Tuesday, January 1, 2013

Erika Menendez - troubled soul?

More is coming to light about the woman who pushed the man into the path of a New York subway train because she hates Muslims and Hindus -  they were responsible for 911. [Erika Menendez, Suspect in Fatal Subway Push, Had Troubled Past].

A troubled past is hardy a surprise. She had apparently been in and out of  mental institutions as well as in and out of jail for violent actions. Arguably the criminal issues can be related to her mental health, but is it correct to exempt those who are perceived as "mentally ill" from punishment and detention given to those who might commit similar acts?

A person angry at another might cause serious injuries to that person and would (or should) receive significant jail time dependent on injuries; but labeling that same person "mentally ill" might result in a free pass. What is the court's role in these particular criminal cases, i.e., what is to be done?

What can be done at the outset is a court ordered psychiatric evaluation. Although, It isn't clear from the NY Times story - the court ordered evaluation may be her first, but it is not her first act of violence.

One wonders just how many times she may have been before a judge and essentially had her conduct in some sense "excused"  because of mental health? I am not saying that people with mental illness that results in violent actions ought to be jailed, as opposed to other detention options - but at the very least an evaluation needs to be done.

But I wonder about the quality of those evaluations, i.e., is it really realistic to think that the psychiatry profession has evolved to a state of accuracy in diagnosis and in predictability of future behavior? And, it seems too often that it is these same professionals that want to excuse all aberrant criminal behavior as mental illness, i.e., not criminal.

And there is what some see as a flaw in the system: “If you are involuntarily committed, once you are no longer dangerous, you are discharged.” [D. J. Jaffe, the executive director of the Mental Illness Policy Organization, an advocacy group]. He notes: “No one monitors if they are taking their medication. Or follows up to see if they are a danger to themselves or others.

Mental illness is not curable, but apparently controllable with medication. However, medication is not the answer either. Can society assume that once individuals are confined and, in a sense, forced to take their medications that may then become "well" enough to be released?

And it does little good to extract some promise of continuing to take the medication. Arguably, if someway existed to continued forcing of the patient to take the medication, then that wellness is plausible. Monitoring is insufficient, in this particular case - she was able to easily avoid monitoring.

It would seem though that monitoring the taking of medication could succeed provided it is rigorously and vigorously applied. But it is easily seen that this is unworkable because somewhere along the way the cost of administration will be an issue that results in defeating even the best of intentions.

It is clearly a conundrum. Detecting and isolating those that are likely to commit violent acts because of some mental health issue is fraught with difficulties, personal liberty is just one of many.

But once violent acts are committed - the justice system (police to judges) ought to take mandated steps to insure those acts will not be repeated. I say mandated because the justice system can't be relied upon to apply needed remedial actions either initially or even consistently.

However, criminal laws are for the most part state defined and enforced. While most states define "criminality" the same - enforcement is very different among and within the states.

Maybe it is truly a conundrum, i.e., an insoluble problem.

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