Brooklyn's mental hygiene court does little for the patients it's supposed to help, according to a group of monitors who have spent the last year documenting the court’s psychiatric hearings. Information contained in their report, which they plan to release this week, shows that patients have almost no opportunity to object to their course of treatment–even when it involves toxic drugs and electroshock therapy.
The court, part of the state's civil court, hears the cases of patients in mental institutions who want to leave the hospital or refuse drug therapy. A State Supreme court judge hears the patients' arguments, but the burden of proof lies on the hospital, which must defend its treatment. “They are supposed to prove both [the patient's] lack of capacity and that the benefits of the drug outweigh the risks,” said report author Tina Minkowitz, who started the all-volunteer Brooklyn Mental Hygiene Monitoring Project last year.
The court watchers, a group of volunteer mental health advocates, documented 35 involuntary medication hearings during a four-month period last year. Only four were decided in favor of the patient. Brooklyn's mental hygiene judge, Maxine K. Duberstein, decided against every one of the 26 patients that she heard. She has since retired.
“[It] is done in a cursory way,” Minkowitz said of the decisions. “And sometimes, the hospital attorney didn't even mention the question of [a patient's mental] capacity, and the court granted the order anyway,” In all but two of the 35 cases, the psychiatrist didn't even specify the drug's exact prescription.
Most forced-drugging cases involve patients who refuse to take Haloperidol, an antipsychotic drug with serious, sometimes permanent side effects. The monitors also had objections with court proceedings. Generally, the hospital's psychiatrist is called as a witness against the patient, so a patient's complaints are measured against the psychiatrists' expert testimony.
Administrative judge Michael Pesce, who oversees all Second District courts, said judges adhere to strict legal procedures, but he admitted the hearings are difficult to decide.
“It's such a sensitive and particular field,” he said. “I was in there, and I said, how the heck do they decide this? It's a judgment call–do you want to play it safe? What do you draw on to make the determination?”
Unlike other courts, Brooklyn's lone judge hears almost all the borough's mental hygiene cases. The practice has drawn criticism from the monitors, but Pesce defends it: “I'm not sure that having a judge that has huge amounts of knowledge and expertise isn't better than having judges in there who really don't know the intricacies of the field, and ask them to rely on consult,” he said.