Thursday, June 15, 2006

Thank You For Sharing?

In the most recent issue of Psychiatric News it was announced that the Substance Abuse and Mental Health Services Administration is giving out $7.2 million in grants to develop or expand six jail diversion programs in various jurisdictions throughout the country. Some of the funds will be used to target repeat offenders, people with mental illness who get arrested as often as once a month. This is good news for both the correctional system and for those suffering with mental illness.

However, consider this part of the article which refers to the sharing of information between systems:

The next step will be linking the databases of all the elements in the system to better track offenders. Each has its own information system, but the systems are not tied together, said Alvarez.

"Someone being seen by a mental health team can be arrested, but the team won't know [the person is] in jail."

With the SAMHSA grant, the mental health center would be notified immediately and contacted again for follow-up before the person leaves jail. In between, the judge at the initial hearing will also have better information to direct disposition of the case. (italics inserted by me)


As a clinician, I'm in favor of anything that helps me provide care to my patient. If I can quickly get clinical and treatment information from a mental health center this is a good thing. I am more concerned when that information slips out of the realm of the therapeutic intervention and into non-clinical realms. Consider this hypothetical situation:


You are a successful small business owner who happens to have bipolar disorder. For years you have been responsible for seeing your doctor regularly, taking your medicine, and generally staying well because you like being well. No one has ever needed to tell you to do this. One day, after George W. announces his intention of invading Lichtenstein for harboring international tax fugitives, you decide to drive to Washington to take part in a peace demonstration. You are arrested, along with six of your Blue State terrorist-hugging friends, and taken to the D.C. jail. You know it's not a good idea to go without your lithium for a few days, so you mention this to the nurse doing your intake assessment. Three days later, at your bail review hearing, the judge decides to release you on bail. The judge announces, in open court, that due to your bipolar disorder you will be required to attend regular appointments with your doctor and take your medication. If you fail to do this, you will immediately be picked up and returned to jail. Your first thought is: "How the (insert expletive) did this judge know this and WHO gave him/her the right to announce it??"

Nevertheless, you bail out and return to your doctor. Upon arrival to your first appointment after arrest, the first words out of your doctor's mouth are: "So, what's this I hear about you getting arrested for being a Blue State terrorist-hugger?"


This hypothetical speaks for itself. Now, that being said the work-around for this problem is quite simple. Ask for the patient's/defendant's/consumer's permission. I usually don't hear this mentioned when people discuss information-sharing between systems. Some mental health clinics have another way of addressing this, by talking to the patient in advance about disclosures in the case of arrest. I think advance directives are a good way to solve this problem.