Right down to the bankers box of notes and the independent psych eval in item 9.

i don't know if you are familiar with our case, or if it's just that this chain of events is simply business as usual.
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Old 09-15-2017, 10:40 AM
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Yourself, your description is 100% spot on. Right down to the bankers box of notes and the independent psych eval in item 9.

i don't know if you are familiar with our case, or if it's just that this chain of events is simply business as usual.
This is business as usual. I am not familiar with your case as I don't make it my business to Google facts revealed in these threads.
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Old 09-15-2017, 02:57 PM
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I never said the process would be straight forward, or that people in the United States cared about the health of others (particularly felons). I simply made a comment based on decent practice in a best ethics scenario. I realise there is a whole heap of adjudication to go through and I have no idea what stage any of this is at yet. As a non-aligned third party here, who has no significant interest in making this case any of my business that's not really a matter to be held to account to though either.

I also realise drugs are expensive, if I had to pay full price to remain relatively healthy, and sane in this country as a resident on a permit or visa, without access to Medicare there is no way in hell I could afford the level of care I afford myself now either. With regard to that, even in tough circumstances people do make sacrifices if not the state often the family unit to cover costs. I am not without my own list of carers surrounding the provisions of my own healthcare needs (some of them family members). You want to hope in the later case you have a good one. The same applies to legal teams also.

Last edited by Roumelio; 09-15-2017 at 03:04 PM..
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Old 09-15-2017, 04:43 PM
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I never said the process would be straight forward, or that people in the United States cared about the health of others (particularly felons). I simply made a comment based on decent practice in a best ethics scenario. I realise there is a whole heap of adjudication to go through and I have no idea what stage any of this is at yet. As a non-aligned third party here, who has no significant interest in making this case any of my business that's not really a matter to be held to account to though either.

I also realise drugs are expensive, if I had to pay full price to remain relatively healthy, and sane in this country as a resident on a permit or visa, without access to Medicare there is no way in hell I could afford the level of care I afford myself now either. With regard to that, even in tough circumstances people do make sacrifices if not the state often the family unit to cover costs. I am not without my own list of carers surrounding the provisions of my own healthcare needs (some of them family members). You want to hope in the later case you have a good one. The same applies to legal teams also.
If a person runs afoul of the Mental Hygiene Laws of their state, aka, they are at extreme danger to self or others, then what happens to a person is completely different. In that case, the needs of the patient are of paramount importance.

Granted, the psych law/rights community has created a paradigm that makes it difficult to force help upon somebody who needs help, so the least restrictive alternative, and the fact that a person cannot be forced to take meds without a court order and that psych beds are limited, and that a person is usually held for between 4 and 72 hours (not including nights, weekends, and holidays) before the psych facility decided that the person does not meet its interpretation of the mental mygiene law's standards for taking it to court to involuntarily commit a person.

But, the standard is different. Further, your health insurance kicks in for voluntary commitments, and most people wind up getting talked into voluntary treatment. Money is not an issue if you have insurance.

(Fwiw, you can take as an example the Miami homeless who were picked up on the mental hygiene laws and held during the recent hurricaine. All were let go at the end of their 72 as FL is a 72 hour state. Extreme danger, no insurance, hurricaine left the area, they were let go)

This is very different than what happens once a crime has been committed.

What society hopes is that a person experiencing an extreme emotional state gets appropriate help early, before hospitalization is necessary. Society hopes that a person has insurance, pays for treatment including inpatient voluntary hospitalization himself. Society hopes that it never has to be engaged in making treatment decisions for a mentally ill person.
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Old 09-15-2017, 05:45 PM
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Its about the same here, I've taken myself in to be assessed involuntary and they've said the most that they could likely do for me is 3 days on assessment and then back out on the streets again. Meanwhile they run you through the gauntlet of what its all going to be like. Tell you how horrible state care is and try to persuade you according to health care conventions that are fairly normative across the developed world that the best thing for your health is to be out on the street.

Now I wasn't so much talking about that. What little I was talking about was the legal side of things was about getting a person settled. I'm aware there is a due legal process, I have no idea what stage that is at in this case, I also have no significant interest in going through the case specifics or providing case specific advice. I have some interest in seeing people who are sick and vulnerable being taken care of properly.

What little of my undergraduate major area I could offer in terms of law is mostly in areas no one cares about or pays attention to (international law in relation to diplomacy). I have no desire to practice criminal law particularly not so in the United States. I have no reason to practice legalese on this forum or in any other space either. I merely suggested a best possible scenario was working towards getting the person in question stayed put. How easy that is, is another matter all together.

Last edited by Roumelio; 09-15-2017 at 05:55 PM..
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Old 09-15-2017, 07:46 PM
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Its about the same here, I've taken myself in to be assessed involuntary and they've said the most that they could likely do for me is 3 days on assessment and then back out on the streets again. Meanwhile they run you through the gauntlet of what its all going to be like. Tell you how horrible state care is and try to persuade you according to health care conventions that are fairly normative across the developed world that the best thing for your health is to be out on the street.

Now I wasn't so much talking about that. What little I was talking about was the legal side of things was about getting a person settled. I'm aware there is a due legal process, I have no idea what stage that is at in this case, I also have no significant interest in going through the case specifics or providing case specific advice. I have some interest in seeing people who are sick and vulnerable being taken care of properly.

What little of my undergraduate major area I could offer in terms of law is mostly in areas no one cares about or pays attention to (international law in relation to diplomacy). I have no desire to practice criminal law particularly not so in the United States. I have no reason to practice legalese on this forum or in any other space either. I merely suggested a best possible scenario was working towards getting the person in question stayed put. How easy that is, is another matter all together.
You are putting the patient in front of the criminal process. The whole reason this stuff goes like this is to accommodate the legal process. Nobody cares about the patient as long as they are competent to stand trial.

Competent means
1. Know their charges and the potential liability
2. Are capable of aiding in their own defense, whether they choose to do so or not.

Mental health issues are a human right. Since the mentally ill make up a significant portion of the prison population, we in the US are failing them. But the fact remains that the criminal process doesn't care how depressed, anxious, delusional, or whatever a person is as long as they don't make a problem in jail. The medication goal is to make them compliant with the jail schedule so that guards and inmates are not injured and that meals are served on time. Suicidality is treated with a suicide smock or blanket in an isolation cell for days at a time with nobody to talk with. This is the stark reality between making things work for the system v. Actually caring for the offender as a patient and person.
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Old 09-16-2017, 02:42 AM
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Force of habit, international law precedents kicking in. I put the health before the justice system. Ask any IGO in the United States such as Amnesty International they will do the same. Yes I understand due process. It's not really my interest, my interest is mental health and well being of humans. Regardless of the crime committed its a basic accepted international human right that a person receives due care. However little things like the UN charter on human rights, UN standard minimum rules for the treatment of prisoners and the Geneva convention, mean to people in the United States these things do exist.

I am aware of the general goings on on the inside of prisons also, my aunt was a guard here in Australia for the best part of 40 odd years before she recently retired. I have had many interesting late night conversations about what happens behind the bars I'm not at liberty to discuss as they involve existing people in the corrections system here in Australia. I am also aware what little of some of the issues that go on through personal interest.

There is an interesting documentary here that has fairly good currency from PBS Front Line about the SHU and mental health facility at Maine State Prison. While its a couple years old, it does a fairly decent job in telling it like it is unlike most prison documentaries.


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Old 09-17-2017, 03:41 PM
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Old 09-18-2017, 08:12 AM
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For me, it comes down what do we, as a just society, actually do with someone who gleefully creates chaos and fear with no regard for sanctions or consequences. Severe beatings at the hands of police, lengthy sentences seem to have no effect.

What do we do about this?
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Old 09-18-2017, 08:16 AM
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Those are the people who end up doing life on the installment plan, or at whom some judge finally throws the book - 30, 40, 50 yrs.
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Old 09-18-2017, 08:42 AM
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Those are the people who end up doing life on the installment plan, or at whom some judge finally throws the book - 30, 40, 50 yrs.
That's what I'm afraid of.

I do hope the parole board considers his mental state as the single, overarching factor for release.

I don't trust them. The authorities have released him in the past when it should have been clear that he is likely to fail horribly. One resident I spoke to at the forensic hospital could not believe he was out loose on the streets. I guess that's part of his education.
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Old 09-18-2017, 09:13 AM
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Can you have a competency hearing for him? If so, that might be the next approach. If he's not able to run his life, answer questions about day and date, isn't oriented to time or place, things like that, or if his family takes his arrest record before a judge, will you be able to win and use it to place him in closed custody psychiatric care?

(Yourself will probably be along to shred what I've said, but we'll just have to wait.... :-))
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Old 09-18-2017, 09:36 AM
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Can you have a competency hearing for him? If so, that might be the next approach. If he's not able to run his life, answer questions about day and date, isn't oriented to time or place, things like that, or if his family takes his arrest record before a judge, will you be able to win and use it to place him in closed custody psychiatric care?

(Yourself will probably be along to shred what I've said, but we'll just have to wait.... :-))
We've been down that road. He's not competent. He's actually one of those rare candidates for NGRI (insanity defense). Medically, he's insane. Legally...maybe, but we all opted for a plea bargain to get him a definite sentence, appropriate treatment, and a minimum of hoopla. I act as conservator.

A big issue for me is getting an objective, unbiased, view of what's really going on in custody. He does revel in disrupting the usual flow of events in prison. Not cool.

The psych facility was the best place so far. 3 years in there. Combination max security prison/ hospital. Far more tolerant of those who deviate from the norm, but they don't put up with shenanigans. He's made some real progress there.

I'm worried about a transition to GP. Hopefully he'll be sent back to where he was if that doesn't pan out.
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Old 09-18-2017, 12:56 PM
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Can you have a competency hearing for him? If so, that might be the next approach. If he's not able to run his life, answer questions about day and date, isn't oriented to time or place, things like that, or if his family takes his arrest record before a judge, will you be able to win and use it to place him in closed custody psychiatric care?

(Yourself will probably be along to shred what I've said, but we'll just have to wait.... :-))
He can have a conservatorship/guardianship - that's the next approach. But it doesn't negate the criminal charges or force a prison to place somebody in a hospital.

If he was out, free, then the course of action would be to have him picked up on a mental health hold. He'd do 72 hours (give or take by state) to determine if he's a danger to himself or others in the free world. If he is a danger, and I mean a present danger of actual harm, then he would go the mental health route through the hospitals.
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