"People with Alzheimer's disease and other forms of mental deterioration are increasingly getting entangled with law enforcement. That has police, prosecutors, judges, psychiatric workers and caregivers struggling to balance the humane treatment of a vulnerable but volatile segment of the populace against the need ...to protect the public." (Source: http://www.talkleft.com/story/2003/07/28/777/13607)
I have lost count on how many times in my 30 + years in senior care I have witnessed similar "horror" stories that violate the rights and dignity of elders. The husband in the one case Laurence referenced (http://tinyurl.com/yk8xyl5) did his best based upon his knowledge of the options available to him. Obviously his intent was not to do harm. Dementia and other causes of functional disability can create considerable burdens for families and society as a whole, but it may be possible to partially alleviate this strain through technical innovations that replace some functions of human caregivers.
We're looking at two key issues here: one, the knowledge of support options that empower families to ensure that their loved ones can remain safely in the family home where they can thrive. The second issue, which I address here, is that lack of advocacy and understanding in the criminal justice system for the mentally ill/mentally challenged/cognitively impaired, i.e., how to balance protection and autonomy—and other ethical dilemmas.
Law enforcement officers are usually the first responders when violence occurs, and they often lack training to understand and handle individuals with dementia. Patients are often arrested, interrogated, and jailed for months because alternatives are not available. Model programs do exist in many states that provide training programs for law enforcement, monitor jails on a daily basis for dementia patients, and provide mental health/law enforcement dementia response teams in the community.
Social workers in the justice system are overburdened with mental health courts, IF the state/county even has them. If they do not, or if they do and lack a social worker/case manager with enough knowledge base of elderly cognitive challenges to advocate appropriately for the family and the elder, we end up with end results similar to your case example. They deserve so much better.
Part of the answer is the county prosecutor's relationship with their Elder Services. The relationship with Elder Services encompasses various areas, including education, outreach, investigation and prosecution. There needs to be trainings for investigators and workers, and involvement in various public information and awareness efforts. Elder Services provides the critical link between those who may have been victimized and the criminal justice system. As the elder population in this country continues to expand and our senior citizens strive to continue to live independent lifestyles, the need for this collaboration will only increase, especially in the area of post-arrest. A challenge here is that many social workers from Elderly Services defer post-arrest advocacy to mental health court (here again, if the county has one) case managers in the court system already overburdened with clients.
The burden this creates for families and communities is high, and more often than not, inadequate health care resources leave patients and their families without the necessary support. A prevailing double stigma attached to mental disorders in general and to the end of life in particular does not help in facilitating access to necessary assistance.
So, in answer to your question, Laurence, our focus needs to be on redirecting resources toward treatment, not containment, and establishing alliances between agencies and providers. As I further venture into mediation as a resource for elders, it may well be a viable intermediary acting as an advocate within the court system to resolve criminal complaints for those with dementia in the criminal justice system. Other recommendations in summary of my earlier points would be:
- Expanded and improved community services.
- Integration of systems to meet the needs of people with mental illness and other co-occurring disorders.
- Training for police to improve initial response to contacts with the mentally ill.
- Increased diversion from the criminal justice system for people with mental illness.
- Improvements in correctional mental health services for those who cannot be diverted.
- Pre-release planning for transition from prisons and jails back into the community with appropriate medical and support services.
The right to quality of life calls for profound modifications in how societies see their elders, and for breaking associated taboos. The way societies organize themselves to care for the elderly is a good indicator of the importance they give to the dignity of the human being.
Deborah A. Wallace, MSM, MGS, PCM, CCM
President/Senior Mediator
Accordo Elder Mediation Specialists, LLC
www.accordomediation.com
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