Mental health and the law
April 17, 2025
With a lump or two in my throat, I’m going to address one of the most difficult issues in the area of law — the complicated situation of those suffering with mental health conditions who are involved in our legal system. I am certainly not going to solve any problems or, unusual for me, even propose a solution. This article is simply my observations regarding a terrible problem, not as a mental health therapist or provider, but as a lawyer.
Some of the mental health conditions seen in our legal system are quite severe. These comprise individuals totally unable to function in the civilized world. Some of them are hallucinatory, hear voices, are catatonic or violent, while some exhibit still other severe symptoms. Interestingly, for many of these people, the mental health profession has medications that can do wonders in returning them to functionality and a drastically improved quality of life. As a result, these are not the most difficult cases as some of these people can be successfully treated.
For example, I remember a woman for whom I was appointed Guardian ad Litem due to her total inability to function. After being arrested for stripping naked and going into a fountain at a mall, she was charged with disorderly conduct and forcibly medicated. At our first meeting, she was disheveled and incoherent. When I met her several months later, she wasn’t the same person. She was well-groomed, communicative, polite and totally coherent. It was a pleasure to talk with her. My services were clearly no longer needed.
On the other side of the spectrum were many of my divorce clients who suffered from far milder mental-health issues, including depression and anxiety. Most were functioning to a certain degree in the world, including holding a job. Many had good insight into their issues and wanted help. For them, a combination of therapy and medication was incredibly helpful. While not as extreme as the woman described above, for many of these people, therapy and medication (and sometimes just therapy) resulted in a far more functional and (dare I say?) happier human being.
The problem, in my opinion, is the middle category: the huge number of individuals whose mental-health problems are not severe enough to warrant forcible medication but also aren’t willing to engage in therapy. And this group is huge. We all probably know someone like this among our family, friends or coworkers.
We cherish freedom in this country and our legal system tries to protect it. So, unless a person is deemed harmful to themselves or others, the legal system won’t impose treatment or even detention on this “middle group.” While involuntary measures aren’t allowed, many don’t have sufficient insight into their conditions to seek help or be willing to cooperate with it, even if it were available. Also, frequently these people believe there is a stigma surrounding mental health.
In my (nonexpert) opinion, for treatment to be successful for anyone, the person has to (a) admit that s/he has a problem and (b) want help for it. But due to the very nature of the mental illness, the person in this middle range is almost always incapable of either.
I’m not convinced that there is an answer for this middle group of mental infirmity given the current state of the mental health profession. We certainly don’t want to commit or force treatment on someone who isn’t a perceptible threat to themselves or others. On the other hand, they’re not functioning normally in society. And they may be inflicting harm on others — just not at the level warranting criminal charges, but inflicting harm nonetheless, frequently on family members.
My belief is that our knowledge of mental health hasn’t advanced sufficiently to be able to address this serious problem. As stated earlier, medications have been developed to help people at the high end of the spectrum of mental-health issues. Therapy can be very helpful to people at the low end. It’s the middle group for which it seems that no effective treatment is available. Some may deteriorate to reach the stage of dangerousness. It would be nice to think that some may improve on their own.
For the rest, it’s a waiting game — which includes waiting for the mental health profession to devise effective treatment and for society to be willing to drop the stigma that surrounds seeking mental health treatment.
