proj 2 rough drafts

Shelby Morrow Tiffany Isaacs ENC 2135 – 38 27 February, 2017

How may the treatment amongst the mentally ill vary?

The treatment of the mentally ill is unjust. They are often pushed aside, forgotten, or treated lesser than others. This paper will specifically evaluate the treatment of mentally ill criminals, which are a population similarly mistreated. Lack of resources, general mistreatment (whether intentional or not), and people with psychological disorders in the judicial system will specifically be evaluated throughout the paper. A stand should be taken for these individuals as they often can’t stand up for themselves. There needs to be a strive for awareness as this population is commonly misunderstood and not justly represented.

A majority of the issues within the justice system regarding the mentally ill and criminally insane is a lack of resources. Danvers State Hospital is a perfect example of how overcrowding and understaffing lead to a significant decline in patient care. The hospital was designed to have 450 admitted patients with various mental illnesses; this hospital however was quite unique- “hospital administration refused to use physical restraints on the patients and emphasized curing patients rather than merely hiding them away from the public” (Brooks). Not using restraints and genuinely wanting to help the patients as well as having the

resources to do so successfully breaks many stereotypes of mental hospitals, but nonetheless upon opening, “Danvers State Hospital was considered a leader in humane treatment” (Brooks). Activities were highly valued at this hospital, many of the patents treatment included exercise and gardening.

A major shift occurred around the 1920s, “the hospital started to suffer from severe overcrowding and a lack of funding” (Brooks). There was an influx of patients, bringing the number to nearly 2,000 while the staff required to maintain that many patients while maintaining the level of care Danvers’s had, was not met- the staff size stayed relatively the same (Brooks). This is the stem of a major issue, without enough staff or money to support the patients, the quality of care will undoubtedly go down. The article written by Brooks, supports this argument, as a result of overcrowding and a lack of funding, “the quality of care began to deteriorate as the overwhelmed staff struggled to control the massive number of patients.

Patients were soon objected to lobotomies, shock therapy, ‘special garments,’ presumably strait jackets, as a means of control” (Brooks). This is a dramatic shift from a hospital titled “leader in humane treatment,” this emphasizes that without resources, no hospital, however pure their intentions cannot properly operate under such conditions.

This hospital received nearly an additional 1,000 patients per annum, which the hospital was not fit to support. Danvers’s did not have the space nor the personnel to support this many new patients considering the attention a new patient requires (Brooks). The hospital undoubtedly could see the deterioration before their eyes and were in a scramble pleading to unanswered requests. The hospital addressed the issue of lack or nurses, the need for modern treatment methods, as well as upkeep of the hospital all requests were unanswered (Brooks).

At the rate the hospital was going, it would not be able to stand such conditions much longer.

The lack of resources resulted quite a large number of deaths, it totaled to about 278 patients in 1939 (Brooks).

A hospital is only capable of supporting a certain number of patients in relation to funding. Whenever the balance gets thrown off, neglect begins; whether that be neglect to the patients, the hospital, or both. In the case of Danvers State Hospital, all facets of the hospital were effected. This was a hospital that was known for its great treatment and due to lack of funding, which directly effects the staffing as well as hospital upkeep, resorted to mistreatment of the patients. In order for patients to get better, sufficient resources must be provided.

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Shelby Morrow Tiffany Isaacs ENC 2135 – 38 27 February, 2017

How may the treatment amongst the mentally ill vary?

The treatment of the mentally ill is unjust. They are often pushed aside, forgotten, or treated lesser than others. This paper will specifically evaluate the treatment of mentally ill criminals, which are a population similarly mistreated. Lack of resources, general mistreatment (whether intentional or not), and people with psychological disorders in the judicial system will specifically be evaluated throughout the paper. A stand should be taken for these individuals as they often can’t stand up for themselves. There needs to be a strive for awareness as this population is commonly misunderstood and not justly represented.

A majority of the issues regarding the mentally ill and criminally insane is a lack of resources. Danvers State Hospital is a perfect example of how overcrowding and understaffing lead to a significant decline in patient care. The hospital was designed to have 450 admitted patients with various mental illnesses; this hospital however was quite unique- “hospital administration refused to use physical restraints on the patients and emphasized curing patients rather than merely hiding them away from the public” (Brooks). Not using restraints and genuinely wanting to help the patients as well as having the resources to do so successfully

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breaks many stereotypes of mental hospitals, but nonetheless upon opening, “Danvers State Hospital was considered a leader in humane treatment” (Brooks). Activities were highly valued at this hospital, many of the patents treatment included exercise and gardening.

A major shift occurred around the 1920s, “the hospital started to suffer from severe overcrowding and a lack of funding” (Brooks). There was an influx of patients, bringing the number to nearly 2,000 while the staff required to maintain that many patients while maintaining the level of care Danvers’s had, was not met- the staff size stayed relatively the same (Brooks). This is the stem of a major issue, without enough staff or money to support the patients, the quality of care will undoubtedly go down. The article written by Brooks, supports this argument, as a result of overcrowding and a lack of funding, “the quality of care began to deteriorate as the overwhelmed staff struggled to control the massive number of patients.

Patients were soon objected to lobotomies, shock therapy, ‘special garments,’ presumably strait jackets, as a means of control” (Brooks). This is a dramatic shift from a hospital titled “leader in humane treatment,” this emphasizes that without resources, no hospital, however pure their intentions cannot properly operate under such conditions.

This hospital received nearly an additional 1,000 patients per annum, which the hospital was not fit to support. Danvers’s did not have the space nor the personnel to support this many new patients considering the attention a new patient requires (Brooks). The hospital undoubtedly could see the deterioration before their eyes and were in a scramble pleading to unanswered requests. The hospital addressed the issue of lack or nurses, the need for modern treatment methods, as well as upkeep of the hospital all requests were unanswered (Brooks).

At the rate the hospital was going, it would not be able to stand such conditions much longer.

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The lack of resources resulted quite a large number of deaths, it totaled to about 278 patients in 1939 (Brooks).

A hospital is only capable of supporting a certain number of patients in relation to funding. Whenever the balance gets thrown off, neglect begins; whether that be neglect to the patients, the hospital, or both. In the case of Danvers State Hospital, all facets of the hospital were effected. This was a hospital that was known for its great treatment and due to lack of funding, which directly effects the staffing as well as hospital upkeep, resorted to mistreatment of the patients. In order for patients to get better, sufficient resources must be provided.

Judicial System- the courtroom.

On the other hand, the mentally ill are protected somewhat. If someone is found without a reasonable doubt that their psychosis is so intense that they could not be responsible for their actions, they will be deemed criminally insane. A study in New York found that eighteen of twenty-two (82%) of defendants who were diagnosed with a psychotic disorder were found not guilty by reason of insanity; most commonly this is individuals suffering from schizophrenia and other psychotic disorders (Cochrane, Psy. D., Grisso, Ph.D. and Frederick, Ph.D.). This is a very reasonable measure because if someone is experiencing an extreme psychotic episode, they often aren’t aware of their actions. So, while the individual is not acquitted, they are not held entirely responsible for a crime they committed when they were not in the right mind. Another division is the mentally ill. They must be found to have been ill at the time of the event, but not mentally insane (Plaut). Treatment is mandatory and must be continued after sentencing; probation will be no less than five years consisting of a full

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psychiatric report being submitted to the probation officer and the sentencing court every three months during the probation period (Plaut). The length of commitment depends on insanity and dangerous findings, if there is no evidence of the disorder being present, the hospital must release the individual (Plaut).

Interestingly enough, as it turns out individuals with mental illnesses tend to not commit federal offenses (drug offenses, white collar crimes, and kidnapping) due to the extensive planning required to commit such offenses (Cochrane, Psy. D., Grisso, Ph.D. and Frederick, Ph.D.). In contrast, there appears to be a correlation between those who suffer from anti-social personality disorder and conviction rates. A study in south London revealed that 69% of antisocial boys were convicted as an adult; additionally, there was a relatively high conviction rate (51%) for individuals who developed the disorder as an adult (Farrington). Thankfully the judicial system has measures in place to protect people who have these disorders. Attempts are made to protect these individuals, but also make sure they are not being taken advantage of, which is why extensive psych evaluations are necessary.

General mistreatment- seen as less The most extreme and potentially most heartbreaking treatment of the mentally ill is how they are viewed as human beings. Imagine being sick and no one will help you because they see you as less than someone deserving of help. This is what mentally ill individuals, in this case specifically criminals face all too often.

Addison Duval from Psychiatry Online had a heartbreaking statement, “The mentally ill criminal usually receives the least therapeutic attention‌ of any of the mentally ill. In some

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states, such individuals are considered as second rate citizens who do not warrant first rate treatment (Duval). Aside from this being extremely sad, it also has major repercussions. Usually there is not even attention given to someone charged with a crime to make a correct assessment and identify a mental illness, this leads to extensive amounts of undetected mental illnesses in the prison population (Duval). Additionally, there is a great deal of misunderstanding which inevitably leads to worsening the condition. The criminally insane are often viewed at as violent people who should be in extreme confinement; this in combination with the little therapeutic attention provides little hope of recovery (Duval).

In Duval’s article, studies done at Saint Elizabeth’s hospital indicates that a large percentage of patients criminal charges were directly due to their mental illness, not because the individual is a criminal in nature (Duval). This proposes the idea of an “accidental criminal” as their behavior is an unfortunate by product of their disease (Duval). This is a perfect example of what makes this so heartbreaking, if the individuals were given proper treatment, their behavior can be prevented or event discontinued. Often, their behavior that caused their charged was their first offense and was never repeated (Duval). On the other hand, if their behavior persists by no means, they should remain under supervision, but if the tendencies are concluded to have originated as a byproduct of their illness, once treated they should be released (Duval). This idea is in opposition to the regulations of many states. “In some states, a patient committed as criminally insane can never be transferred to a hospital for civil patients, no matter the resulting therapeutic benefits or how safe the move may be” (Duval). Its severe mistreatment to have these patients confined in “rigid authority” when they no longer require this supervision, but the mistreatment and isolation is extended due to the location of many of

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the hospitals. “Some of the state hospitals for the criminally insane are intentionally built in geographically isolated areas and visits of relatives and friends are thus made more difficult and time consuming� (Duval). This allows the patient to be forgotten, this intensifies the neglect as they purposely due this to disconnect the patients from the outside world. When people start to lose interest in an individual their behavior and mood will worsen.

In an attempt to better the facilities and directly affect the treatment of patients Duval makes a list proposing how to better the quality of the hospital, she proposes: to enlighten attitude, have proper facilities, adequate staff in quantity and quality, educate the community, allow experience to continue growth (Duval).