The Monsey machete attack, the media is focusing on the racism of the horror. Soon, the focus will move to any mental disease history. Today, the first mental disease article hit the newsfeed.
The public discussion will follow the bread crumbs leading to the well-trot “mental illness means violence” stigma. This stigma will lead the discussion, and in time the discussion will find another well-trot topic:
Why wasn’t he getting treatment?
Assisted Outpatient Treatment. Kendra’s Law. Preemptive Services.
It’s a no-brainer. It’s obvious. It’s a simple solution. Why hasn’t it happened yet?
The conversation on preemptive services exists. It has for years. To answer these questions, here are some thoughts on what’s holding things up.
I’m placing no dispute or endorsement for preemptive treatment. This info is based on advocacy work I’ve done in jail diversion and law enforcement crisis response. And what might sound like an absolute is only to shorten this article.
As I see it, there are three conflicting factions that stall any serious and productive resolution.
One faction is law enforcement. Their primary principle is “officer safety first.” Repeated engagements with a violent peer wears on the officers. Left to their own, violent peers would be removed from society permanently … not execution, permament incarceration. Since this isn’t possible, preemptive and mandated statutes like AOT are ideal to them.
The next faction is parents of adult children with violent mental illness. In New Mexico, well-organized members of this faction can be found in NAMI. Their primary motivation is love. They love their children and want for their children safety and happiness. Left to their own, these parents would have the legal authority to direct their adult child’s treatment, including the legal authority to place their adult child inpatient; often, violent peers need safety from themselves. Since their children are adults, rarely is guardianship granted. So, AOT is very attractive to these parents, as are programs like Community Engagement Teams.
The final faction is civil rights advocates. These individuals are often lawyers who studied constitutional rights for peers. Ensuring all programs, services, procedures, and statutes adhere to constitutional guarantees first and foremost is what motivates them. They are watchdogs and are often directly opposed to both law enforcement and parents.
The iffy collaboration of these three factions jam up any real progress on preemptive services. I’ve muscled my way onto enough committees and elbowed my way in to sit at enough tables that I have a really good handle on the segregation and dynamics of preemptive service development.
A few closing remarks:
Purposely, I left out providers because traditonally they side closely with law enforcement. Providers are witness to “revolving door treatment.” In and out of the ER, in and out of jail. Providers interact with law enforcement by circumstance.
And, I didn’t include peers. I’ve been doing this long enough I know peers are undependable. This includes me. A peer’s primary purpose is being healthy. This is a fulltime job. Many times, symptomatic behavior is intense enough all their energy goes into staying well. It’s very difficult to be fully dedicated to advocacy, legislative advisement, directed community committees, and all venues where the discussion and decisions affect peers and how pees function in society.
Peers can’t guarantee consistent availability. I was knocked out of the game for two years after being attacked by another peer at an APD meeting. Two years is what it took to learn about myself and CPTSD. Writing this comment now that I’m back is a huge triumph for me.
What I’m saying about peers is it’s difficult creating lasting advocacy groups to see a project through from start to finish. If peers can get themselves to the table, they are the only true volunteers, with families as well. Every other faction receives a salary as their part in the behavioral health community. It’s also tough to be a meaningful faction when available time is curtailed by having to make a living elsewhere.
The term “preemptive services.” It’s a semantics argument, stating “preemptive”; it portends a violent act fueled by mental disease is a foregone conclusion. “Preemptive” also suggests a lack of trust in the peer and a lack of faith in recovery and maintained wellness. I’m giving feedback on how I would view this if I was mandated to “preemptive services.” It’s not a useful term.
The final comment is there is a notion that “everyone has a right to their mental illness.” This is true However, everyone has the same social contract and part of that contract is behaving in a way that isn’t harmful to the community. Violent behavior from mental disease breaks this contract and like anyone else, a peer must be removed from the community if attacking others.
I know the original lament is this dude is only going to get help now, after he killed someone, and the humane thing to do was to get him services before he killed someone.
As I like to put it: “Catching us upstream before we hit the rapids.”
I just wanted to share my thoughts on why such an obvious solution stalls and doesn’t come to fruition.