South Carolina recently passed a law that requires police officers in the state to undergo training to better recognize when a mental illness, not malicious intent, is behind a person’s actions. The legislation, passed unanimously by both chambers and signed by the governor in May, applies to all 16,000 officers, including corrections officers, in South Carolina.

Training in “mental health or addictive disorders,” as the law terms the newly required subjects, is already standard practice for 59 accredited police agencies in South Carolina. But for the remaining 240 or so agencies, the course will be added to the 40 hours of re-training officers complete every three years for recertification.

Supporters of the new training requirements say officers need to be equipped to deal with people whose actions can be ascribed to illness, not ill intent.

“Someone may be acting in a strange way,” said State Law Enforcement Division Chief Mark Keel, “and officers need to understand it’s not just out of meanness but someone has an issue going on and they need help — not necessarily jail, but a hospital.”

The legislation does not define the exact number of training hours officers are required to commit to mental health, nor does it outline what the course would include. Instead, the law says the course must be approved by the Criminal Justice Academy, which is working with the National Alliance on Mental Health to hammer out the details.

In its most recent training catalogue, the academy offers a course titled, “Law Enforcement Awareness for the Mentally Ill.” According to the course description, it will “help the first responder as well as the seasoned officer better understand what someone with a mental illness is dealing with.” The course will include “group discussions with mentally ill clients.” 

According to a recent survey conducted by the Council of State Governments Justice Center, 41 of 42 states (eight states did not respond to the study) “have standards for mental health training.” State standards for mental health training, the survey found, are often instituted by a state’s officer training entity. Some states, like South Carolina, use the state legislature to pass legislation that addresses training. 

South Carolina is no stranger to the problems that can arise when officers are not properly trained to spot mental illness.

In August 2010, Andrew Torres’ family asked three officers to come to his Greenville home, and enforce a court order that would commit him to a mental hospital. Torres did not willingly comply, and the officers tasered him (the exact series of events are in dispute). Torres, who had been diagnosed as schizophrenic, went into cardiac arrest, and died at a hospital. Torres’ family sued the officers, and in 2014 were awarded $500,000 for the death of their son.

The recently-passed bill, sponsored by Senator Vincent Sheheen (D-Camden), is meant to prevent such episodes from happening again. Sheheen recently said that if officers are not properly trained, a confrontation with a mentally ill subject “escalates to criminality or violence or trouble.” He added: “It’s not fair to law enforcement to put them on the street and not equip them.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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Instagram is the worst app for your mental health, according to a new study released by the U.K.’s Royal Society for Public Health (RSPH).

Researchers surveyed nearly 1,500 14 to 24 year olds and found that heavy usage of the photo sharing app led to poor body image and sleep, as well as higher levels of anxiety and depression.

.@YouTube only net positive platform for mental health whilst @Twitter – @facebook – @Snapchat & @instagram all net negative #StatusOfMind pic.twitter.com/E95Ob2D1vp

— RSPH (@R_S_P_H) May 19, 2017

Although “FOMO”–aka the “fear of missing out”–may not be a real a mental condition, it has been shown to take a serious toll on young people; the survey found that users who spent more than two hours on social media were more likely to report poor mental health, increased levels of psychological distress, and suicidal ideation.

The #StatusOfMind report explains:

This phenomenon has even been labelled as ‘Facebook depression’ by researchers who suggest that the intensity of the online world – where teens and young adults are constantly contactable, face pressures from unrealistic representations of reality, and deal with online peer pressure – may be responsible for triggering depression or exacerbating existing conditions.

“Instagram easily makes girls and women feel as if their bodies aren’t good enough as people add filters and edit their pictures in order for them to look ‘perfect’,” one survey responder explained about the app.

Snapchat, Facebook, Twitter, and YouTube were found to be similarly damaging to mental health, counteracting positive effects like self-expression, self-identity, and community building.

Here is the @instagram profile that led to it being ranked worst for young people’s mental health and wellbeing in our report #StatusOfMind pic.twitter.com/9SbfoQwMY1

— RSPH (@R_S_P_H) May 19, 2017

Even with all of the negative side effects, quitting social media altogether can be can be extremely hard for users, according to Shirley Cramer, chief executive of RSPH.

RSPH and the Young Health Movement are now calling on social media companies to:

• Introduce a pop-up heavy usage warning on social media
• Identify users who could be suffering from mental health problems by their posts, and discretely signpost to support
• Highlight when photos of people have been digitally manipulated

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

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Capital punishment in the United States has long faced public scrutiny. The death penalty is a topic of debate among Americans largely due to concerns about its efficacy in deterring crime, as well as growing rates of botched executions. In 2016, the U.S. saw a record decline in death penalty use and public support. A number of states postponed scheduled executions due to drug shortages and botched executions. While capital punishment remains legal in 32 states, this number could steadily decrease based on the current political climate.

Current Death Penalty Trends

The Death Penalty Information Center (DPIC) reported that 30 people were sentenced to death in its 2016 Year End Report–the lowest number of death sentences since states began to re-enact death penalty statutes in 1973. It found that executions also declined more than 25 percent, with only 20 executions carried out in 2016 by just five states.  Public opinion polls show support for the death penalty at a four-decade low. At just 49 percent, support fell below 50 percent for the first time in 45 years, according to a study by the Pew Research Center. This is a seven point drop from the previous year.

The DPIC concluded that the number of people waiting on death row decreased in 2016, as prisoners either passed away in custody, or obtained relief from their convictions. There was also a decline in the number of counties in death penalty states pursuing capital punishment. This past year three states–California, Nebraska, and Oklahoma–overwhelmingly voted to reject propositions that would have eliminated the death penalty. In California there hasn’t been an execution since 2006, and yet residents still seem to be in favor of its use, when deemed appropriate. Geography also played a roll in American death penalty trends. Eighty percent of all executions in 2016 were carried out by only two states–Texas and Georgia.

Mental Health Issues

Historically, executed prisoners tend to be those who are the most vulnerable, with the poorest legal representation. The DPIC’s review found that at least 60 percent of executed prisoners exhibited a combination of mental health issues including: signs of mental illness, brain impairment, and low intellectual functioning.

In Texas, a mentally ill prisoner was executed who exhibited signs of mental illness since infancy and was diagnosed with a variety of mental afflictions by the time he was 18. Georgia also executed an intellectually disabled prisoner, who was black, even though he had an openly racist juror, a trial lawyer who slept through portions of the trial, and significant evidence of an intellectual disability presented in post-conviction proceedings. Additionally, six of the prisoners who were executed in 2016 were 21 or younger at the time of their offenses.

A case argued before the Supreme Court in late 2016 attempted to dispute the constitutionality of executing prisoners with intellectual disabilities. Moore v. Texas questions the “standards that may be used to determine whether a defendant convicted of murder is mentally deficient.” Lawyers for the defendant argued that Texas utilizes outdated methods of determining mental capacity, rather than the standards mandated by the Supreme Court. The defendant, Bobby J. Moore, has an average IQ of 70 based on multiple tests. Texas argued that there is no national standard for determining mental capacity; the ruling from the Supreme Court, while still currently unknown, will certainly have a profound effect on other states’ death penalty procedures.

Botched Executions and Experimental Drugs

The overall decline in the use of the death penalty may also be attributed to recent botched executions. Lethal injection, the most utilized form of execution, has a botched execution rate of 7.12 percent. All manufacturers of FDA-approved drugs that could potentially be used for lethal injections have enforced a strict ban on selling their drugs for that purpose; companies are no longer keen on associating any of their products with capital punishment proceedings.

Problematic lethal injection procedures have been of great concern for the past few years and have occurred all over the country. In Ohio, the prisons’ agency is attempting to obtain a drug that could reverse the lethal injection process if needed. If executioners were not confident the first three drugs rendered a prisoner unconscious, they would be able to use the drug to reverse the effects. This request comes after executions have been on hold in the state since January 2014, when a prisoner gasped and snorted during the 26 minutes it took him to die. Arizona’s last execution was also in 2014, when a prisoner took two hours to die after receiving an injection of the drug midazolam.

As recently as December 2016, a man executed in Alabama struggled for air, coughed, heaved, and clenched his left fist during the 13 minutes of his execution. Two consciousness checks were performed during the execution. The inmate moved his arm both times after the tests. The first drug used in the three-drug cocktail was midazolam. The Supreme Court ruled in a 5-4 decision in 2015 that the use of midazolam is constitutional, in spite of reports that the drug does not reliably render an inmate unconscious.

Despite its death row population remaining in limbo after the Supreme Court struck down the state’s capital sentencing system in January 2016, Florida is poised to start utilizing a new experimental lethal injection drug. Such a move is likely to cause more litigation in the coming future, as anti-death penalty advocates are troubled by the use of experimental procedures in lethal injections.

Efficacy in Deterring Crime and Racial Bias

Though capital punishment is employed to deter violent crime, there is little evidence that it actually does so. In a 2008 Death Penalty Information Survey, 88 percent of polled criminologists said they do not believe that capital punishment is an effective deterrent for crime. As recently as 2015, non-death penalty states had a murder rate of 4.13, while death penalty states had a murder rate of  5.15—a 25 percent difference. In every year since 1990, non-death penalty states had a lower murder rate than death penalty states. And in a 2008 poll of 500 police chiefs, the death penalty ranked last in their priorities for reducing crime.

Moreover, the racial bias in the criminal justice system is astounding. Over half of the current death row population since 1976 is non-white. Interracial murders also disproportionately target blacks. Since 1976, 283 black defendants have been executed for the murder of a white victim; this is in stark contrast to the 20 white defendants executed for murdering a black victim. A 2014 study performed by Professor Katherine Beckett of the University of Washington, found that jurors in Washington from 1981-2014 were four and a half times more likely to sentence a black defendant to death than a non-black defendant.

Conclusion

The decline in the number of prisoners executed in 2016, as well as the decrease in the number of people sentenced to death, seem to signify a move away from capital punishment in the U.S. Such a drop in executions may be attributed to states putting their executions on hold after extremely troublesome lethal injection proceedings over the past few years, rather than a general shift toward other sentencing alternatives. Regardless of waning numbers, citizens voted in large margins to retain the death penalty in multiple states this year, indicating that support for the death penalty in particular cases is still acceptable to many. Whether any state protocols and procedures will change, however, depends heavily on Supreme Court decisions in the future.

Nicole Zub

Nicole is a third-year law student at the University of Kentucky College of Law. She graduated in 2011 from Northeastern University with Bachelor’s in Environmental Science. When she isn’t imbibing copious amounts of caffeine, you can find her with her nose in a book or experimenting in the kitchen. Contact Nicole at Staff@LawStreetMedia.com.

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The 21st Century Cures Act easily passed through the Senate on Wednesday by a vote of 95-4. With the inclusion of grants for mental health care and research on cures for life-threatening diseases, the bill enjoyed bi-partisan support in both chambers. Some progressives, like Elizabeth Warren (D-MA) and Bernie Sanders (I-VT), opposed the bill, fearing it could lead to unsafe drugs hitting the market, and could fail to curtail drug costs.

But President Obama, looking to build upon his health care legacy, which includes passing the Affordable Care Act, said last weekend that the 21st Century Cures Act is an “opportunity to save lives, and an opportunity we just can’t miss.” Highlighting the billions of dollars the bill will pledge toward Alzheimer’s and cancer research, as well as funds to combat the opioid epidemic, Obama added: “It could help us find a cure for Alzheimer’s,” and “could end cancer as we know it and help those seeking treatment for opioid addiction.”

Supporters tout the bill as the first major mental health legislation in nearly a decade. Included in the $6.3 billion package is money to create suicide-prevention programs, and grants to increase the number of  mental health professionals, like psychologists and psychiatrists. The bill also designates $1 billion in state grants to combat the opioid epidemic. It also includes a stipulation that is meant to speed up the approval process of breakthrough medical technologies, which is worrisome to some lawmakers who opposed the bill.

“I cannot vote for this bill,” Warren said last week, citing its watered down safety requirements for new drugs. “I will fight it because I know the difference between compromise and extortion.” And on Tuesday, Sanders, a longtime critic of Big Pharma, said “if you want to lower the outrageous cost of prescription drugs, vote against this bill.” He added: “It is time to stand up against the pharmaceutical industry and stand up with the American people who are tired of being ripped of by this extremely greedy industry.”

Vice President Joe Biden was one of the staunchest supporters of the bill, which includes $1.8 billion for the Cancer Moonshot Initiative, parts of which were recently named for Biden’s son Beau, who died last year from a brain tumor.

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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The movie theater chain Cinemark will no longer pursue the $700,000 in legal fees that four surviving victims of the shooting were to pay after they lost a lawsuit to the theater. Four years after the mass shooting at the movie theater in Aurora, Colorado, this particular case is finally closed after the remaining plaintiffs reached a deal.

Attorneys for the theater chain on Tuesday said:

All plaintiffs in this matter have now waived appeal of the jury’s verdict and the case can now be deemed completely over. Defendants’ goal has always been to resolve this matter fully and completely without an award of costs of any kind to any party.

Surviving victims initially sued Cinemark for not having sufficient security at its theaters, hoping to raise the bar for other theaters across the country. They brought up the lack of security cameras, guards, and silent alarms on the emergency exit doors.

However, Cinemark’s lawyers concluded the theater could have done nothing to prevent the shooting and that the ultimate responsibility lay with the shooter. Cinemark was entitled to ask the plaintiffs to pay for its litigation costs, a bill that amounted to $699,187.13. But now they’ve reached an agreement, which means that any appeals will be dropped and Cinemark will not demand any legal fees from the victims.

The shooting in 2012 left 12 people dead and over 70 injured, including children and an unborn baby. The assailant James Holmes entered the movie theater during a screening of the Batman movie “The Dark Knight Rises,” dressed in a long black coat, a gas mask, throat protector, and leggings. He carried an assault rifle, a shotgun, and two handguns and allegedly said something like “I am the Joker” before he started his shooting rampage. He also had dyed his hair shock orange.

Holmes’ mother spoke out about the event in May this year and urged people to be more open about mental health issues. She didn’t know her son suffered from schizophrenia until she was in court.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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Thousands are homeless in West Virginia this week after torrential flooding that left at least 23 dead. Clay, Fayette, Greenbrier, Jackson, Kanawha, Monroe, Nicholas, Pocahontas, Roane, Summers and Webster counties were all damaged in the floods. Bodies were found days after the rains began, having been dragged miles from their homes by the rushing water. But for West Virginia, the reconstruction won’t just be physical, it will be emotional too.

Let’s start with the massive need for rebuilding–FEMA has already approved over $18 million in individual assistance for medical and housing support, but this is just the beginning of the disaster relief process. FEMA began by coordinating disaster centers and donation centers for those who lost their homes to the flooding but it will now need to provide temporary housing and unemployment benefits, assist with home repair, and provide low-cost loans to cover uninsured property losses. With over 4,000 flood victims registered to date, FEMA is looking at years worth of construction and economic assistance. If a similar natural disaster strikes other communities this summer, FEMA’s budget will be stretched thin. In the 2016 financial year, FEMA was granted $7.37 billion for the Disaster Relief Fund, a sum that seems somewhat less significant once we factor in that the Disaster Relief Fund is used not only for disasters that occur in 2016 but for the costs of past disasters as well, including Hurricane Sandy. West Virginia’s reconstruction has only just begun and there is no way to fix a deadline for when it will end.

But beyond the physical reconstruction, there is also a need for emotional support. In the wake of natural disasters, communities are more vulnerable to a rise in mental health issues. Consider that in the wake of Hurricane Katrina, a survey of 392 low income parents affected by the storm found that the prevalence of serious probable mental illness doubled and that nearly half the participants studied exhibited probable PTSD. The American Psychological Association operates the Disaster Resource Network, a group of approximately 2,500 licensed psychologists who work with the Red Cross to integrate mental health into disaster preparedness training, but with so many communities at risk, it is difficult to reach every town that is vulnerable.

FEMA’S Crisis Counseling Program (CCP) provides funding for a variety of counseling services, including both individual and group counseling, but there is no guarantee that the counselors provided will be able to work with victims of disaster indefinitely. Building trust and making progress with a counselor can take months or years, and with so few qualified counselors available to work in disaster areas, those who cannot seek counseling on their own dime may never return to counseling once the CCP grant runs out. In West Virginia, an economically disadvantaged state with one of the highest rates of unemployment in the nation, the likelihood of most flood victims being able to attend counseling without a CCP grant is almost nonexistent.

In a nation where communities are constantly grappling with floods, hurricanes, tornadoes and wildfires, FEMA’s work is never done. The agency has worked to transform itself, in a post-Katrina world, into an effective disaster relief agency that can anticipate every need of a community in its darkest hour. Yet FEMA is not beholden to stay in the community forever–it will rebuild and aid as much as it can, a process that may take years, but that does not undercut the fact that FEMA relief is only temporary.

The deeper effects on the community, particularly the scars left by grief and PTSD, last long after the aid money has run out. Organizations like Counselors without Borders are doing critical work in disaster scenarios but they do not have the resources or staff to reach every victim of every crisis. Individuals will play the greatest role in creating positive mental health in disaster communities. Trained counselors and psychologists can donate their time, volunteers can work on emergency and suicide hotlines, school administrators can strive to create safe spaces for students–this type of holistic, community-based dedication to protecting mental health can truly rebuild a town after it has been destroyed. However, when flood victims are focused on rebuilding their homes and businesses, these efforts can fall by the wayside—why focus on mental health when poor physical health is the greater threat to a flood victim’s immediate well-being? How can a community choose to spend money on group counseling for a family instead of spending that grant on rebuilding that family’s home? This is our next great challenge when dealing with natural disasters: making mental health as important as bricks and mortar.

Jillian Sequeira

Jillian Sequeira was a member of the College of William and Mary Class of 2016, with a double major in Government and Italian. When she’s not blogging, she’s photographing graffiti around the world and worshiping at the altar of Elon Musk and all things Tesla. Contact Jillian at Staff@LawStreetMedia.com

The post Needed: Mental Healthcare in the Aftermath of a Disaster appeared first on Law Street.

An estimated 15.7 million adults in the United States experienced at least one major depressive episode in 2014. Rates of depression have been on the rise in the United States for some time, causing some researchers to refer to it as an “epidemic.” The cause for this increase is unknown but some speculate that depression may be another “disease of modernity,” like obesity.

As with obesity, depression and the related condition of loneliness, are often linked to lifestyle. Modern life can isolate us from other human beings, causing loneliness and contributing to depression. Loneliness is more than just a negative feeling. It can have very real effects on a person’s health. Medical conditions like heart disease, cancer, and Alzheimer’s disease are all made worse by loneliness. Even our immune systems are weakened when we are lonely.

Depression is also more than just a negative feeling. Everyone has, at some point, felt depressed. Many people experience what is commonly referred to as “situational depression,” which does not rise to the level of a mood disorder. The death of a loved one or a job loss can trigger an episode of depression. This is the type of depression most of us are familiar with and while therapy helps situational depression, drugs are typically not part of the treatment. However, for people suffering from depression that rises to the level of a depressive disorder, a kind of “chemical depression” where the person’s brain chemistry is misaligned in some way, drugs can be an important part of treatment.

Modern psychiatry has made amazing developments in the treatment of mental illness with drug therapy. Just a short time ago, a patient whose depression was resistant to treatment through therapy and medication had the option to try electroconvulsive therapy or ECT. (Some patients were forcibly electroshocked without their consent, which is a whole other ball of wax). ECT is incredibly controversial and not for the faint of heart. Today there may be a new solution for patients who find that their depression does not respond to therapy or FDA-approved drug treatments.

This new solution is not quite as controversial as ECT but there are concerns about the use of this drug to treat depression. How worried should we be about introducing ketamine as a treatment for depression?

Off-Label

Ketamine is commonly used in veterinary medicine to tranquilize or euthanize animals and it is even used to tranquilize humans as well, typically for surgical procedures. It is also sometimes used as a date-rape drug and is probably best known by its nickname: “Special K.” Ketamine a psychedelic drug like LSD or mushrooms, which can cause hallucinations in addition to general euphoria. It’s typically found at raves and parties, but it does have several medical applications. While its medical use comes with few side effects, ketamine abuse can lead to amnesia, incontinence, and death. Unsurprisingly, it is also highly addictive.

Even so, medical professionals are impressed with ketamine and its potential to be a nearly miraculous treatment for depression. In the video below, Dr. Sanjay Matthew, an expert on depression and professor at the Baylor College of Medicine, explains the emerging research on ketamine as a treatment. What makes ketamine such an exciting new option is the speed with which it delivers results. Most depression drugs take weeks or months to start working for patients. The wait time to see if the medication will even be effective is not just an inconvenience, as many people who need treatment are at a high risk for suicide; a two to three-month wait for relief could be fatal.

As Dr. Matthew explains, ketamine works in hours, not weeks. For some patients, it could literally be life-saving. There is, however, a risk to the use of ketamine as a treatment. Like all medicines, there are potential side effects. In ketamine’s case, the main danger is the likelihood of addiction. That potential certainly does exist, much like opioid pain-killers have dramatically increased the number of people addicted to pain medication, often spurring them to try heroin as well.

How Does it Work?

Ketamine works differently than traditional anti-depressant medications and would be most helpful for patients who have “treatment-resistant” depression. As many as 40 percent of depressed patients don’t get symptom relief from traditional anti-depressants. Most traditional anti-depressants work by creating new synapses in the brain’s serotonin reception system, which is why that treatment can take several weeks to be effective. By contrast, ketamine treatment fosters the creation of enzymes required to stimulate connections between existing synapses, which may be why the results with ketamine are so immediate. While 40 percent of depression cases can be resistant to treatment, in ketamine trials 70 percent of people with resistant depression improved dramatically with its use. The National Institute of Mental Health sponsored randomized trials for both depression and bipolar disorder that have found significant benefits from the use of ketamine.

Risks and Concerns 

This story from NPR highlights some of the concerns surrounding the use of ketamine, including the fact that it is not currently FDA-approved to treat depression. Ketamine has been used as an anesthetic since the Vietnam War, but it can also cause hallucinations and lead to addiction. It was made a Schedule III substance in 1999, putting it on par with LSD in the eyes of the law. This is why many companies are seeking to create drugs that are similar to ketamine in their effect on depression but without the high. Both a nasal spray and a pill are being explored by two different companies as potential treatment options. These drugs are all still currently in the clinical trial phase, so it could be years before any of them are approved for depression treatment.

Using an unapproved drug when other treatments have failed is grounds for asking questions, but it isn’t necessarily too dangerous for us to feel comfortable with. Even if the drug is highly addictive, it is still being administered by a physician–the dose is highly controlled. And it is being used to treat a population of people, severely depressed and suicidal patients, who are more likely to be self-medicating with drugs and alcohol if they aren’t otherwise helped. Versions of ketamine, either in new sprays or pills as well as its current use intravenously, have been used successfully for years in various medical settings. And while ketamine can be addictive and dangerous, the cost-benefit analysis on ketamine has already been done in other medical situations.

Split Responsibilities 

Part of the problem with the use of ketamine is not necessarily its addictive potential or the possible medical complications, but that it spans two different medical categories and doesn’t really “fit” into either space. Doctor Carlos Zarate Jr., the chief of neurobiology at the National Institute of Mental Health, explains that ketamine is typically administered by an anesthesiologist, who isn’t qualified to determine if a patient should be taking it. But a psychiatrist, who could tell if the patient is a candidate for the drug or not–for example, a bipolar person on the verge of a manic episode–isn’t necessarily willing to administer the actual treatment. A specialty clinic or research trial would have both hands on deck–a psychiatrist to manage the psychological aspects of treatment and an anesthesiologist to handle the medical aspects and potential complications.

Ketamine already has an established track record in the medical community as a drug that can be used to stop physical suffering. It is actually the go-to drug in emergency rooms for children with serious pain. Ketamine can cause hallucinations and an “altered” sense of reality, even at the low doses that are used to treat adults with depression. But most of the negative consequences, such as hallucinations and addictive behavior, come from the drug being used in much higher doses and not under doctor supervision. The risk is still there but it has already been proven to be a risk that doctors are willing to take in other medical situations.

The problem with ketamine is much like the problem with opioid painkiller abuse. The opioid epidemic comes not from having and using opioids, when they are needed, but from not treating opioids in a way that acknowledges how dangerous they can be. It was caused by patients, doctors and drug companies that advertised, falsely, that the likelihood of addiction is low, pushing painkillers as the wave of the future. (If you’re interested in the institutional contribution to the rise of the opioid epidemic take some time to watch Frontline’s “Chasing Heroin”). But the lessons to be learned from the opioid epidemic are not to avoid new drugs that have addictive potential. Almost all powerful drugs have the potential for addiction and most medications have potential side effects. It’s a cautionary tale that speaks to the need to monitor treatment and remove financial incentives for over-prescribing and over-promoting new wonder drugs. We should approach the use of ketamine carefully, but not deny its potential usefulness because it can be abused.

Conclusion

Ketamine is not a miracle cure for depression. But, according to Dennis Hartman, who participated in a research trial for the drug treatment with the National Institute of Mental Health, it saved his life and allowed him to manage his depression the way one would manage any other chronic illness. In 2012, he helped found the Ketamine Advocacy Network, which advocates for the drug to be used as a treatment for depression. When you visit the website it starts a tracker which will count how many suicides have occurred, pharmaceutical sales have been generated, and how much economic loss has resulted from depression. If you check out the site, you will likely be surprised by how fast those numbers climb.

Sometimes the “next big thing” is a hoax or a Pandora’s Box with consequences we do not foresee–just as we did not have the foresight to anticipate the rampant abuse that would result from an effort to relieve pain with the development of opioid painkillers. But sometimes the “next big thing” in medicine is something like penicillin. If every time Alexander Fleming came across a moldy cantaloupe he threw it out, the world would be a very different (and far less populated) place.

Resources

The Washington Post: A One Time Party Drug Is Helping People With Deep Depression 

The Washington Post: Loneliness Grows From Individual Ache To Public Health Hazard 

The National Center For Biotechnology Information: Depression as a Disease of Modernity: Explanations For Increasing Prevalence 

DrugInfo: Australian Drug Foundation, Ketamine

NPR: Ketamine Depression Treatments Inspired By Club Drug Move Ahead In Tests

NPR: Club Drug Ketamine Gains Traction As a Treatment For Depression

Ketamine Advocacy Network

PBS: The Real Story Behind The World’s First Antibiotic

National Institute of Mental Health: Rapid Antidepressant Works by Boosting Brain’s Connections

Al Jazeera America: Could Ketamine Become the Next Great Depression Drug?

Mary Kate Leahy

Mary Kate Leahy (@marykate_leahy) has a J.D. from William and Mary and a Bachelor’s in Political Science from Manhattanville College. She is also a proud graduate of Woodlands Academy of the Sacred Heart. She enjoys spending her time with her kuvasz, Finn, and tackling a never-ending list of projects. Contact Mary Kate at staff@LawStreetMedia.com

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Happy Monday Law Streeters! Start your week off right and catch up on all of Law Street’s top stories that you may have missed from last week. ICYMI keep reading to learn more.

1. World Shocked by Terror Attacks in Brussels, Death Toll Still Rising

The city of Brussels, Belgium fell victim to a series of ISIS-claimed terror attacks during Tuesday’s morning rush hour at the Zaventem airport and downtown Maelbeek subway station. So far, at least 34 people have been reported dead, and the number of those injured is in the hundreds. Read the full article here.

2. Mental Health Care: Should We Be Treating the Mind the Same As The Body?

Every year 38,000 people in the United States kill themselves. In America, we have more people who are victims of suicide than are victims of homicide. Or car accidents. Or prostate cancer. Yet mental health care in the United States: how and whether it works, how it is funded, and  the challenges it faces, is rarely discussed. It isn’t something that we like to talk about. Read the full article here.

3. Best Legal Tweets of the Week

Check out the top legal tweets of the week. Read the full article here.

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

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Every year 38,000 people in the United States kill themselves. In America, we have more people who are victims of suicide than are victims of homicide. Or car accidents. Or prostate cancer. Yet mental health care in the United States: how and whether it works, how it is funded, and  the challenges it faces, is rarely discussed. It isn’t something that we like to talk about.

In his book “A Common Struggle,” Patrick Kennedy goes into intimate detail about the alcoholism, drug addiction, and mental illness that he and his family have struggled with. As the title suggests it is a problem that is dealt with by millions of Americans–as patients, caregivers and loved ones. The book, in addition to trying to de-stigmatize mental illness, chronicles the passage of the Mental Health Parity and Addiction Equity Act of 2008. If you have no idea what that is you are not alone. According to a survey by the American Psychological Association, 96 percent of Americans have no idea that this law exists or that it requires insurance providers to treat a mental illness in the same way it would treat a physical one.

Mental Health and Mental Health Parity

Mental health care in the United States is faced with a two unique challenges: access and attitudes. The United States spends $113 billion a year on mental health care. Despite the significant investment, it is more difficult to get access to a provider for mental health services than it is to get access to a physical health provider. Nearly 90 million Americans live in a “shortage area” for mental health care providers–compared to 55.3 million Americans who live in a shortage area for primary care physicians. But an even greater barrier to treatment are the attitudes about mental health. When researchers looked into why people were refusing treatment, 71 percent said that they wanted to solve the problem on their own.

A response like that would be considered ridiculous if it was given after a cancer diagnosis. Yet, because mental illness is considered to be different from a physical illness, we don’t find this response as shocking in that context. Some people do deal with mental illness and addiction on their own, some people even do so successfully. But for individuals who want or need treatment, an attitudinal change that allows patients to believe they are entitled to receive it, and the ability to actually access it, is critical.

Take a look at this explanation of the situation given by Representative Jim Ramstad. This video was his commentary in favor of the Mental Health Parity and Addiction Equity Act of 2008. Essentially, this law requires that insurance providers treat a mental health issue the same way that they would treat a physical health issue, with the same co-pays, deductibles, and access to treatment, including treatment for substance abuse. Ramstad argues in favor of passing the law, citing himself as a success story for treatment.

The arguments dividing supporters and opponents on this issue are the same reasons that people don’t seek treatment: cost and attitude. The human cost of living with mental illness is very high but treatments for mental illness can also be extremely expensive. Treatment often includes therapy, which involves repeatedly engaging the services of a professional for hours each month. That’s a hefty price tag. When treatment involves medication, as it often does for serious mental illnesses like bipolar disorder and schizophrenia, the cost of the medications themselves can be staggering. This is often because the dosages need to be carefully calibrated, frequently adjusted, and generics are not always readily available. All of this involves more physicians and psychiatrists. Hospitalization and in-patient treatment can cost thousands of dollars for just a few days. Insurance companies are understandably reluctant to be responsible for providing these services.

The Costs of Mental Illness

It’s difficult to calculate society’s financial costs for the nearly 42 thousand deaths that were attributed to suicide in 2013. But a 2008 study by the National Institute of Mental Health attributed $193.2 billion dollars per year to lost earnings from mental health disorders in general–largely based on missed workdays because of mental health concerns. That study isn’t accounting for the lost productivity while at work or people who can’t work or are underemployed due to their mental illness. A more recent and more holistic view of the cost of mental illness would cite $444 billion, which includes treatment and the lost wages of patients but not caregivers, according to a report from USA Today. Even that isn’t taking into account the true total economic cost of mental illness.

In effect, what mental health parity does is shift some of the financial burden of treating mental illness to insurance companies, the same way that it does for physical illnesses. But it isn’t a bulletproof solution. One very key component in the bill, which Representative Ramstad addresses, is that mental health treatment would only be provided when it was considered a medical necessity. However, it isn’t clear what qualifies as a medical necessity.

Long-term therapy may be highly beneficial to an individual but may not be considered a medical necessity. A 72-hour psychiatric hold, also beneficial and potentially life-saving in terms of preventing immediate harm, might have a better chance of being considered a medical necessity. The long-term therapy, which could possibly prevent the need for the psychiatric hold, is in all likelihood the more expensive of the two options, just as physical therapy is a very expensive treatment for a chronic medical condition. Insurance companies can and do use medical necessity to thwart patients from using their insurance for treatment of mental illness.

The State of Mental Health Care in America

Mental health parity is an important step, but it does not do anything to address the problem of mental illness for the uninsured and doesn’t do enough to address mental health concerns for those on Medicare/Medicaid. It also does not deal with the much larger problems of access to appropriate treatment and the involvement of the criminal justice system.

The video below, an interview with Liz Szabo of USA TODAY about their series “The Cost Of Not Caring,” explains some of the economic costs of mental health care and how those costs are being borne by millions of Americans. The article that accompanies the series does an even better job of expanding on the concerns with the mental health care system in the United States.

Reduced investment in mental health services by state and local authorities produces a system where we still pay for the mentally ill, just in different ways than you might expect. The main effect of mental health parity is to move some of the burden from the individual to a private insurance provider. While the main consequence of reducing services for mental health shifts the burden from asylums, where the mentally ill used to go, and other institutions that were designed to deal with them, to hospitals and prisons. These already stressed institutions have difficulty coping with the added demands now placed on them, leading to a system that does an ineffectual job because it deals with the physically ill, the mentally ill, and criminals who actually need to be incarcerated as a unit–rather than dividing them into separate categories and treating them accordingly.

Better Alternatives

There are treatment options that can be tried, which may cost more at first, but produce better results in the long run for the individual with a mental illness and his or her community. To compare the problem to a physical one, if amputating a broken arm was cheaper than setting a broken bone and then using physical therapy to regain full range of motion–most of us would still not say that is the best treatment. Because in the long run, the loss of productivity to the individual and to society is much higher and the expense to fix the arm would be viewed as an investment in that person’s future. Why then, when someone comes to the hospital with a chemical imbalance in their brain, rather than misaligned bone fragments, do we not explore more expensive treatment options–ones that would be investments in that person’s most productive future given the nature of the illness.

In 2008, the National Institute of Mental Health began the RAISE project, to research Recovery After Initial Schizophrenia Episode. Researchers in the RAISE trial found that after the two-year study period was concluded, schizophrenic patients who received a model of treatment that included family counseling and help to secure a job–services that are not covered by insurance companies, which typically only pay for drugs and limited therapy for outpatient treatment–did better than patients who only got basic services.

The added cost for these services was about $3,600 a year for each patient and according to the researchers yielded a better quality of life for the patients. Which is, certainly, a difficult thing to quantitatively measure. Because the study only lasted for two years it is hard to say if, over the person’s lifetime with the illness, the initial investment will prove to actually prevent more costly complications like hospitalizations. But the initial results suggest that including this type of counseling and other services may be worth the long-term investment.

For a surprisingly cogent and unsurprisingly hilarious look at the issue of mental health and innovative treatment options, check out John Oliver’s segment on mental health:

Conclusion

Removing the stigma of mental illness by treating it in the same way you would treat a physical ailment is a positive first step towards dealing with the mental health care crisis in this country. But it is only the first step. Thousands of Americans die from mental illness every year. Millions suffer from it chronically and face the challenges of dealing with a mental disease daily.

Because it touches so many of us so intimately, mental health treatment in America is not an easy topic for most to discuss. Usually, it only becomes part of our public discourse in the wake of a mass shooting. But that’s like only talking about a disease if it is an air-born pathogen. Those diseases are the most obvious for us to see as a threat; nothing is sexier on the evening news than a flu pandemic. But it is the less glamorous food poisonings that might be more deserving of our attention. It’s messier and more embarrassing to talk about, but you are also more likely to be affected by it.

Resources

USA TODAY: Mental Health System Crisis

Goodreads: A Common Struggle 

American Psychological Association: Help Center: Parity Law Resources

Washington Post: Seven Facts About America’s Mental Health Care System 

The Kennedy Forum: Parity 

Centers for Disease Control: Mental Health 

The Huffington Post: US Mental Healthcare System

Slate: Is My Work Medically Necessary? How Insurance Companies Get Around Rules For Mental Health Care

New York Times: New Plan To Treat Schizophrenia Is Worth Added Cost, Study Says

Mary Kate Leahy

Mary Kate Leahy (@marykate_leahy) has a J.D. from William and Mary and a Bachelor’s in Political Science from Manhattanville College. She is also a proud graduate of Woodlands Academy of the Sacred Heart. She enjoys spending her time with her kuvasz, Finn, and tackling a never-ending list of projects. Contact Mary Kate at staff@LawStreetMedia.com

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As mass shootings become the focus of public attention after two high-profile incidents in the span of  a couple of days, more and more people are demanding a response from Congress. Speaker of the House Paul Ryan recently faced a question about how to address mass shootings to which he responded saying that the focus needs to be on mental illness. Ryan then pointed to a bill from Representative Tim Murphy, a Republican from Pennsylvania, which seeks to overhaul the American mental health system. While nearly everyone agrees that the United States needs a better approach to mental health, the connection between mental illness and mass shootings is much more complicated than it may seem.

Before we get into the validity behind associating mental health with mass shootings, it is important to acknowledge the fact that most Americans see it as an important underlying problem. According to an ABC/Washington Post poll from October, Americans are nearly split on whether the government should prioritize passing new gun laws or protecting gun rights, but nearly two-thirds believe that improving mental health treatment is necessary to address mass shootings. When asked whether mass shootings are a reflection of problems with identifying and treating people with mental health issues or inadequate gun control laws, 63 percent believe mental health is the issue. There is a partisan difference in opinions–Republicans overwhelmingly focus on mental health while only 46 percent of Democrats focus on mental health alone. But despite those differences, only 23 percent of respondents said inadequate gun control laws were more concerning than mental health issues.

While Democrats often criticize Republicans’ reluctance to talk about gun control after mass shootings, it’s fair to say that addressing mental health problems is a greater concern for their constituents than stronger gun laws are. So in the wake of the tragic Sandy Hook shooting in 2012, the Republican Party looked to Rep. Tim Murphy, the only psychiatrist in Congress, to come up with a response. Murphy traveled across the country to speak with communities and mental health experts to determine the best way to fix the current system. While Murphy’s bill, the Helping Families in Mental Health Crises Act, marks the most comprehensive approach to overhauling the U.S. mental health system, it’s important to ask how doing so will affect mass gun violence.

In a review of research on mental health and gun violence, Vanderbilt University professors Jonathan M. Metzl and Kenneth T. MacLeish find that there is little evidence to suggest that mental illness causes gun violence. While it is true that in the aftermath of mass shootings reports often indicate that the perpetrator experienced some sort of paranoia, delusion, or depression prior to the attack, suggesting that mental illness caused the shooting is another matter. Metzl and MacLeish cite the finding that less than 3 to 5 percent of crimes in the United States are committed by people with mental illness, and that proportion may be lower in terms of gun crime.

In fact, people with mental illness are far more likely to be the victim of a crime than the perpetrator. For example, one study found that people diagnosed with schizophrenia are victimized at rates 65 to 130 percent higher than the general public. The authors concluded, “In general, the risk associated with being in the community was higher than the risk these individuals posed to the community.” Saying that all people diagnosed with mental illnesses are likely to commit mass shootings is about as useful as saying we should take away the gun rights of white men because most mass shooters also fit that demographic. In reality, the vast majority of white men and people diagnosed with mental illness will not commit mass violence.

Metzl and MacLeish also question the claim that mental health professionals can predict and prevent gun crime. While efforts to prevent the next mass shooting are well intentioned, basing that off of psychiatric diagnosis is remarkably difficult. The authors argue that psychiatric diagnosis is primarily a matter of observation, and they note that for that reason “research dating back to the 1970s suggests that psychiatrists using clinical judgment are not much better than laypersons at predicting which individual patients will commit violent crimes and which will not.”

In some ways, the difficulty in using psychiatric diagnosis to predict mass violence is a matter of math. Public health research can be used to determine a person’s risk of heart attack based on large-scale studies and randomized trials, but when it comes to mass shootings and mental health, the data is limited. As Jeffery Swanson, a professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine, notes in his research on predicting rare acts of violence:

In a U.S. city the size of San Jose, California, (population about 1,000,000), about 4,000 people every year will have a heart attack; perhaps one or two will be killed by someone with mental illness wielding a gun. Treatment evidence for preventing death from myocardial infarction has piled up from hundreds of clinical investigations over several decades, involving more than 50,000 patients in randomized trials by the early 1980s . When it comes to persons with mental disorders who kill strangers, there is nothing remotely resembling such an empirical evidence base.

The Republican mental health bill marks an ambitious effort to address a growing problem in the United States, but saying that it is a plan to prevent future mass shootings is misleading. According to the Treatment Advocacy Center, there are 350,000 Americans in state jails and prisons who have been diagnosed with a severe mental illness–that, among other things, is what Rep. Murphy’s bill seeks to address. The bill would restructure the funding for mental health care and change health privacy rules to allow family members to get information about a loved one’s treatment. On the other hand, the bill does not address whether or not someone with a mental illness should have access to guns.

Instead of advertising Murphy’s bill as a means to solve mass shootings, Congress should focus on the need for mental health reform by itself. The Helping Families in Mental Health Crises Act does have controversial provisions, notably whether states should be encouraged to develop Assisted Outpatient Treatment programs, which allows courts to compel treatment for individuals before he or she has a mental health crisis. And whether Murphy’s plan to move funding from the Substance Abuse and Mental Health Services Administration–which he views as wasteful and ineffective–to a create an Assistant Secretary for Mental Health is the best way to spend money on mental health treatment.

Murphy’s bill is certainly ambitious and he already has some bipartisan support and backing from important mental health groups, but it also has some controversial provisions. For this reason, the debate on its passage should focus on whether or not it will improve and expand treatment for the 10 million Americans who experience severe mental illness in a given year–not whether it will prevent mass shootings.

Read More: Police Brutality and the Mentally Ill in America

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post Fixing Mental Health Care Will Not Stop Mass Shootings, But That’s Okay appeared first on Law Street.

This won’t be news to anyone who experiences it, but this “just in”–being targeted and locked up by racism and the criminal justice system dramatically increases people’s experiences of depression, suicide ideation, and many other types of “mental illness.”

Except here’s the thing: like Bruce E. Levine over at AlterNet has shown, the U.S. government’s Substance Abuse and Mental Health Services Administration (SAMHSA) has shoved under the table a survey that demonstrates the explicit connections between high rates of mental illness and mass incarceration, racism, unemployment, heterosexsim, and classism.

One of the most damning aspects of the survey is that the rate and severity of experiencing mental illness is double for adults who have contact with the criminal justice system compared with adults who don’t. (Seriously. Check it out.) There seems to be the perception that this country locks up people because they experience mental illness: this is often true, and is repulsive. But if we want to look at the proverbial big picture, we also have to consider the ways that mass incarceration–and the solitary confinement often involved with imprisonment–and the virulent racism that shapes the prison-industrial complex actually cause mental health issues.

Levine writes, “[f]or decades doctors — and Big Pharma — have pointed to neuroscience [as explanations for “mental illness”]. Cultural variables are often more telling.” Indeed. But by SAMHSA’s logic, why damn the system that produces these mental illness-causing oppressions when you can convince people to buy overpriced, toxic pharmaceuticals drugs and therapy from it?

Of course, people who experience these oppressions don’t need government-sponsored studies and surveys to elucidate the ways that racism, mass incarceration, classism, and heterosexism make many of us live with severely impaired mental health.

Personal Example Time: I am certain that my being a white queer woman in this society fundamentally shaped my diagnoses as depressed and bipolar. Expected to be easily “corrupted” and traumatized because of my whiteness and white privilege; expected to be dedicated to others and feel guilty for putting myself first because of my womanness and heterosexism; expected to daily endure the structural and interpersonal impacts of sexism and queerphobia and always be “polite” about it…my diagnoses (and the feelings that precipitated seeking them) are not surprising.

White men–much like those who shoot people in schools and much like Germanwings co-pilot Andrea Lupitz–are routinely portrayed empathetically by mainstream media sources (instead of being called terrorists) because of their emotional angst and “understandable” mental illness when they kill over 100 people. However, people (especially working-class women) of color who defend themselves against attack are imprisoned, villified, and pathologized. In light of this, the consequences of not addressing racism, heterosexism, and classism in mental health are… well… life-threatening.

And far, far beyond depressing: the causes and consequences are outraging.

Jennifer Polish

Jennifer Polish is an English PhD student at the CUNY Graduate Center in NYC, where she studies non/human animals and the racialization of dis/ability in young adult literature. When she’s not yelling at the computer because Netflix is loading too slowly, she is editing her novel, doing activist-y things, running, or giving the computer a break and yelling at books instead. Contact Jennifer at staff@LawStreetMedia.com.

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From bizarre laws to college admissions strippers, Law Street has you covered on everything you might have missed last week. Our number one story of the week came from Marisa Mostek who added the Pacific Northwest states to her series of the Dumbest Laws in the United States. Hint: hope you don’t want to buy a new mattress on a Sunday, because that’s out of the question. Anneliese Mahoney wrote the #2 post on Columbia University’s policy allowing students who have experienced trauma to petition for delayed exams, which became a hot topic in the context of the recent Ferguson and New York grand jury decisions. And Ashley Shaw had the #3 post of the week with a report on now-defunct FastTrain College’s admissions practices that will have you scratching your head and wondering how this happened in real life. ICYMI: check out Law Street’s Best of the Week.

#1 The Dumbest Laws in the United States: Pacific Northwest Edition

I was wrong a couple weeks ago when I said that California laws are crazy. Many of the Golden State’s laws that I mentioned now seem completely sane in comparison to those I’ve discovered in Washington and Oregon. For example, if you are trying to woo the opposite sex by saying your dad just won the lottery and drives a brand-new Lamborghini when in fact he doesn’t have a dime to his name, you better think again. In Washington state it is illegal to pretend that your parents are rich. Read full article here.

#2 Columbia Law takes Progressive Stance on Mental Health

In light of the incredibly controversial and nation-sweeping announcements that grand juries in Missouri and New York failed to indict the cops who killed Michael Brown and Eric Garner, respectively, Columbia University Law School made an announcement. It regarded the reactions that some of the students may be having to those verdicts, and offered counseling, opportunities to talk to professors regarding the indictment. Read full article here.

#3 BS in Dancing: When Stripper Work Admissions, It Might be a Scam

With a name like FastTrain College, you probably expect a top-notch education system along the lines of Harvard or Yale; however, what you apparently get is a different type of top entirely. When FastTrain wants you (so basically if you are a man), it will send out its top admissions officer. And by top officer, I of course mean an exotic dancer dressed provocatively in an effort to lure you into the school. Read full article here.

Chelsey D. Goff

Chelsey D. Goff was formerly Chief People Officer at Law Street. She is a Granite State Native who holds a Master of Public Policy in Urban Policy from the George Washington University. She’s passionate about social justice issues, politics — especially those in First in the Nation New Hampshire — and all things Bravo. Contact Chelsey at staff@LawStreetMedia.com.

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One of my favorite parts of my job here at Law Street is that I get to work with incredibly intelligent individuals with whom I occasionally disagree. Blogger Allison Dawson is one of those people. Today, she wrote a piece entitled “Columbia Law Students Can Postpone Exams in Light of Grand Jury Decisions.” It’s a great take–but I think there are a couple important points missing.

For some context, here’s the background: in light of the incredibly controversial and nation-sweeping announcements that grand juries in Missouri and New York failed to indict the cops who killed Michael Brown and Eric Garner, respectively, Columbia University Law School made an announcement. It regarded the reactions that some of the students may be having to those verdicts, and offered counseling, opportunities to talk to professors regarding the indictment, and this:

The law school has a policy and set of procedures for students who experience trauma during exam period. In accordance with these procedures and policy, students who feel that their performance on examinations will be sufficiently impaired due to the effects of these recent events may petition Dean Alice Rigas to have an examination rescheduled.

There’s a crucial part there that I want to make sure we’re all very cognizant of, and that’s that a Columbia Law student can’t just walk into Dean Rigas’ office and say “hey, I’m feeling weird about these indictments, can I take those exams later?”

The Academic Procedures outlined by Columbia make it pretty clear that petitioning to not take an exam isn’t really an easy practice. It certainly seems that a petition is by no means a guarantee to skip an exam, and that Columbia takes petitions pretty seriously. Columbia’s policy states:

Some petitions can be decided on within two to seven business days; others may require a meeting of the Rules Committee or the faculty and will take longer. It is advisable to make your petition as early as possible and not to assume the results of a petition.

A follow-up letter makes it seem like they really would only allow someone to postpone an exam under rather dire circumstances. The Vice Dean for Curriculum, Avery Katz wrote:

Accordingly, students who wish to request a rescheduled exam, or other similar accommodation, should either write to the office of Registration Services with an individual explanation of the basis of the request, or speak in person with an academic counselor in the Office of Student Services.  Unless time pressure is severe, meeting with an academic counselor is the preferred alternative, in case our student services staff can offer support or other resources that may be helpful.

I truly hope that if anyone uses this to try to get out of taking an exam, that Columbia would catch it with its policies. To anyone trying that, here’s a message to you: you’re a shitty person, and you are making it harder for those who actually do need to postpone an exam. Honestly, I highly doubt that many people will end up asking to postpone their exams because of these grand juries, or that Columbia will honor those requests.

All that being said, the fact that Columbia Law is recognizing that the grand jury announcements could have been triggering for a student is excellent. I agree with Allison that our future lawyers need to be able to accept and learn from the outcomes of our legal system, but I think that’s oversimplifying what those failures to indict really mean. The grand jury decisions were symptoms of significantly larger issues in our justice system, like racial inequality, police brutality, and a culture of violence. The protests that have continued all around the nation show that these conversations didn’t stop when those grand juries made their decisions.

No one gets to dictate what could cause someone to have emotional or mental difficulties and need help. Columbia Law has policies in place that allow students to make their case if they are suffering from anything that would impede performance on exams. The letter that went out yesterday just clarified that. There will of course always be people who try to take advantage of the policy, and I truly hope Columbia Law is able to identify those people. But the fact that Columbia is taking such a progressive view on mental health and triggers is truly refreshing. It’s the thought that counts, and for Columbia Law, this truly was a good thought.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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Many prisons use solitary confinement as a mechanism to control their prison populations and minimize the threat of danger to other inmates and prison staff. Yet extreme isolation is an unnatural punishment and can cause severe psychological, or sometimes even physical, damage. The effectiveness and methods of solitary confinement has been debated since its modern day inception as a form of punishment in the 1800s, yet it was not until recent years that states began to question the constitutionality of the matter. As convicts, prisoners have little sympathy from the general population; yet there are arguments for the release of prisoners who are placed in solitary confinement for indefinite amounts of time and for non-violent reasons. The argument in favor of regulating or eliminating the age old method is that these people are being placed under “cruel and unusual” circumstances, and are being released back into society in an even worse condition than before they were incarcerated. As of 2013, the United States holds roughly 2.3 million inmates in federal, state, and local jails, 80,000 of which are in solitary confinement.

What is Solitary Confinement?

There are two main types of solitary confinement that are primarily used in the United States. Disciplinary solitary confinement is used to punish an inmate for a violation of minor jail rules or protocol; administrative solitary confinement is used to isolate dangerous prisoners from the rest of the prison population and staff. Often prisoners who are placed in the latter group will remain in Supermax cells for months to years, sometimes for an undetermined length of time.

Typically solitary confinement is reserved for the most threatening and aggressive inmates, so the conditions are not cozy. Cells are typically “80 feet [10 by 8 feet], not much larger than a king-size bed,”  and sometimes even smaller; they do not have any windows and the floors are hard concrete. The door is typically heavy metal and locks with massive bolts.  Prisoners are isolated for 23 hours out of the day, and receive one hour of heavily monitored recreational activity in another slightly larger cell. Meals are slid through a small space in the door so prisoners remain completely isolated even during meal times.The cell is left bare, so prisoners often resort to habitual pacing and sometimes create routines to mimic life outside of prison. Prisoners may receive an early release from the designated amount of time if they practice “good behavior” and attend classes to improve themselves.

 History of Solitary Confinement

Solitary Confinement is thought to have started in a Philadelphia jail in the 1800s. The Quakers felt that by placing criminals in isolation they would have time to read the Bible and repent for their sins. The original idea behind solitary confinement was to reform inmates, as opposed to violently punishing them.

The Invention of Solitary Confinement — The Eastern State Penitentiary:

Another early prison that used a form of solitary confinement was the New York jail, Auburn. There, the “Auburn System,” a method of punishment in which prisoners were required to do manual labor all day in silence before being sent off to solitary confinement for the remainder of the night, was developed. This system gained popularity in prisons across the country. During this time, Auburn and other prisons also used forms of torture as a punishment. One popular method was the “shower bath.” This consisted of placing a prisoner under a constant flow of an excessive and painful amount of water. The flood would beat them over the head, getting into their eyes and mouths, nearly drowning them. Sometimes the shock would cause prisoners to fall dead moments later.

Psychological Effects and Ethics

It is hard to think of people who have committed heinous crimes as actual people, yet putting them under such harsh conditions can be embarrassing, alarming, and disgusting. Many times inmates display suicidal tendencies and harm themselves with makeshift weapons. Others resort to odd and erratic behaviors such as rubbing feces on themselves, pacing mindlessly, or cutting themselves. If solitary confinement is supposed to teach a lesson, it may be counterintuitive to its original purpose. Prisoners who are placed in solitary confinement will experience several psychological and physical effects of being in isolation for an extended period of time. According to Frontiers in Psychology, “One’s own existence is something that one experiences in the kinds of pragmatic projects that one shares with others.” When deprived of the basic human need of socialization for long enough, people begin to display mentally unstable and even insane behaviors.

Prisoners in solitary confinement may begin experiencing:

Visual and auditory hallucinations

Hypersensitivity to noise and touch

Insomnia and paranoia

Uncontrollable feelings of rage and fear

Distortions of time and perception

Increased risk of suicide

Post Traumatic Stress Disorder (PTSD)

The development of crippling obsessions

When prisoners do not experience any interactions with other people they begin to lose a sense of reality. Their internal thoughts become a blur with the external world, which they have ceased to experience. Not only is this inhumane, but it also defeats the purpose of punishing the guilty. Integrating the prisoner back into society becomes more challenging, and they become a product of isolation. This is not only detrimental to the individual, but also society.

According to International Journal of Offender Therapy and Comparative Criminology, in 1890 the United States Supreme Court  began to note the inhumane and damaging effects that solitary confinement has on the prisoners:

“A considerable number of prisoners […] became violently insane;  other still, committed suicide, while those who stood the ordeal better were not generally reformed and in most cases did not recover sufficient mental activity to be any subsequent service to the community.”

ABCNews personality Dan Harris voluntarily spends 48 hours in solitary confinement:

Prisoners’ Rights

The Eighth Amendment includes the cruel and unusual punishment clause and serves as the basis for civil rights advocates’ arguments against the use of solitary confinement in American prisons. The fact that prisoners have little to no human contact, let alone see daylight for months to years, could be considered cruel and unusual. The argument that solitary confinement violates a prisoner’s constitutional rights prevails as the center controversy for advocates and courts. While incarcerated, prisoners are provided with medical and mental services, although whether they are adequate or not is debatable, and many cases regarding health care and general prison conditions have been brought to the forefront within the last 20 years.

To view the document outlining prisoner’s medical, dental, and mental health rights click here.

Case Study: Pelican State Bay Prison  (Ashker v. Brown)

The case Ashker v. Brown was sparked by a  2011 hunger strike led by prisoners at Pelican State Bay Prison in Crescent City, California. The strike drew attention to the unpalatable conditions that prisoners in solitary confinement experience. In an extended effort in May 2012, the  Center for Constitutional Rights filed a lawsuit against Pelican State Bay Prison for allegedly violating the Eighth Amendment as well as the Due Process Clause in the Fourteenth Amendment.  Many prisons lack adequate medical care, and prisoners are denied an in-depth review of their cases before being placed in solitary confinement.

Case Study: Nicole Guerrero v. Wichita County

Pregnant inmate Nicole Guerrero was placed in solitary confinement in a Texas jail in 2012. While in ‘the hole’ she began to experience excruciating pain and intense cramps due to labor. The medical staff at the prison reportedly ignored her for hours. She was forced to give birth alone, and when the prison medical staff finally came to the scene the baby was dead due to the umbilical cord being wrapped around its neck. This case supports the argument noting the lack of medical attention prisoners in solitary confinement receive, and brings states closer to regulating the controversial practice.

Peoples v. Fischer

In June 2012, the New York City Civil Liberties Union filed a lawsuit on behalf of prisoner Leroy Peoples. Peoples spent three years in solitary confinement for filing false legal documents. Violating any of the codes that the prison regards as against protocol has the potential to send a prisoner into solitary. According to the Civil Liberty Union, “only 16 percent of isolation sentences from 2007 to 2011 were for assault or weapons.” Solitary confinement served the original purpose of protecting staff and other inmates from potentially dangerous prisoners; now prison systems are abusing the extreme form of punishment, and overusing solitary confinement for reasons other than violence. Another issue that the NYCLU addresses is the fact that solitary confinement is used as a source of punishment for juveniles, pregnant inmates, and the mentally ill. The Union argues that this is inhumane and more permanently damaging to these more vulnerable groups of inmates. Currently, the outcome of the case is in reconsideration, and “if the process fails, the NYCLU will resume litigation.”

Click here to see the Institutional Laws of Conduct.

Innovation in the Prison System

Recently Colorado signed into legislation a law that bans prisons from placing mentally ill inmates in long-term solitary confinement. According to the Wall Street Journal, “Maine and New Mexico have taken steps to reduce their use of solitary confinement, and Nevada and Texas are studying the issue.” Similarly in a document, New York has decided to “remove  youth, pregnant inmates and developmentally disabled and intellectually from extreme isolation.”

Click here to see New York’s agreement to reform solitary confinement in the prison system.

Some opponents of the practice suggest alternative methods; instead of placing inmates in solitary confinement,  they could be sent to a mental-health care unit within prison where the individual can be treated instead of punished. Of course, this idea receives strong opposition, yet New York has decided to enact a version of it.

Resources

Journal of Constitutional Law: Prolonged Solitary Confinement and the Constitution

NYCLU: Peoples v. Fischer

Correctional Association of New York: Shining Our Spotlight on Auburn Correctional Facility

CNN: Solitary Confinement: 29 Years in a Box

PBS: Solitary Confinement and the U.S. Prison System

Pennsylvania Prison Society: Violence in the Supermax: A Self-Fulfilling Prophecy

Washington Post: Va. Prisons’ Use of Solitary Confinement is Scrutinized

The New York Times: New York State in Deal to Limit Solitary Confinement

Center for Constitutional Rights: Ashker v. Brown

NYCLU: Lawsuit Secures Historic Reforms to Solitary Confinement

CNN: Texas Wom Claims She Gave Birth Alone in Jail, Baby Died

Wall Street Journal: Colorado Becomes Latest to Back Ban on Solitary Confinement of Mentally Ill

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Madeleine Stern

Madeleine Stern attended George Mason University majoring in Journalism and minoring in Theater. Her writing on solitary confinement inspired her to pursue a graduate degree in clinical counseling after graduation. Madeleine is an avid runner, dedicated animal lover, and a children’s ballet instructor. Contact Madeleine at staff@LawStreetMedia.com.

The post The Evolution of Solitary Confinement in the United States appeared first on Law Street.

After a botched execution in Oklahoma rose questions about the cruelty of the death penalty last month, capital punishment is in the news again this week. The Supreme Court has ruled a Florida law unconstitutional that barred the execution of any prisoner with an IQ less than 70, after the case was heard in March. The law was intended to prevent inhumane treatment of those prisoners, but the Justices who voted to strike down the law stated that a strict IQ cut off did not take into account inherent issues with IQ tests. The ruling was 5-4, with the more liberal side of the court voting to overturn Florida’s law. The perennial swing vote, Justice Anthony Kennedy swung to their side.

The problem with such an inflexible law is that it allowed some prisoners, who fell just above the 70 point threshold, to be executed. IQ tests are not even close to absolute–there is a margin of error that needs to be taken into account. Someone with an IQ of 71 could have the same mental capacities as someone who receives an IQ test of 69. Florida’s law doesn’t recognize that. There is also the fact that IQ can vary over time. When you reach your 50s or 60s, your score will usually go down by a point or two. There’s also the problem that our IQ scores, as a society, have changed over time. Every decade, our average IQ scores go up by about 3 points. Finally, there’s the matter of education–people who had more access to education may score higher on an IQ test, even if their mental abilities are the same as another with less education. The benchmark of “70” means little to nothing, other than an arbitrary number used to decide the future of some prisoners.

Many US states that still allow capital punishment have some sort of IQ or capability requirement in order to sentence a prisoner to death. However, most of those states take a holistic look at prisoners, incorporating psychological assessments and recognizing the margin of error that is present in an IQ test. Florida was one of the few with a purely numerical cutoff, but the others with similar laws will also be forced to reevaluate their policies. The other states are Alabama, Arizona, Delaware, Florida, Kansas, Kentucky, North Carolina, Virginia, and Washington. Although Kansas’s death penalty hasn’t actually been used in half a century, and Washington may be moving towards abolishing theirs.

The case that made it to the Supreme Court involved a man named Freddie L. Hall. He has been in prison since 1978, when he was convicted of murdering a 21-year-old woman who was pregnant. His execution has been hanging in the balance due to his borderline IQ scores. He has taken nine IQ tests over roughly the last 50 years. On those tests, he has scored anywhere from low 60s to 80. His most recent tests have hovered right around that 70 benchmark–a few over and a few under. However, not all of his tests have been deemed admissible in court and the one that was used in his most recent hearing had a score of 71. That means that Hall was just one point about the 70 cutoff, even though there’s no evidence to suggest that he consistently could score above 70. Throughout Hall’s entire life, his doctors had classified him as mentally disabled based not just on IQ scores but on other tests and on their analysis.

As a result of the rule regarding Hall, and the changes that the nine aforementioned states will have to make, there are a few prisoners who may get another chance at appealing the ruling that put them on death row.

This is a great step towards a recognition that IQ tests have not, for a long time, been conclusive, and that something as serious as the death penalty needs to be decided on a case-by-case basis whenever possible.

[New Republic]

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Anneliese Mahoney (@AMahoney8672) is Lead Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

Featured image courtesy of [Biologycorner via Flickr]

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post IQ Requirements for Death Penalty to Change Due to SCOTUS Ruling appeared first on Law Street.

Buying a $299 whiteboard that can stop bullets is a startling reality for educational professionals across the country. The LA Times estimates that Hardwire LLC sold around 100 such boards to schools in 5 different states. According to the website “the high-tech tablet — which hangs on a hook, measures 18-by-20 inches and comes in pink, blue, and green — can be used as a personal shield for professors under attack and as a portable writing pad in quieter times”.

Being an alternative to arming teachers, the invention of this multifunctional tablet draws attention to the fears in the American education system.

But does this mean that people are simply waiting for more mass shootings to happen? Does it mean that it’s no longer safe to send your kids to school, or pursue a career in education?

I decided to look at the statistics to find the definitive answer, specifically a Small Arms Survey New Armed Actors Research Note, provides a reliable data on gun ownership in participating countries. According to their report, the United States has 270,000,000 firearms in the possession of its civilian population alone, making the U.S. the world’s leader in civilian gun ownership. Although almost every American agrees that mass shootings, particularly those at schools, are a very important issue, there remains a great deal of disagreement on how to solve the problem. Anti-gun folks will argue that all mass shootings happened just for one reason: the availability of guns. The solution they offer is to prohibit guns, and voilà, the problem is solved! But the reality is – the prohibition of guns will not happened because American society is not ready for that. The latest poll by Gallup showed that 74 percent of Americans are against banning guns for civilians! Thus, it will take many more significant events like school shootings for Americans to change their perceptions on firearms and reform gun laws in the United States. Furthermore, the government can’t even tighten existing gun laws due to the political rivalry, and strong lobbying of pro-gun organizations. In contrast, pro-gun politicians suggest that we arm teachers, and again, voilà, the problem will be solved. The irony of this proposition is all too clear to me, so I have to ask: is it really going to help? Mother Jones analyzed 62 mass shootings in America, finding that not even one of these events was prevented by an armed bystander.  In fact, some of these heroes were actually injured or killed as a result of their attempts to stop the attack.

Live Science indicates that although mass shootings are not a common phenomena, when compared to other violent crimes in America, the amount has been steadily increasing. The same source suggests that most of the shooters had difficulty to connect with other people and wanted to be seen as notorious as possible. The interesting characteristic of almost all mass shooters is their ability to plan and execute their projected shootings despite their mental instability. This reminds me of Edgar Allan Poe’s “Tell-Tale Heart” where murder was meticulously planned and executed by the unknown narrator who is suffering from a mental disease. The Huffington Post suggests that “a history of abuse or ineffective parenting, a tendency to set fires or hurt animals, a sadistic streak, and self-centeredness and a lack of compassion” all can characterize mass shooters. So will arming teachers prevent these people from shooting until their last breath? Probably not.

The problem of mass shootings, especially on campuses, is not only due to the availability of guns, but also to the lack of proper treatment for the mentally-ill. Real Clear Politics encourages us to address the widespread problems of young unstable adolescents and to stop meaningless fight about gun control. The violence exposure through TV and video games combined with alienation, individualistic culture, pressure to succeed, and mental disturbance, can create a lonely mass shooter who might come to your college, school, movie theatre, or grocery store tomorrow.

I decided to look at the statistics again, but now within the American mental health care system. Washington Post provides seven facts about mental health system in the United States, among those are high price tags on mental health services, bias in mental health treatments, and restricted access to mental medical care. Fox News also breaks down for us what is wrong with mental health care in America, and the picture is not all bright. Inadequate training of professionals in the industry and sky-high costs of treatment itself are only two perplexing realities of mental health care system today.

So how do we cure campuses form mass shootings? Changes can happen, but people should not only be aware of the issue realities, they should fiercely advocate for changing the ineffective policies that currently exist. Tightening gun laws to prevent mentally-ill people from accessing firearms, and providing more mobility and resources to mentally-ill people alone can decrease mass shooting incidents. The problem itself should be viewed as multidimensional issue that involves government, local communities, educational system, and healthcare.

There is no time for meaningless fights about gun control and dubious ideas to transform schools and colleges to citadels with armed teachers. A $299 pink board also won’t help tackle the problem.

But what should teachers and students do in the meantime?

Teachers will buy those colorful boards hoping they will never use them as “protection shields”, put guns in their classroom drawers, and start to teach hoping that history will never repeat itself.

In memory of Sandy Hook Elementary Shooting.

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Valeriya Metla is a young professional, passionate about international relations, immigration issues, and social and criminal justice. She holds two Bachelor Degrees in regional studies and international criminal justice. Contact Valeriya at staff@LawStreetMedia.com.

Featured image courtesy of [woodleywonderworks via Flickr]

Valeriya Metla

Valeriya Metla is a young professional, passionate about international relations, immigration issues, and social and criminal justice. She holds two Bachelor Degrees in regional studies and international criminal justice. Contact Valeriya at staff@LawStreetMedia.com.

The post Guns, Whiteboards, and the Mentally Ill: How to Cure Campuses From Mass Shootings appeared first on Law Street.