A decision in June by the U.S. Supreme Court will limit prosecutors' efforts to forcibly medicate most psychotic criminal defendants in order to render them competent to stand trial. In a 6 to 3 ruling, the justices said that antipsychotic drugs can be used only in "limited circumstances," and they set specific criteria that lower courts must follow in determining whether defendants can be medicated against their will.
The case involves Thomas Sell, a dentist who was accused in 1997 of Medicaid fraud and money laundering and was further charged in 1998 for conspiring while free on bond to kill a witness and the FBI agent who arrested him. Sell, who had a history of mental illness, was subsequently diagnosed as having a delusional disorder of the persecutory type and deemed incompetent to stand trial. The lower court ordered that, although Sell may not be a danger to himself or others, he should be treated with antipsychotic medication to help him gain the capacity to stand trial. Sell challenged this ruling, asserting that he has the constitutional right to refuse medication. An appeals court upheld the ruling, and Sell has spent the past five years in jail, including 20 months in solitary confinement, and in prison hospitals while the case worked its way through the legal system.
The Supreme Court was asked to clarify the circumstances in which a criminal defendant who is legally incompetent to stand trial but who is competent to make personal medical decisions, including the decision to refuse antipsychotic medication, and who is not dangerous to himself or others can be involuntarily medicated. Justice Stephen Breyer, writing for the majority, stated that the lower courts were wrong in approving forced medication solely to render Sell competent to stand trial and that other criteria must be met, which the Court noted that it had already explicated in previous rulings. Breyer wrote that the government had not met its burden of showing a "compelling interest" in trying the defendant or "a need for treatment sufficiently important to overcome the individual's protected interest in refusing it."
The Supreme Court's ruling means that the trial court must now reconsider its decision in light of the other criteria. First, "special circumstances" must be considered when the government seeks to show that it has an "important interest" in bringing a defendant to trial. In Sell's case, his already lengthy confinement could constitute such a circumstance. Second, the government must show that "medication is substantially likely to render the defendant competent to stand trial and substantially unlikely to have side effects that will interfere significantly with the defendant's ability to assist counsel in conducting a defense." Third, a court must conclude that "less-intrusive treatments are unlikely to achieve substantially the same result." Finally, the medication at issue must be "medically appropriate" treatment for the defendant's mental illness.
The American Psychiatric Association filed a brief for the government, arguing that medications that restore a defendant to competency are often the most medically appropriate way of treating the mental illness. "The court should not ignore the real costs of leaving a defendant untreated," the brief noted.
In the wake of the ruling, the Justice Department released figures showing that every year hundreds of defendants facing federal charges are medicated—most of them willingly—and that a majority become competent to stand trial. In a recent one-year period, about 80 percent of 285 defendants voluntarily accepted medication. Of the 59 people who were treated against their will, about three-quarters were rendered competent.
Program for Minority Research Training in Psychiatry: The American Psychiatric Institute for Research and Education, an arm of the American Psychiatric Association, seeks applications for the Program for Minority Research Training in Psychiatry. Funded by the National Institute of Mental Health, the program aims to increase the number of psychiatrists from minority groups who enter the field of psychiatric research. The program provides medical students and psychiatric residents with funding for stipends, travel, and tuition for an elective or summer experience in a research environment. Training takes place in research-oriented departments of psychiatry in major U.S. medical schools and other appropriate sites. Stipends are also available for one- or two-year postresidency fellowships for minority psychiatrists. For residents seeking a year or more of training and for postresidency fellows, the deadline for applications is December 1, 2003. For medical students the deadline is three months before training is to begin. For more information call the program's toll-free number, 800-852-1390, or contact Ernesto Guerra at 703-907-8622 (e-mail, firstname.lastname@example.org).
Nominations sought for outstanding community leaders: The Robert Wood Johnson Foundation's community health leadership program (CHLP) is seeking nominations of outstanding community health leaders who have expanded access to health care and social services to underserved and isolated populations in communities across the United States. An award $120,000 is given to each of ten winners—$105,000 for program support and $15,000 as a personal stipend. Nominees for this annual award must be in midcareer, must have five to 15 years in the field of community health, and must be working to improve effective community-based programs that are struggling to grow and respond to emerging challenges, rather than more established programs. Letters of intent to nominate must be received no later than September 22, 2003. More information about the award is available at the CHLP Web site at www.communityhealthleaders.org.
New resource for providers of aging services: The Substance Abuse and Mental Health Services Administration (SAMHSA) in partnership with the Administration on Aging and the National Council on the Aging have developed new materials to help providers in the aging-services community better cope with issues related to medications, alcohol, and emotional problems among older people and learn how best to provide the knowledge and support they need to deal effectively with these issues. The toolkit— "Get Connected! Linking Older Adults with Medication, Alcohol, and Mental Health Resources"—addresses the needs of this population by promoting new linkages to help older adults gain access to needed substance abuse and mental health services. Older Americans make up less than 13 percent of the population. It is estimated that 17 percent experience problems with abuse of alcohol or misuse of prescription drugs and that about one-fifth of the mental health problems experienced by those over 55 are not part of the normal aging process. The kit includes fact sheets, a video, consumer brochures, training guides and curricula, and a services resource guide. The kit can be ordered free of charge by calling NCADI at 800-729-6686 or visiting www.ncadi.samhsa.gov.
Guide for women recovering from substance use disorders: "Helping Yourself Heal: A Recovering Woman's Guide to Coping With Childhood Abuse Issues" is an eight-page brochure designed to help women identify the many feelings that may arise during substance abuse treatment. In addition, it describes experiences generally considered as abuse and common symptoms of adults who were abused as children. The brochure also provides guidance on how to address childhood abuse issues in treatment as well as insights into how substance abuse treatment providers can help. A list of federal and other resources is included. The brochure was created to accompany Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues, number 36 in the Treatment Improvement Protocol (TIP) series developed by the Center for Substance Abuse Treatment and published in 2000. Free copies of the brochure and the TIP can be ordered from NCADI by calling 800-729-6686 or visiting www.ncadi.samhsa.gov.
Children's Program Kit for children of addicted parents: A new analysis of data from the 2001 National Household Survey on Drug Abuse shows that about 6 million children under the age of 18 years—10 percent of those aged five or younger—were living with at least one parent who abused or was dependent on alcohol or drugs in 2001. SAMHSA has developed a Children's Program Kit to help substance abuse treatment professionals create programs to help children of addicted parents cope with the effects of their parents' addiction. The kit was developed in partnership with the National Association of Children of Alcoholics and covers a wide variety of topics and practical teaching strategies for elementary, middle-school, and upper-school children, including stories and videos. The kit also contains information to help parents understand the needs of their children as well as training materials for treatment staff who plan to offer support groups for children. The free toolkit can be ordered by calling NCADI at 800-729-6686 or visiting www.ncadi.samhsa.gov.
Science-based prevention programs: A new edition of Science-Based Prevention Programs and Principles: Effective Substance Abuse and Mental Health Programs for Every Community has been released by the Substance Abuse and Mental Health Services Administration (SAMHSA). The volume, which summarizes two decades of research on prevention programs, presents a state-of-the-science review of substance abuse prevention theory and practice and includes a compendium of tested and effective model substance abuse prevention and mental health promotion programs. Interventions are identified at the individual, family, peer group, school, community, and society levels. Thirty-four programs are highlighted, and contact points for each model are provided to enable the community to arrange firsthand learning. Free copies of the volume can be ordered by calling NCADI at 800-729-6686 or visiting www.ncadi.samhsa.gov.
New psychiatric administrators: The American Psychiatric Association's committee on psychiatric administration and management has certified 11 psychiatrists in psychiatric administration and management. They are Surjeet K. Bagga, M.D., of Bloomfield Hills, Michigan; Jeffrey L. Clothier, M.D., of Little Rock, Arkansas; Edward G. Gordon, M.B., F.R.C.P., of Bedford, Nova Scotia; Yadollah M. Jabbarpour, M.D., of Salem, Virginia; David Gary Krefetz, D.O., M.B.A., of Philadelphia; Petros Levounis, M.D., of New York City; Thomas S. Newmark, M.D., of Philadelphia; Kamal K. Raisani, M.D., of Tuscaloosa, Alabama; Lourdes J. Delgado-Serrano, M.D., of Hanna City, Illinois; Jeanne L. Steiner, D.O., of Hamden, Connecticut; and Harold R. Viets, M.D., of Mobile, Alabama.