"There are several things terribly wrong with the Oklahoma Mental Health Code, Title 43A. One is the presumption that anyone with a mental illness is a second class citizen, not deserving the same standards of justice as any other citizen. Among others is the presumption that if any of those other citizens feel “threatened” by someone with mental illness, the fault lies automatically with the person with mental illness, who then has to be “fixed” by State counselors and psychiatrists. This denies the notions and existence of bigotry and simple dishonest malice in their entirety. For another, it encourages law enforcement and prosecuting authorities to use State mental facilities to detain and punish people they cannot otherwise prosecute under the law. For another, the Code fails to take into account the conflict of interest inherent in allowing the counselors and psychiatrists of a State mental facility to decide who should be incarcerated there. These do not exhaust the list.
Let us consider the last, conflict of interest. For the 1995 Session, the Joint Legislative Audit and Review Commission of the Virginia General Assembly presented a “Review of the Involuntary Commitment Process”. In the main this report considered the budgetary costs and possible improvements in the expense of mental health operations in the State of Virginia. Thus any humanitarian or civil liberty improvement recommended also had to have the effect of reducing the expenditures for such operations.
Recommendation (26) stated “for adult commitment hearings … a qualified evaluator who is not and will not be treating the individual, who has no significant financial interest, and who is not employed by the facility to which the individual will be committed should complete the mental health evaluation. The independent evaluator should also be expected to attend and testify at the commitment hearing.” In other words, those who run a State mental facility should be strictly divorced from the process of deciding who gets put there, so as to avoid an abuse of power, incarcerating individuals without true necessity, that would cost the State money. And they should show up and be prepared to justify their findings, possibly subject to cross-examination.
Title 43A almost says that, but not quite. 43A-1-105 states, “No person admitted to any facility shall be considered or presumed to be mentally or legally incompetent except those persons who have been determined to be mentally or legally incompetent in separate and independent proceedings of an appropriate district court.” But it does not adequately state how those proceedings shall be “separate and independent”.
43A-5-104 states, “Any person who intentionally falsely attests to the mental illness, alcohol dependency, or drug dependency of any person, or whose false attestations as to mental illness, alcohol dependency, or drug dependency of any person is proved to be the result of negligence or deficient professional skill, or who signs such an evaluation or petition for pecuniary reward, or promise thereof, or other consideration of value or operating to his or her advantage, other than the professional fee usually paid for such service, shall be guilty of a misdemeanor, and, upon conviction thereof, shall be punished by payment of a fine not to exceed One Thousand Dollars ($1,000.00), or imprisonment in the county jail not to exceed one (1) year, or both such fine and imprisonment.” But it does not explicitly recognize that this could be a problem in allowing mental facility personnel to effectively decide for the Mental Health Court Judge who should be committed to the facility.
43A-10-109a.A.7 states that uniform policies for ODMHSAS personnel shall ensure that “no employee whose responsibilities relate in any manner to services provided to or on behalf of a vulnerable adult is subject to a conflict of interest which would impair the ability of the employee to carry out his or her employment duties in an impartial manner”. Yet it does not fully and explicitly define and enumerate possible conflicts of interest, such as the unethical practice of allowing treating physicians at the facility to decide for the Mental Health Court Judge who needs their involuntary “help”.
While 43A clearly indicates that it is a bad idea for the staff of an State or State-sponsored mental facility to make the evaluation or decision for involuntary commitment, for the jailers to decide who gets jailed, it does not does not make explicit prohibitions against such unethical behavior. Except in a round-about manner it 43A-5-104.
This ignores the long and squalid history of psychiatric institutions abusing their legal powers and patients. Psychiatrists and counselors at mental facilities have a natural tendency and self-interest to find that people need their services. Some decades past, such mental facilities were forced to release most of their inmates because of horrible abuses and inhumane treatment. For example, one harmless man was kept for years because he played an imaginary trumpet, and another for talking to an imaginary wife. But no one took up the slack with out-patien programs for those people, so they became the mentally ill homeless sleeping on the streets up to today. Even after that, psychiatric hospitals have been caught in insurance scams, snatching ordinary people off the streets and committing them just to milk their medical insurance. Even children.
So when, as in the City and County of Tulsa, the Mental Health Court Judge depends almost exclusively upon the evaluations of mental facility personnel, there are no checks and balances to restrict commitments to those who need such “help” and have no other alternative. The commitment process is not “separate and independent” as required in 43A-1-105, and taxpayers bear the burden. For an involuntary commitment, the treating psychiatrist from the facility can be the “witness”, “mental health evaluator” and petitioner for commitment. Thus ensuring a steady supply of involuntary “consumers”.
Furthermore, once an inmate is incarcerated, the facility psychiatrists and other personnel are the sole arbiters of who gets out when. Because the Judge typically rubber-stamps their decisions, disagreeing only to keep an inmate longer. This is a corrupt and corrupting system, costing the State money by filling beds without true medical necessity, and having them full when those people, if any, who really need such help can’t get it. There are no true checks and balances.
I defy anyone involved in this sordid process to demonstrate otherwise. Especially that any significant number of people brought before it, allegedly to be “helped”, have actually escaped it. Title 43A states in several places that those who are found not to be in need or are no longer in need of such “consumer services” shall be released immediately. Yet where are any independent checks and balances to make sure that this is done? They don’t exist. The local Mental Health Court Judge and mental facility will even go so far as to deny that an individual’s psychiatrists of long standing exist or have any say in the process. And if those psychiatrists are employed by the State, say at the University of Oklahoma, they will abandon a patient to avoid any confrontation with their fellow State employees. So much for the Hippocratic Oath, “First, do no harm”.
Until the State Legislature sees fit to cease imposing its bent version of Sharia Law upon those of us with mental illness, until it restores to us and protects our constitutional rights to be treated with equal justice and due process, many more will face this psychiatric tyranny. And have their lives permanently damaged in this ugly process.
I contend that the shortcut of allowing mental facility to do the mental health evaluations that determine the need for commitment cannot save any money. That in the long run, this can only be done by accepting the cost of bringing in outside and truly independent mental health evaluators, who have utterly no self-interest in filling beds in the facility. "