Saturday, October 29, 2011

What I Learned Part III

  • More on social media and medicine today. One survey of a surgery department showed half of residents and faculty had public Facebook accounts and a third posted professional information.
  • People are using "mindfulness" therapy to treat sex offenders. No studies on efficacy.
  • Offenders with bipolar and psychotic disorders are twice as likely to have more than two additional arrests than non- SMI offenders.
  • Some criminal defendants try to claim that the government is a corporation, and that they should be tried under contract law rather than criminal law. This is sometimes called a "straw man defense" and may prompt judges to request a competency assessment.
  • Defendants who graduate from mental health courts demonstrate improved life circumstnaces with regard to housing, quality of life, symptoms and compliance. Some studies have shown mental health courts to result in improvement for as many as 78% of defendants.
  • Court ordered custody evaluators are more likely to recommend paternal custody if the mother is poor or has a history of psychiatric admissions. They are more likely to recommend maternal custody if the father has a history of arrests.
  • No suicide prediction tool has a predictive validity greater than 3%.
  • Forty percent of patients given opioids for non-cancer pain misuse their meds, 5% become addicted.
  • In the UK people with ASPD may be subject to multiagency public protection agreements, sharing information between government agencies.
Coming up tomorrow:
      Correctional risk management and the forensic sciences sampler. Good luck to everyone without power in the snow!

27 comments:

Sunny CA said...

I found all your entries from the conference to be very interesting.

Dinah said...

How did I become the Apple inserter?

rob lindeman said...

Here we go again!

I doubt very much that any criminal defendant devises the straw man strategy on his own. If he did, I'd say there's clearly nothing wrong with his mental status: if he's with-it enough to attempt to delay proceedings with annoying motions, he clearly can assist in his defense!

But aren't criminal defense attorneys suggesting the straw man defense? And if so, why are courts punishing defendants for their counsels' misdeeds in court?

wv = retzate. If there isn't already an atypical anti-psychotic with this name, there will be soon.

ClinkShrink said...

Sunny: Thank you, I enjoy doing them.

Dinah: You're a good apple inserter. How's Siri?

Rob: Surprise! I agree with you. The criminals don't learn it on their own, they learn it from other defendants and it's a delaying tactic. No one at AAPL is suggesting this is proof of incompetence.

Liz said...

that's a disheartening statistic on suicide prevention. just another indication of how poor we are at predicting the future in any way.

http://pocketshrink.blogspot.com

Liz said...

like sunny, i've enjoyed these conference posts.

when i got out of the psychiatric unit, i played spy, and was a bit shocked that my psychiatrist had an open facebook profile... especially considering the facility he was working at. i wonder if he just didn't realize it could be viewed by anyone...

rob lindeman said...

Ann,

I'm pleased that the AAPL agrees with me. I would be shocked if it were otherwise. What concerns me is that courts continue to use competency evaluations to harass defendants, AND that psychiatrists play along. What would happen if you conscientiously objected from participating in these charades?

wv = rapoodi. Seriously, I think this is a name for the genitals in an Asian language. Or perhaps my competency needs to be assessed.

Alison Cummins said...

Rob,

You’re begging the question. What evidence do you have that courts use competency evaluations to harass defendants?

rob lindeman said...

I should say "retaliation", not "harassment". I suspect courts tend not to order competency evaluations for defendants who keep their mouths shut and their hands folded.

wv = resse; what Germans call those tasty chocolate-peanut butter treats we put in Halloween bags.

Alison Cummins said...

Rob,

I don’t follow you.

Courts order evaluations for people who appear to be behaving oddly. I’m pretty sure that people who declined to defend themselves against serious charges have been evaluated, because that’s odd behaviour.

Alison Cummins said...

http://en.wikipedia.org/wiki/Competency_evaluation_%28law%29#Competence_to_plead_guilty

“The competency standard for pleading guilty or waiving the right to counsel is the same as the competency standard for proceeding to trial as established in Dusky v. United States. A higher standard of competency is not required.”

That is, someone who wants to sit there with hands folded can be evaluated for competency if the court thinks that it’s odd behaviour under the circumstances.

Alison Cummins said...

See also:
http://law.jrank.org/pages/1277/Guilty-Plea-Accepting-Plea-elements-guilty-pleas.html

rob lindeman said...

Thanks for the links, Alison. At the risk of straying too far off-topic: I believe courts jump for joy at nolo contendere or guilty pleas. If nothing else it means much shorter trials.

What I meant was this: Ann lifted up two scenarios in which competency evaluations "can be" ordered by courts. In both scenarios, the defendants make claims that annoys the court: The sovereign citizen claims the court has no jurisdiction; the "straw man" claims the State is a corporation. In each case, it appears the court asks psychiatrists to evaluate the defendant because the claim annoys the court, not because the behavior is odd per se.

My main point is that I believe psychiatrists, as physicians, ought not to act as instruments of a pissed-off court to punish annoying defendants.

wv = cosels; 1) howard and family; 2) not quite cossets, not quite coddles.

Anonymous said...

Rob's cracking me up with the word verification.

wv = cosels; 1) howard and family; 2) not quite cossets, not quite coddles.

Ha!

Dinah said...

Rob--

We shrinks don't see psychiatric evaluations as "punishment." I don't believe you'll get our profession to say that it's inappropriate to ask someone questions. Sometimes people answer the questions and we conclude that they do not have a psychiatric disorder.

You seem comfortable with the distinction that children under 18 can't make their own decisions. This is a totally arbitrary line. Some children seem capable of making informed decisions at much younger ages. Why doesn't that bother you?

And, sir, it's ClinkShrink to you, at least on this particular blog. Her identity does seem to change across cyberspace.

rob lindeman said...

Dinah,

Would that a competency evaluations were "just asking questions"! You know better and so does Clink (we're back using code names)

I'm actually greatly discomfited by practicing medicine on unwilling and unco-operative clients. What gave you the impression that I'm comfortable with the distinction? But let me turn the question back to you: why are you comfortable with treating adults like children?

wv = chear. What rose up when I discovered that my server had not, in fact, crashed this morning.

Dinah said...

Rob,
It's the funniest thing. I was at work and I looked next to me, and you weren't sitting there! Are my patients calling you to say I treat them like children? What does that mean anyway? It seems like that type of judgment is something that is not a clear cut yes-no thing, but a matter of perception, and for the record, the only person who has ever voiced a concern that I treat them like a child is one of my real life actual children.
I'm not sure what your frame of reference is on these things. I'm sure you're right that some psychiatrists treat a few or some or all of their patients "like children" (whatever that means).
Okay, from my non-forensic perspective, a psychiatric evaluation entails asking questions AND making observations. Sometimes I review records or talk with a primary care doc, and if a patient brings a family member to an appointment, I will speak with them in the patient's presence.
You'll forgive my incorrect presumption about your comfort level, I hope.

rob lindeman said...

When I say that psychiatrists treat adults like children, I mean only this:

Psychiatrists treat adults against their wills, with incarceration, or threat of incarceration if the person does not comply with a treatment regimen. Psychiatrists also excuse bad behavior on the part of adults, as you would on the part of a child, with the argument that mental illness deprives a person of responsibility for his actions (as minor status deprives children of this responsibility.)

If you don't do that to your clients, good for you. But "no-not-I" is a hell of a bad way to make an argument. Psychiatrists do these things as a matter of course in their daily work, much the same way that I practice every day on people who do not want me even to examine them. At least I am honest enough to admit as much.

wv = bioneup; an marker of mental illness, easily obtainable from a blood draw (keep dreaming!)

Anonymous said...

Rob,
Did you ask your own kids if they wanted to be born, or did you force life upon them? Come on, be honest with yourself. Where would you take your child if he or she became suicidally depressed? Where would you take your wife if she suffered postpartum psychosis and had a plan to kill herself and the kids? Okay, don't answer that one. What advice would you give a family who came in to your office if you believed the mother was suffering postpartum psychosis and had a plan to kill herself and her child?

rob lindeman said...

Great philosophical question, that first one. Life is forced on us, if you must put it that way. We don't have a choice as to coming into this world. Same goes for leaving this world, but for different reasons. Suicide is today identified as a disease that "kills" people. Folks who want to kill themselves must be sick, so they need to be incarcerated for their own good.

But your examples are easier ethical questions. Even I agree that threats to commit murder must be acted upon immediately. You could have asked a better question: what if the mother comes to me and tells me she wants to kill only herself?

wv = flatio; obsolete sexual practice involving... well never mind.

Anonymous said...

Rob,

You did not answer the question. I know that threats to commit murder must be acted on but who would you call?

As to the question of life, no we do not choose to come into the world but someone chooses for us. Knowing how you feel about making decisions for others, perhaps against their will, why did you have children? Lots of people decide not to.
Rob, they are all philosophical questions.Ethics is a branch of philosophy. You took Phil 100 after that Poli Sci 101 course, remember?
Nice way to avoid answering though.

rob lindeman said...

Ok, if I heard someone were planning to commit murder, I would call the police.

I'd love to tell you why my wife and I decided to have children, but we'd be totally hijacking this thread, and in any case, this was a shared decision, since it still takes a man and woman to produce a child. Having said that I've been told to try to do it to myself on several occasions.

wv = lityin; the principal proteinaceous ingredient in belly-button lint.

Anonymous said...

Rob,

I will assume that should your wife ever suffer, God forbid, from postpartum psychosis and have urges to take her life (suicide) and those of your children (murder), that you will call the police, you will not seek medical attention for her, you will call the police because it is not a medical emergency. Thank you for clarifying that point, Rob.

rob lindeman said...

You're welcome!!!

ClinkShrink said...

Rob: It's Anne (with an 'e') or more formally Annette (as on the book), at work it's Dr. Hanson. On the blog and among friends (even off-blog) I'm often 'Clink.' Unusual, yes, but so far this behavior has not triggered a competency assessment.

Regarding harassment, retaliation or punishment and competency assessments: Putting someone on trial who is not mentally fit to understand what's happening to him, much less capable of defending himself, is fundamentally unfair.

Adam said...

Thank you !!

Maggie said...

Has anybody else noticed that nearly all of the relevant and meaningful discussion that used to occur in the comment section of this blog has evaporated? I'm trying to fathom why a blogger would put up with this degree of trolling, but I just can't imagine it.

Is there some part of this dynamic I'm missing? From where I sit, it just looks like harassment.