Competency Restoration
What takes up a greater part of my mental real-estate these days is my job. I happen to think I have a very interesting job that has LOADS of implications in people’s lives, so I thought I’d share. My job title is officially, psychiatric social worker. It means that I have an MSW, and that I work with psychiatric patients at one of the largest state mental health hospitals in the nation. Even better, I work on the Forensics unit. This means that most of my patients have legal charges pending and are there for a competency evaluation (and sometimes mental state at time of offense) and competency restoration. The rest of the few that come in are people who come in for evaluation for civil commitment after their criminal charges have been dismissed.
Following so far?
What is competency restoration? It seems that in my job, if there is ANY job to do, there seems to be a law suit or government agency (because of a law suit) requiring that particular job to be done. It seems that through the years, someone decided it was unfair for a person of questionable mental state, who could not name the members of the courtroom, let alone, assist their attorney in their own defense to be taken to trial for their alleged offenses. (At this point, I’m just going to clarify that I’m not going to talk about NGRI - Not Guilty By Reason of Insanity. I work in Competency Restoration and on an admission ward, which means that my patients have charges pending OR dismissed.) So in order for the case to proceed, a person of questionable mental status (or in some cases, an attorney who wants his client’s mental status to appear questionable) gets sent for a period of 15-30 days (depending on misdemeanor or felony) for evaluation for competency (and usually mental status at time of offense). After that, if they need more treatment, they are sent for a 90 Day Competency Restoration, in which the patient gets medicines, 1-1 therapy, recreation and classes that help in the patient’s ability to work with their attorney in their defense. And just to get your civil libertarian panties in a bundle, many of these guys… MOST of them, come with a forced med order. This means that the hospital has the right to administer medications to the patient against their will. In addition, most court orders I read specifically state that the right to a speedy trial is WAIVED. These guys are in limbo while on my ward. They are still detained and in a high security facility, they still have charges, but as much as a year can pass in the hospital before the court ultimately has to dismiss the charges. Meanwhile, when beds at the hospital are full, the patients have to wait in jail until a bed is free.
The range of cases I get are between people trespassing in a public park in the early morning to a single repeat offender with charges of First Degree Rape and First Degree Murder (with an additional 4 other felony charges relating to the crime). My patients range from people talking in word salad (gobbledy gook nonsense that’s hard to fake) and clang associations (sort of rhyming loosely strung together phrases/ideas) to people who will quite honestly, calmly tell you in the most earnest and pleasant way, “Oh, I know who the judge is, he’s the antichrist.” Then there are the occasional malingerers - who for whatever reason, react and interact in a way that is to make them appear much more sick than they actually are (if they even have psychiatric issues at all.) There are young and old, healthy and strong, people who come in just after their “first break” and people who have been in and out of the system since they were born.
[I deleted a couple paragraphs that go into some of the nitty-gritty stressors, that will be another post elsewhere.]
This is my first social work job after achieving my MSW degree in 2004, and it’s teaching me a lot. I love to share what I do. But man, writing this post has made my head pound. I think I need a vacation.
Tags: civil liberties, jobs, social work