Why mental health and the law matters

Postscript

August 14, 2020

Why mental health and the law matters

A small team in the Department of Psychiatry and Behavioral Sciences is launching the Center for Mental Health, Policy, and the Law. 

As a medical student, Jennifer Piel did a rotation at a juvenile detention center and her passion for law and medicine came together. She witnessed the barriers getting young vulnerable people treatment and resources.

Today, Dr. Piel is a forensic psychiatrist on a mission to provide psychiatric help for people involved in the justice system – both those facing criminal and civil entanglements – and those working with them.

She and a small team at the Department of Psychiatry and Behavioral Sciences are launching the Center for Mental Health, Policy, and the Law.  We had a lot of questions for Dr. Piel. Here is our Q&A:

What is forensic psychiatry?

Forensic psychiatry is the subspecialty of psychiatry involving the intersection of mental health and the law. Forensic psychiatrists understand the procedures and processes of the justice system and provide assessments on mental health.  They assist courts and the judicial system with medical-legal questions, such as whether a criminal defendant was insane at the act or competent to stand trial. They provide treatment at correctional facilities and assist people with re-entering the community after incarceration. They also advise courts, health systems, and providers on issues relating to the regulation of mental health.

What are some examples of assessments?

Forensic mental health specialists perform assessments of competence to stand trial, insanity at the time of the act, other mental state assessments, and evaluations of whether one’s mental illness is a mitigating factor for sentencing.

On the civil side, forensic mental health specialists perform a number of medical-legal assessments, such as whether someone sustained psychological harm from their claimed injury (such as from a car accident or workplace harassment), capacity to execute a will, workplace violence risk assessments, and whether someone is fit (from a mental health standpoint) to return to work.

Why is the center needed?

For one, there is a huge need for forensic psychiatrists and psychologists in this country. Ranges of behavioral health conditions in our correctional facilities can exceed 70% percent. (According to a 2018 report from the Bureau of Justice Statistics, nearly 2.2 million adults were held in America's prisons and jails at the end of 2016.) Even those who don’t have a pre-existing mental health condition before entering the correctional system, the stress and challenges associated with detention cause many to experience psychological distress while detained.

We are interested in collaborating with community partners to enhance diversion efforts and create training opportunities and consultation for law enforcement, correctional providers and emergency services working with this population.

What will the center do?

We will have a training component. This would be to train future forensic psychiatrists and psychologists to be leaders in justice-involved settings. We also want to provide some education for people new to working in correctional settings so they can understand the challenges unique to this population and to their care delivery. We want to provide education to other stakeholders in the justice system, such as first responders, lawyers, and judges.

We will have a research and policy arm to evaluate best practices for forensic populations; advise care facilities, clinicians, and the legislature on topics related to mental health and the law. We can offer advice on the anticipated ramifications of legislation on mental health laws and care delivery, such as changes to the state’s Involuntary Treatment Act.

We will have a service arm – a dedicated clinic to conduct specialized forensic mental health assessments and answer medical-legal questions.

Are there any other similar centers in the country?

We had an opportunity to look at models around the country for advancing forensic mental health education and services. We were impressed with the University of Virginia’s Institute of Law, Psychiatry & Public Policy and aim to do similar work that helps our state.

How did the center come about?

A team of UW Medicine psychiatry faculty worked on a legislatively funded proposal to create a forensic teaching program at Western State Hospital to expand the workforce in this area. This aligns with Gov. Jay Inslee’s interest to create a forensic center of excellence at Western State Hospital.

As part of this proposal, we advanced the idea of a university-driven center to pool resources fostering more engagement around forensic mental health training, workforce development, scholarship, service and policy.

What is the path to get into forensic psychiatry?

Go to medical school. Do a residency in psychiatry.  And then do a one-year fellowship in forensic psychiatry.

Where did you do your fellowship?

I attended Case Western Reserve University in Cleveland for my forensic fellowship. I worked with Dr. Phillip Resnick, considered one of the best forensic psychiatrists in the country. He has done hundreds of forensic assessments. He worked on the case of Ted Kaczynski (the serial bomber who sent explosive packages to people involved in modern technology) and Andrea Yates (the mother who drowned her five children and was found not guilty by reason of insanity), among others.

Do you envision lawyers as part of the center?

We want to provide some continuing education and training for the legal community, especially with public defenders and others who routinely have contact with persons with mental illness. We currently have a course in Psychiatry and the Law that is open to law students and health professional students.

What would a perfect world look like to you?

We want to help persons with behavioral health conditions be appropriately diverted from the criminal justice system and into more suitable resources. We want to work with community and other partners to research best practices and evidence-based modalities for better care delivery for this population. There exists a lot of barriers to care for persons in the criminal justice system, and I would love to see easier access to early screening to get more people the help they need.

Does this mean you support defunding the police?

We want to be part of the discussions on how to help provide better solutions for people with behavioral health conditions when they interact with the police and other players in the justice system.  These solutions could involve researching new approaches, evaluation of current approaches, and training and implementation support. Our main goal is to advance a scholarly approach to addressing the needs of people with behavioral health conditions who come into contact with the justice system.  

- Bobbi Nodell, bnodell@uw.edu, 206.543.7129 
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