Wednesday, May 17, 2006

Change Of Scenery

Good news! I’ll be switching units at Green Acres shortly, from the acute civil ward to the long-term forensic ward. When I say “civil” here I don’t mean to imply “polite and well-mannered”—it’s been anything but. “Civil” in this context means “not currently in the custody of the correctional system.” The forensic side, on the other hand, houses our patients who have become seriously ill in jail, or are under evaluation for competence to stand trial for a crime, or have been found not responsible for crimes due to the influence of their mental illness.

It’s that last group that I’ll be working with primarily, and I must say, I’m looking forward to a break from the frenzy and hazards of my current ward. You might think this sounds backwards, seeing as I’m about to pick up a dozen murderers, attempted-murderers, arsonists, rapists, and so forth. But the truth is, some of these are among the least ill, least dangerous, and most motivated people in the hospital. They’ve been remanded to G.A. indefinitely, until they can prove to the courts that they are “no longer a threat to society”. That’s a vague and exceedingly difficult standard to reach. So they’re with us a long time, getting treatment, every six months allowed a hearing for incremental steps towards release. In the best-case scenario, this will take several years. Possibly many years. Not so much because treatment necessarily takes that long—often it does not-- but because society takes a dim view of releasing these folks, no matter how sane they become. “Lock ‘em up and throw away the key” is the common sentiment after a grim, publicized crime. As these patients come up for review by the courts, the victims and community at large often rally again and again in attempts to keep them hospitalized. Media attention and photos published in the papers serve only to exacerbate anxiety; at these times some patients receive death-threats and other harassment.

In my opinion, it’s very misguided— for every stable forensic patient making the newspaper because he is asking to increase, say, his supervised employment from four to eight hours a week, there are several extremely ill civil patients teetering on the edge of committing serious crimes but getting no attention. Many civil patients leave the hospital sicker than the forensic patients who have years more hospitalization in front of them.

Once fully treated, some forensic patients have barely perceptible mental illness. They are routinely mistaken for staff around the hospital. You would not glance at them passing on the sidewalk. If I had to choose one particular patient from Green Acres to have as a roommate, it would be one of the murderers.

Anyway, as so much in the world of mental health, what seems like up is really down, and the front door is actually the back. But no matter— for this shrink, the switch to working with “the criminally insane” is going to be a bit of a vacation.


Blogger The Locum said...

I got to do a wee bit forensic psychiatry as a student, and have fond memories of playing pool with a very pleasant chap who'd spent a decade in the State Hospital for killing somebody. I think he was mildly famous among the med students as "that nice murderer".

My Word Verification is ofmqyq

5/18/06, 5:27 PM  

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