Category:

Personality Disorders, Developmental Differences Conceptualization Matters--- It Matters A Lot In The Criminal Justice System

5/27/2020

Personality Disorders are Largely Pejorative Labels we use for Behavior We Don't Like When We Don't have another Label

How this becomes so clear is when someone gets tagged with a "personality disorder" and the diagnosing professional has failed to actually even apply the flawed criteria in the DSM.

How are "personality disorders" treated in the Criminal Justice System (generally, anti-social personality disorder): pretty much an official and "scientific" stamp of approval of MORAL REBUKE and justification for often HARSH PUNISHMENT.

I'm not for putting anybody at risk or ignoring legitimate safety concerns, BUT a lot of what we have going on in the AMERICAN CRIMINAL JUSTICE SYSTEM amounts to TORTURE -- that is ADSEG, but it is not limited to that.

This is what is so frustrating about the AMERICAN JUSTICE SYSTEM -- in most cases (not all) the real issue is PUNISHMENT -- if we provide humane alternatives that sufficiently address safety -- a lot of these cases would go away.

INTEGRATION OF PHYSICAL & MENTAL HEALTH -- INTEGRATION OF BIOLOGICAL & ENVIRONMENTAL EXPLANATIONS OF BEHAVIOR

What we have traditionally been very sympathetic to is a history of "TRAUMA" -- often regardless of what danger or risk the person actually poses. I saw this played out in a case in which a young man had been physically abused by his step father and ultimately killed his stepfather.

The young man was acquitted -- unfortunately there were very serious needs that did not get addressed and he came back on a subsequent serious charge.

    Certainly prosecutors make moral arguments against these defendants BUT the issue is really does this person present a risk and has that risk been adequately addressed.

    Further, it is really the BIOLOGICAL CONSEQUENCES of TRAUMA that can most directly contribute to the BEHAVIOR -- and that can be very individual. I would submit that BIOLOGICAL CONSEQUENCES are the PROXIMATE CAUSE for both the act and the mental element of the crime.

    So it appears I'm really arguing in some senses for the integration of the ACTUS REUS (the act) and the MENS REA (mental element) of the crime.

    [Of course, the real practical answer is HOUSING, SERVICES and PLACEMENTS to SCALE.]

Economist Thomas Sowell is now almost 90 years old and a Senior Fellow at Stanford's Hoover Institute -- Wikipedia

Val's Take: I'm not quite so harsh as Thomas Sowell, mainly because I make plenty of mistakes and I think most people do.

On the other hand, the Mental Health Profession is really paying no price for failing to address a scientifically invalid Diagnostic Manual -- now maybe the Mental Health Profession doesn't understand the consequences of that -- BUT the National Institute of Mental Health does.

At least NIMH understands the scientific ramifications -- they probably don't know the criminal justice ramifications.

NIMH wants to completely solve this -- We're for it! BUT it appears that is going to be SEVERAL YEARS -- MEANWHILE we need INTERIM PROCEDURES to prevent further INJUSTICE.

Experts Warn There's a Huge Problem With How Mental Health Problems Are Diagnosed

3/7/2020

When creating a universal diagnostic tool for psychiatric illness, imperfection is inevitable. Now in its fifth edition, the widely-used 'mental health bible', known as the Diagnostic and Statistical Manual (DSM-5), has had a slew of controversies and some want to do away with it entirely.

As far back as 1968, experts have criticised the manual's myriad flaws, arguing that its "disjunctive" categories are "unusable in a scientific context". A detailed analysis of five key chapters in the current edition has now come to a similar conclusion.

Researchers from the University of Liverpool argue that today's diagnoses for 'schizophrenia', 'bipolar disorder', 'depressive disorders', 'anxiety disorders' and 'trauma-related disorders' are scientifically worthless as tools to identify these conditions.

Analysing chapters for these categories in DSM-5, the authors conclude that the manual's rules are inconsistent and subjective, leaving a huge amount of overlap in symptoms between diagnoses.

The results mirror a study from 2014, which demonstrated that when using both the fourth and fifth edition, two people could receive the same diagnosis without sharing any common symptoms in the majority of cases.

That very same year, another team of researchers calculated that in the DSM-5 there are 270 million combinations of symptoms that would meet the criteria for both PTSD and major depressive disorder.

"This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose," says co-author Peter Kinderman, a clinical psychology researcher at the University of Liverpool.

Orchid "Reaction"

Whenever things are "WRONG" -- like the DSM 5 -- there is a tendency to pitch everything out, including an integrated physical health/mental health model of medicine.

That is what the Liverpool researchers did and it is what others have done.

Often in reaction to paradigms that don't seem to sufficiently take into account TRAUMA or ADVERSE CIRCUMSTANCES.

THE PROBLEM: That trauma and those adverse circumstances are hugely problematic because they are working on HUMAN BIOLOGICAL SYSTEMS.

It's looking more and more that we will have a piecemeal approach to biomarkers and improved treatments.

Policymakers: "Burden of Proof" and "Reason" should help us get through this. The overwhelming evidence is that the majority of criminal defendants are dealing with some type of "cognitive disability."

That doesn't mean we have great treatments for cognitive disabilities (sometimes we do) -- but we can at least have humane care.

Mental Health professionals overwhelmingly want to help -- in many cases in the criminal justice system -- they just aren't and this is one of the great ethical catastrophes of modern times.

THE BIZARRE INTERSECTION BETWEEN LAW AND "GIFTEDNESS": ADULTING WITH "EXCEPTIONALITIES" IN THE CRIMINAL JUSTICE SYSTEM

8/25/2019

Some Not So Random Thoughts
Who you find in the Criminal System -- lawyers, judges, defendants are largely the "EXCEPTIONALITIES" in our Society.

    Further, attorneys tend to be hit pretty hard with addiction and mental health problems -- not unlike the defendants in the Criminal Justice System.

  Further, many of those gifted kids in the Humanities did go into LAW [see video below].

BUT there is a BIG DIFFERENCE between REASONING & LOGIC ability and EMOTIONAL REGULATION -- and in fact we would argue INTENSE EMOTION is NOT logic's opposite -- but rather often logic's fuel.

  Further, there is a REASON why so much is made of "JUDICIAL TEMPERAMENT" and that is because it is so hard to find among lawyers.

   Ironically, Society needs the DEVELOPMENTAL DIFFERENCES of attorneys, judges and defendants to craft innovative solutions to our most long standing problems in the Criminal Justice System.

Tonic on Demand
Bipolar Disorder (2016)

See 3:18: Bipolar linked to the EXCEPTIONALITIES in the Humanities -- above average, below average -- the main thing -- NOT AVERAGE.

Often, the Criminal Law is a lot about:

MORAL OUTRAGE
SELF RIGHTEOUSNESS
PERFORMANCE ART

and this all gets wrapped up in some authentic and not so authentic concerns for JUSTICE.

Historically, the SEARCH for JUSTICE has typically TRUMPED the SEARCH for SOLUTIONS to pretty COMPLEX PROBLEMS.

In fact, Judges would likely say they CANNOT SOLVE those problems for fear of intruding on the sphere of influence of the Legislative Branch.

The Blurred Lines Between Developmental Disability & Mental Illness, and Some Thoughts about "Giftedness"

Bringing Giftedness Down To Earth So We Could Start Recognizing It in Unlikely Places

Report from the National Task Force on Lawyer Well-Being

"Exceptionalities" include learners with disabilities, learners who are gifted and talented, and learners with disabilities who are gifted and talented

Click Image to go to Slide Player.

Acclaimed Neuroscientist & Author Antonio Damasio explains why the Mind encompasses more than just the Brain.

Faith, Criminal Justice, AND bringing religion in from the Cold

9/21/2018

It took A LOT OF FAITH to put out into the world some of the radical religious and spiritual ideas that have been around for thousands of years.

One of the most challenging is that "God" is not just with me or for me -- but God is with my adversary and for that person as well.

So that's a pretty big incentive to find areas of mutual benefit.

Speaking of which, when it comes to the Criminal Justice System, our society is really very receptive to treatment options for bad behavior -- BUT they gotta work & we gotta fund them. We can't just engage in them as a matter of "Faith."

But if we conclude these treatment options have weaknesses or they are not available -- we can't just go back to this person is "evil" -- even though the acts more than qualify as evil.

What does it mean for "God" and us to be on the side of both society's victims, perpetrators, and often people who occupy both roles?

That's a tough question -- some of our marginalized religious folks might be able to help us answer it.

Religious Historian Karen Armstrong asks the provocative question [paraphrasing]: "If you don't believe in God -- which God don't you believe in?"

We're in the midst of a scientific revolution -- Our moral duties don't start after it's ended -- They're here right now

9/20/2018

The Scientific Revolution we're currently in the midst of is going right to the heart of:

The Mental Health Profession
The Legal Profession, especially the Criminal Justice System, and
Our Widespread Ideas of Bad Human Acts + "Intent" as a Justification for PUNISHMENT,
How we provide for Safety.
And what treatments are most efficacious for people with invisible cognitive disabilities such as:
- Mental Illness
- Brain Injury
- Developmental Disability
- Substance Use Issues
- Etc.

This is causing not only enormous conflict in the society BUT also enormous internal conflict as we wrestle with these issues and anticipate what may be to us unacceptable outcomes when our systems haven't caught up with the often horrific conundrums we're facing.

For example -- if the State was providing adequate bed space and intensive services -- would we really be struggling as hard as we are with getting people with invisible cognitive disabilities out of the Criminal Justice System.

We think that it was that internal conflict and anticipation of undesired consequences that led media commentator Amy Holmes to observe both that convicted criminal defendant Wanda Barzee was:

A "psychotic menace," and
"We don't know if Wanda Barzee has a mental illness or not."

But it is even more complicated than that: There's plenty of evidence that the Structure of our Criminal Justice System is FUNDAMENTALLY UNFAIR.

And the current scientific revolution is not only cutting to the heart of the significance of human "intent" --- it's taking some of those SOFT concerns about social environments and turning them into some pretty HARD biomarkers.

Two related examples are how childhood trauma and post traumatic stress disorder can affect the immune system.

Well, that's really significant because damage to the immune system can really affect the brain.

Now -- are we all the way there yet to clear biomarkers on ALL human behavior -- no, but we are on our way.

GASP!

In the meantime, we know enough to know:

We don't know it all,
We don't know enough to be making the assumptions we're making in the Criminal Justice System,
We have to have safety, and
We should be treating all people as humanely as possible.

Let's Do That -- and we're NOT DOING IT NOW.

What we're doing now in the Criminal Justice System is immoral and unethical.

"The Immune System Does Produce Behavior . . . Our Model of Healthcare is outdated"

-----------Prof Sir Robert Lechler, President of the Academy of Medical Sciences, the United Kingdom

From the Telegraph

Beckman Institute for Advanced Science and Technology @ the University of Illinois

Decision Making is Shaped by Individual Differences in the Functional Brain Connectome

--Beckman Institute for Advanced Science and Technology at the University of Illinois
19 March 2018
http://neurosciencenews.com/connectome-decision-making-8661/

[S]tudy found that these individual differences are associated with variation in specific brain networks -- particularly those related to executive, social and perceptual processes.
https://www.sciencedaily.com/releases/2018/03/180320141334.htm

Media Commentator Amy Holmes

Some of these scientific discoveries do implicate our moral and religious beliefs; although some religious people may have a leg up on the secularists in living in a world without "judging" individuals..

God of the Gaps, Criminal Liability of the Gaps

It's Kinda Funny BUT Religious Folks May Be More Adaptable to the Changing Science than Our Mental Health Profession & Legal Systems

Pope Francis

CO Injustices & the Need for An Inclusive CO Olmstead-Stat Addressing Among Many Other Things -- "Dangerous" Behavior

3/23/2018

Human beings do terrible things and we do have to protect vulnerable people, ourselves, and our communities from dangerous behavior.
We do need to get really worked up about this to do what needs to be done.
But the ENERGY spent in punishing people for "bad" or "dangerous behavior" largely:

doesn't work,
is counter-productive,
often leads to additional trauma for people who already traumatized, and
turns the perpetrators of some of the worst behavior into BIZARRO CELEBRITIES -- think Charles Manson.

I think it is pretty normal to want to understand "Bad" or "Dangerous Behavior," and it is really a wonderful calling for those who try to provide treatment.
A serious problem comes when we don't have good treatments --- THEN WE REALLY DEMONIZE PEOPLE.
Further, we have come up with about a dozen pretty UNSCIENTIFIC PERSONALITY DISORDERS to register our DISGUST with certain behavior while @ the same time largely having LITTLE INSIGHT into appropriate treatment.
Well, what about that -- people who are behaving really badly and we don't have good treatments?
Is the logical conclusion that those people just belong in prison?
Well, that is and has been our conclusion for sometime in many cases [especially, regarding anything more subtle than florid psychosis]-- except, it doesn't work very well.
It also doesn't work very well to have people who are abusing or harming family members or strangers in the community.
What happens when somebody in the Criminal Justice System pretends to be "psychotic" for an incompetency to preceed or insanity evaluation?
Well, most of the time they are NOT successful -- BUT in a few cases they are.
What happens when they have been in the hospital a long time, and they want to get out? Typically, they are not released because they have a "mental defect."
So there's a lot more going on with people than what our Criminal Laws and Justice System will recognize as a defense.
AND we think that is because we're afraid people would get away with the crime.
The truth is there may be some people who are pretty seriously dangerous, we don't have good treatments -- and a term of years for an individual act of violence or depravity is really pretty disconnected from the long-term issues presented.
BUT does it logically follow that punishment is appropriate? No, it doesn't logically follow that punishment is appropriate, BUT SAFETY is ESSENTIAL if we are going to have a healthy, vibrant community.
That means a much greater recognition of "invisible disabilities," the social determinants of health, and the mind-boggling immensity of factors affecting human behavior.
If you've got that recognition, you probably already know how important:

the Social Determinants of Health,
Community Mental Health,
Sophisticated therapy for Brain Injury,
Community Supports for People with Developmental Disabilities
the Integration of Physical & Mental Health
Communities that are Physically & Emotionally Accessible & Inclusive
Housing
Institutional Mental Health,
Supported Employment
Inclusive Olmstead Planning

---REALLY ARE. Colorado is doing a lot, BUT not enough to prevent the incarceration of thousands of Coloradans with "Bad" or "Dangerous Behaviors"

We can't ignore those behaviors -- but we can't ignore the injustices wrought be many of the sentences that are handed down in Colorado Courtrooms everyday.

We need to turn C-Stat into an Inclusive CO Olmstead-Stat and get @ the ROOT CAUSES of these problems.

Kenisha Godin sentenced to 8 years for abandoning her children in a locked room for days.

https://www.denverpost.com/2018/03/19/kanesha-godin-child-abuse/

Crap Justice,
Crap Services

Personality Disorders

C-Stat

Above is a REALLY LONG video on a REALLY IMPORTANT topic -- the Neuroscience Behind Behavior. Dr. Robert Sapolsky is a professor of biology, neurology and neurological sciences, and neurosurgery @ Stanford University:

"You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain

the childhood experience

the hormone

the gene

or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
. ------Prof. Robert Sapolsky Stanford

It's Kinda Funny BUT Religious Folks May Be More Adaptable to the Changing Science than Our Mental Health Profession & Legal Systems

3/22/2018

Certainly, two of the biggest historical scientific revolutions were the Copernican Revolution and Darwinian Evolution.
Now, both those Scientific Revolutions really implicated our Religious beliefs.
The Scientific knowledge we're gaining regarding:

"Immune-Gut-Brain Triangle" or the "Brain-Gut Axis,"
"The Functional Human Connectome,"
Biological Predispositions to Certain Harmful Substances
The role of discrimination in Harming Physical & Mental Health
The role of Trauma in Immune System Damage, and ultimately Cognitive Damage
Etc.

--really implicate our Mental Health and Legal Systems -- and in many ways our Religious Beliefs are ahead of the game.

The Neuroscience Revolution & the Microbiome Revolution, of course, may ultimately represent one of the great ironies of human history.

As I mentioned in a previous blog, Ancient Greek Historian Thucydides saw the benefits of religion -- he also saw its downsides in Superstition and how that could play out in the Society.

Well, the reality is "SCIENCE" is a lot more complicated than we often like to acknowledge and that was really one of the things that Philosopher of Science Thomas Kuhn demonstrated in his book, "The Structure of Scientific Revolutions" and further developing the concept of the "Paradigm Shift."

From our perspective, the evidence has been around for some time that at the very least we were making pretensions to knowledge we couldn't possibly have, especially when it comes to understanding "bad human behavior."

At the same time, we have to have safety.

The very real possibility that we are further traumatizing already traumatized people and further damaging their immune systems and their cognition -- may take the mental health & legal systems quite awhile to come to terms with.

BUT our Religious folks may be able to do this much more quickly. Are they the ones who are really ready for the 21st Century?

Saint Augustine

Robin Williams

New Science Is Amazing & It has huge moral implications for our society -- now

Pope Francis

Religious Historian Karen Armstrong

Arthur Schlesinger, Jr. -- great American historian who worked from 1939 to 2006 -- Wikipedia

Mental Health's Tower of Babel: Science, Clinical Practice, the Criminal Justice System, Politics, and Individuals with "Mental Illness"

2/24/2018

There's A LOT to be said about the current lack of:

logic,
reason, and
coherent, clear and precise definitions

in Mental Health practice and policy.

We are only scratching the surface, but we will be continuing to develop these ideas because it is so important to rational:

Mental Health practice
Legal practice, and
Public Policy discussions and decision-making.

Ultimately, this ISN'T about knowing everything. It's really about:

Honesty
Honesty about what we do know;
Honesty about what we don't know;
& the Honesty to Limit Our Actions accordingly.

WE ARE NOT DOING THAT.

We've got an incoherent mess of systems and we've lulled ourselves into believing it doesn't really matter -- EXCEPT it does matter -- A LOT.

Science: The DSM 5 is not a valid diagnostic tool because it just describes symptoms and does not get to the underlying biology.

Science Up

New Science is Amazing, and it has HUGE Moral Implications for our society -- Now

Clinicians: Rely on the DSM 5 because they largely don't have anything else. This reliance extends to reports and testimony in the Criminal Justice System.

Criminal Justice System: They have their own standards for "insanity" and "incompetent to proceed" that don't mesh well with the DSM 5 much less current scientific knowledge and lack thereof. Of course, those LAWS are largely the result of the political process.

"Even a dog distinguishes between being stumbled over and being kicked"

Insanity

Politics: The will of the majority, largely concerned with SAFETY. Public policy discussions tend to use BROAD categories like "MENTAL ILLNESS" to discuss extremely complicated issues such as gun control. Clinicians can provide some refinement, but are largely unable to provide the clarity and precision that is needed.

Housing & Service Provision for people with "mental illness" are not provided as required by LAW or as needed, but on the basis of political budgetary calculations that may not be irrational from a SHORT TERM political calculation but are irrational both with respect to the TRUE NEEDS of people with disabilities and the LONG TERM COSTS to the Society. So we have a grossly inadequate supply of:

Housing;
Bed Space;
and Intensive Mental Health Services

Even though our Federal Laws and CMS Oversight Procedures would seem to prevent the ABUSE, NEGLECT and RIGHTS VIOLATIONS of people with disabilities that are rampant in most States and in Colorado -- when we don't follow or adequately enforce the LAWS -- it doesn't prevent the ABUSE, NEGLECT or RIGHTS VIOLATIONS of people with disabilities.

Colorado Abuse & Neglect Scandals

Alicia Keys & 60 Minutes: "Cause Right Now It Don't Make Sense"

Individuals with "Mental Illness": Are probably more acutely aware than most in the society, that "MENTAL ILLNESS" is BOTH a Biological Reality and a Social Construct. Tens of Millions of people with "mental illness" in the US are vulnerable to unfair stigma and refusal of reasonable accommodations. Additionally, over 300,000 people with mental illness are in the US Justice System, and Thousands are in the Colorado Justice System.

On this MLK Day: Do We Live in a "S**hole" Country, State or City?

1/15/2018

Martin Luther King, Jr. wasn't perfect and neither are we.
Whether it is in:

Justice -- in which the US is ranked #15 among countries in the world; largely because of the World's concern regarding our racially discriminatory Criminal Justice System;
Our expensive Healthcare System that does not produce better results.
A country awash in guns that would do well to look @ an Australian-style buy-back program.
A Country largely dominated by a Religion of Material Wealth and has the Spiritual Depth to show for it -- that is NOT lost on the rest of the World.
Or a Behemoth of a Country that is largely still challenged to Capitalize on Diversity rather than bullying and often imprisoning those who are different.
And those stuggling people are often a direct result of the Country's bullying.

we might not want to cast those stones @ others too hard.

In the 2016 Denver MLK Marade video, in answer to the question "Why is Michael Marshall Dead?" one of the men says because Michael Marshall was:

Poor
Homeless
Black, and
Was a Person with a Mental Illness

We have always thought that was a pretty accurate answer.

The Michael Marshall case finally settled for $4.6 million with Denver and the Sheriff's Office.

We have always felt strongly that the failure of the State of Colorado to provide adequate Housing and adequate Intensive Mental Health Services were HUGE Factors in the Marvin Booker jail death, Michael Marshall jail death, Ryan Partridge self maiming while experiencing psychosis in the Boulder Country jail -- as well as other horrific incidents and the daily violation of human rights of people with mental illness that we have become numb to.

So we have to work with our imperfect Brothers and Sisters where ever they may be to fix these horrors.

That means that ALL Sides have to insist on Truth while recognizing whether one lives in a "S**hole" Country, State or City" --- is generally a matter of perspective.

Boulder County Jail Inmate with Psychosis Gouges Out His Own Eyes: Possible Jail & County Liability for State Failures to Adequately Resource Mental Health

1/2/2018

Well, Colorado State Government is trying to address Mental Illness in Criminal Justice, BUT

The Scale of the Problem is HUGE.
The Lack of Inclusion of People with both mental illness & criminal justice involvement absolutely negatively impacts the effectiveness of policies; and
The refusal to address this through Olmstead Planning -- reasonable & measurable goals, reasonable time frames, and funds to support the plan -- make coming to terms with the Scale of the Problem almost impossible. --- AND Oh Yeah, it's the Law.
Last year, Colorado approved approximately $2.7 million for housing and supportive housing for inmates with mental illness leaving jails and prisons. That's great, but that's a drop in the bucket with respect to the need.
AND Colorado needs a lot more bed space and needs to implement Open Dialogue and the Soteria approach to mental health community treatment.

We're really seeing the tip of the Iceberg when we see these lawsuits filed against jails, prisons, or mental health facilities regarding inmates or patients with mental health issues.
With regard to private lawsuits, it really helps if you're dead or horribly maimed. Otherwise, most private attorneys are not going to take the case, and they probably can't afford to.
With regard to systemic public interest cases, they are hugely important and hugely resource intensive.
So a lot of stuff -- really bad human rights violations not amounting to death or maiming -- are allowed to fester -- leading to more horrible problems.
True compliance with Olmstead and Parity is in large measure the ANSWER.
Addressing the Scale of the Problem, rather than running from it ---- would help a lot, too.

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Val's Blog

Personality Disorders, Developmental Differences Conceptualization Matters--- It Matters A Lot In The Criminal Justice System

Experts Warn There's a Huge Problem With How Mental Health Problems Are Diagnosed

THE BIZARRE INTERSECTION BETWEEN LAW AND "GIFTEDNESS": ADULTING WITH "EXCEPTIONALITIES" IN THE CRIMINAL JUSTICE SYSTEM

Faith, Criminal Justice, AND bringing religion in from the Cold

We're in the midst of a scientific revolution -- Our moral duties don't start after it's ended -- They're here right now

CO Injustices & the Need for An Inclusive CO Olmstead-Stat Addressing Among Many Other Things -- "Dangerous" Behavior

Above is a REALLY LONG video on a REALLY IMPORTANT topic -- the Neuroscience Behind Behavior. Dr. Robert Sapolsky is a professor of biology, neurology and neurological sciences, and neurosurgery @ Stanford University:

It's Kinda Funny BUT Religious Folks May Be More Adaptable to the Changing Science than Our Mental Health Profession & Legal Systems

Mental Health's Tower of Babel: Science, Clinical Practice, the Criminal Justice System, Politics, and Individuals with "Mental Illness"

On this MLK Day: Do We Live in a "S**hole" Country, State or City?

Boulder County Jail Inmate with Psychosis Gouges Out His Own Eyes: Possible Jail & County Liability for State Failures to Adequately Resource Mental Health

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