Years ago, when I was applying for medical school, I had to go through the usual gyrations of filling out the applications and attending interviews. Part of the application process for medical school is to write an essay about why one wants to become a physician and what their goals and desires are. The medical students all had dreams of wanting to be part of people’s lives and making a change in a positive fashion. We all talked about wanting to help people. After years of practicing as a psychiatrist in allopathic medicine, I now find myself helping people in a way I never imagined.
Many doctors gradually realize how our health care system does not bring people to health but keeps many in a cycle of chronic disease. Over time it became clear to me that psychiatry does not have the best answer to emotional problems of distress and everyday issues such as anxiety and depression. More and more, I realized how damaging the medications are. As a hospital-based psychiatrist, every day I saw how people’s lives had been ruined by psychiatric drugs. Because I have been able to see the other side of psychiatry, I have more and more been involved with the legal system and helping people terminate their abusive mental health commitments and guardianships.
In the state of Wisconsin where I live it is very difficult to get off a mental health commitment. The counties fight tooth and nail to keep people in the system. One is expected to stay in the system for the remainder of their lives. Across the St. Croix River in Minnesota, the mental health commitments usually just expire after a few months.
I was contacted by Elizabeth Rich, whose son tragically took his own life because he was unable to get out of a mental health commitment situation, which negatively impacted his life. Elizabeth Rich’s son’s story can be found here.
Elizabeth is an attorney. She left the corporate world to help others that were unable to terminate their commitment status. She contacted me to see if I would do the IMEs or independent medical examinations to contest mental health commitments for people that were stuck in the system.
Elizabeth asked me to help Ryan, a young man in his 30s who had been under a mental health commitment for several years. In the course of my work, I had seen him at two different hospitals where I worked and I was familiar with his history, he had been diagnosed with schizophrenia.
In the state of Wisconsin where I live, people under a mental health commitment or guardianship have the right to request a jury trial for a review of their case. A jury trial is desired because the counties frequently rubberstamp a commitment or guardianship and the county workers seem to all be on the same side, even the county appointed public defender. However, it is not common for jury trials to happen; lawyers on both sides don’t want to go through trouble and time.
Usually, a commitment hearing is a 10-minute affair where the judge rubberstamps the initial or ongoing commitment order, which usually is accompanied by an order for medication. Elizabeth believes that requesting a jury trial allows one to have fairer hearing because a jury may be more likely to look at both sides of the situation, whereas the judges generally wish to go along with the county’s direction, which of course would be to continue a mental health commitment.
Ryan had a hearing coming up for an extension of his commitment. Elizabeth requested a jury trial, and it was to take place in a county in Wisconsin. I did not believe we could prevail in the jury trial because Ryan always has a low level of psychosis and paranoid thoughts even though he functioned fairly well in the group home where he was living. With his VA benefits, Ryan wanted to return to school, eventually have a full-time job and be totally self-sufficient, which I thought was realistic. In spite of the fact that I believed that we would not win a case due to Ryan’s ongoing low-level psychotic thinking, I thought that I would support Elizabeth and complete the IME and testify on Ryan’s behalf. If she thought that we had a chance, it was worth going through the independent medical examination process and jury trial.
Ryan had been living in a group home. His rights were very restricted. He was unable to leave the group home except for appointments for medical or psychiatric reasons. He was in a rural area far away from his family. He had nothing to do during the day and ended up sleeping a lot. Ryan wanted to return to school and eventually have full-time employment. He had a history of several episodes of psychosis with long periods of stability in between. The excessive restrictions of his commitment did not allow him to have any type of quality-of-life.
Ryan’s hearing took place during COVID, and this was the first time that I had attended a jury trial on Zoom. I sat in front of my computer and there were different tiles for both opposing attorneys, the judge, the patient, along with the court recorder and court clerk. One of the tiles was for the jury. When I saw the jury come in, I thought for the first time that we could win this case. The jury consisted of six men, very casually dressed, some had their hands in their jean pockets as they ambled slowly in and took their seats. I was thinking in my mind that these men could see this for what it was, government overreach.
Elizabeth worked very hard preparing for the jury trial. First, the county psychiatrist testified and said that Ryan was still psychotic and required mental health treatment. It was the usual; he was a danger to himself due to his history of psychosis he needed commitment to ensure he take his medications.
I then testified after the county psychiatrist. Elizabeth did a masterful job on direct examination. Ryan did utilize the resources at the VA clinic, and I made the point to the jury that he was receiving the care he needed and did not require the county supervision of the mental health commitment. He was not a danger to himself or others and the VA psychiatrist was attempting to minimize the amount of medication he was taking.
I testified that although Ryan continued to have some mental health symptoms, he did not require the supervision of a mental health commitment. He was a veteran and was getting his care at a VA clinic and he had been hospitalized at the VA hospital several times. He had been compliant with their treatment program. The VA psychiatrist actually stopped one of Ryan’s antipsychotic medications. Generally, it is thought that being on more than one antipsychotic medication is the quality of care issue. It used to be that psychiatrists would never use more than one antipsychotic at a time. Although the VA psychiatrist did the right thing to discontinue the second antipsychotic medication, it increased Ryan’s symptoms. The VA psychiatrist had abruptly discontinued one of his antipsychotic medications, which led to, in my opinion, an increase in his symptoms not due to the need for the second antipsychotic, but the increased psychosis was due to withdrawal as the Zyprexa was not tapered.
The cross examination by the county attorney was quite mild in my extensive experience testifying in commitment cases. I had testified previously in the same county with a different prosecuting attorney who was very aggressive, and I was prepared for her, but she had become a judge in that county and was no longer the prosecuting attorney. The cross did not last very long, and I was surprised that the prosecuting attorney did not push me harder about Ryan’s ongoing symptoms.
Elizabeth texted me later that day that the jury had terminated Ryan’s commitment and that we had won the case. We were overjoyed. The mental health commitment and medication order were discontinued. She said that Ryan put his head in his hands and seemed extremely relieved after the verdict came in. We were very happy for Ryan because he had many plans for his life. He wanted to have a job, a relationship and maybe even have children. He certainly had the potential to become fully self-sufficient.
