Locked in, eating cutlery

This leads to my concern about the second implicit message in these news stories. That message is: "I shouldn’t have to be responsible for these people." While the discussion is framed in benevolent terms – who could argue against the need for better access to community care? – the underlying message from both sides is that neither agency wants them in their facilities. Wardens don’t want them in their jails and they are also not welcome in hospitals. Is it any wonder that Patient M had to swallow cutlery to get help? If I could pick up the vibe from a news story, I’m sure Patient M could pick it up in person. I can only hope that both Ms. Aldridge and Patient M would be more welcome in the outpatient setting that Sheriff Dart and author Montross would send them to.

Our mental health services will not improve as long as agencies continue to shift responsibility between one another and compartmentalize care. Treatment should begin at the point of contact, regardless of location, and transition smoothly between agencies as the patient’s level of care changes. I’m aware that when it comes to mentally ill offenders and insanity acquittees, a humanitarian argument will fall on deaf ears, which explains the reliance on an economic rationale. But let’s not lose sight of the fact that the practice of medicine reflects the essence of humanitarian values. Care of the most challenging patients is the best demonstration of those values.

Dr. Hanson is a forensic psychiatrist and coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011). The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.