We Need To Get Real About the State of the Science &

"Mental Health Treatment Adherence"


​So this is pretty inflammatory AND it needs to be.

We are NOT arguing that "Mental Health Treatment Adherence" in the the Criminal Justice System is meant to be non-therapeutic.  In fact, we think it is well intentioned.

But mental health treatment in 2017 is a pretty mixed bag, and as a Society it is pretty hard for us to acknowledge that because we don't have anything else.

The former head of the National Institute of Mental Health, Dr. Thomas Insel, started the Research Domain Criteria Project in large measure because the DSM 5 lacks scientific validity and psychiatry has not achieved the same levels of quality other areas of medicine have  achieved.

Further, all this is very individual.

​This is NOT well suited to the heavy dockets of the Criminal Justice System.


              So what we have is an extremely complicated situation:
  • a Mental Health Profession that is a lot better than it was 100 years ago -- AND we have got a  long way to go.  Outside of the National Institute of Mental Health & the Research Community, Clinicians either don't know  that there is still a long way to go or don't acknowledge that -- AND it's like really, really important  AND if you know it -- it has policy implications.
  • The Criminal Justice System wants to do the right thing and it is pretty overwhelmed with its heavy dockets as it is;
  • As mental health advocates at some point we can't have our cake and eat it too.  If people are dangerous, they are going to be institutionalized.  We don't think it should be a jail or prison. However, that is not meant in any way to delute our commitment to attorney Rule of Professional Conduct 1.3[1] regarding Attorney Diligence -- see Rule to the right)
  • Treatments and Medications can be healing and life-saving, just the opposite, and everything in between  and it is all very individual.  Genetic testing may help for some medications, but it is not always available.    Forced treatment is so problematic because the State of the Science for this profession is so poor.


​For Some-- taking medication can be like pouring oil all over their mental engines --- yes some gets into the right place, but also all over one's mental engine block -- in some cases doing more harm than good. ---see Caltech Neuro-scientist David Anderson's TedxTalk below. 
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​Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods. 

Yet, we know so little about mechanisms at each level. Too often, we have been guided more by religion than science. 

That is, so much of mental health care is based on faith and intuition, not science and evidence. 

On the plus side, we put a premium on listening and compassion. We help people to change through understanding.

But not enough of our care has been standardized to a high level of quality, as expected in the rest of medicine.
​
                                               ------------Dr. Tom Insel, Director of the National Institute of Mental Health from his October 2014 Blog Atonement  -
See more at: https://orchidadvocacy.org/1-science-up.html

Rule of Attorney Professional Conduct -- Diligence 1.3[1]

[1] A lawyer should pursue a matter on behalf of a client despite opposition, obstruction or personal inconvenience to the lawyer, and take whatever lawful and ethical measures are required to vindicate a client’s cause or endeavor.

A lawyer must also act with commitment and dedication to the interests of the client and with zeal in advocacy upon the client’s behalf.

A lawyer is not bound, however, to press for every advantage that might be realized for a client. For example, a lawyer may have authority to exercise professional discretion in determining the means by which a matter should be pursued. See Rule 1.2. 

The lawyer’s duty to act with reasonable diligence does not require the use of offensive tactics or preclude the treating of all persons involved in the legal process with courtesy and respect.

http://www.cobar.org/For-Members/Opinions-Rules-Statutes/Rules-of-Professional-Conduct/Rule-13-Diligence​