Criminal court first; treatment second

Two judges in Rock Island County, Iowa are demonstrating deep compassion for helping those with severe mental illnesses. The judges, who already have heavy case loads, have started a mental health court to divert people with mental illnesses who have committed a crime from jail into treatment.

The judges are making a difference in the lives of many people with severe mental illnesses by helping them get treatment and keeping them out of jails and prisons.

Conklin, 58, and Bell, 54, are sharing the load, and both are aware they are breaking new ground. They credit their successes to the defendants themselves, along with the case managers who are the real mental health experts.

Despite the help, it isn’t easy.

“Some days you just have to tell people what time it is, and that’s not real nice,” Conklin said. “While some of these people have waited in jail, they’ve become caged animals. We have to get them back before we can get them better.”

Sadly, people with severe mental illnesses aren’t getting this type of compassionate intervention and tough-love before they commit a crime. No- to see Judges Conklin and Bell you must make it to criminal court.

Accepting the reality of mental illness

Blogger and writer for National Review, Jennifer Roback Morse comments on Michael Judge’s moving piece about Sonny Iovino in the Wall Street Journal:

“In my view, the problem is that the modern world is so deeply committed to rationality and autonomy that we can not accept the reality of individuals who are not capable of rational thought or of using their autonomy.”

Wall Street Journal: "Free to Die in Iowa"

In today's Wall Street Journal, Michael Judge has a powerful piece about the Sonny Iovino case in Iowa:

After Iovino's death, a spokesman for the VA Medical Center told the Cedar Rapids Gazette, "If somebody doesn't want to be treated, you can't treat them." This is simply not the case. Given his debilitated state, the VA psychiatrist on duty could have forced Iovino to receive the treatment that might have saved his life ...

In fact, Iowa's commitment standard is better than many states', which demand that a person be an "imminent" danger to himself or others. In Iowa, however, to be eligible for AOT a person must lack sufficient judgment to make responsible decisions concerning treatment; and be either (1) a danger to self/others or (2) unable to satisfy the need for "nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death."

When Iovino was picked up by police just two days prior to his death, he was digging up the earth with his bare hands, talking to himself, barefoot in frigid weather, and huddling near a building's exhaust vent to stay warm. He was at the very least a danger to himself ...

Iowa’s cold-hearted system leads to hypothermia

Photo from Gazette.com: "Personal items and trash are strewn about the homeless camp under Iowa City's Benton Street bridge Thursday. Transient Sonny Anthony Iovino, 55, was found dead from hypothermia under the bridge Wednesday."

The cause of death for Sonny Iovino is officially listed as “hypothermia.”

But it is clear he was a victim of something equally as chilling – a system that bounced him around, seemingly unable (or perhaps unwilling) to help him.

Iovino was a familiar face to Iowa City police, and was repeatedly picked up in the past 5 years on charges like disorderly conduct, public intoxication and simple assault. In fact, “In the first seven days of November, he'd had five encounters with police.”

So fittingly, it seems from news stories that it was the police who tried the hardest to get him help. Yet all the doors were closed to him because he was severely mentally ill and belligerent – a combination that too often fails to ignite compassion.

When officers took Iovino to the VA Center, he was turned away because he was uncooperative.

When the doctor asked to take his vital signs, Iovino made what reports called an inappropriate comment. "I take that as a no," UI Police Officer Alton Poole reported the doctor as saying. The doctor released Iovino back to police.

Yet, when officers then transported him to jail, he was turned away because he was too sick.

Johnson County Sheriff Lonny Pulkrabek told The Gazette the jail won't admit anyone with an immediate medical need. He said the doctor's note indicated Iovino needed hospitalization for mental illness.

He was behaving erratically, and was, in fact, nearly naked in a city where the average temperature in November hovers at 31 degrees. Yet he couldn’t get the help he clearly needed.

The spokesperson for the medical center that released him back to police said hospital officials did all they could:

"If somebody doesn't want to be treated, you can't treat them."

Whether officials are ignorant of state law or willfully ignore it, the result is the same. In reality, Iowa has the option of assisted outpatient treatment, and actually uses its law to a certain extent, but not as much as it could, mainly because of its restrictive eligibility standard.

Iowa's commitment standard basically holds that to be eligible for outpatient treatment or hospitalization, the person must lack sufficient judgment to make responsible decisions concerning treatment AND is either (1) a danger to self/others, including that of serious emotional injuries to family members and others OR (2) unable to satisfy need for nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death.

From news reports, it sounds like Mr. Iovino met that criteria. Perhaps everyone was tired of trying to help him. Perhaps his attitude and belligerence made him unpleasant to interact with. Perhaps everyone was busy and didn’t want to take the time.

The end result should shame everyone involved.