Let’s Talk about the Law - Mental Illness and Legal Matters, Part Two (Ep. 13)

Guest: Judge Lisa Wexler, Connecticut

Many of our listeners have shared frustrations with the law, confusion about the process, and want to know more. Today we get the story from the other side of the bench.

 This is Part Two of our conversation with Judge Lisa Wexler (https://www.lisawexler.com/ ). Judge Lisa has been a probate judge in Connecticut since 2013. She is a graduate of Johns Hopkins University and NYU School of Law. She has practiced law in NY and CT for many years and is also a professional mediator . Lisa is also the creator of The Lisa Wexler Show, a daily talk radio show airing on WICC-600 in suburban CT and metro NY. 

We Talk About: Part Two: 

CT one of three US states that doesn’t have Assisted Outpatient Treatment (AOT). Do you wish it did?

Need for “acute event” to be admitted to hospital. Can we intervene before it gets to that point? 

Civil Commitment (Minnesota and some other states)

How hard is it to make decisions for those with Schizophrenia and their families? Do you ever wish for more power, or less? 

How much does/should the average Judge know about mental illness before making decisions like these? 

What state laws would you change if you could?  

Issues of Dangerousness, Gun Control , Access 

“Right of Notice” vs “Right to Appear” re hearings for families

Probable Cause hearings 

CIT (Crisis Intervention Training) for Police 

For the 3 moms: What would you most want judges to know?

Judge Lisa: What would you most want family members to know ?

Transcript

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SPEAKER_03 0:01

Welcome to our podcast, Schizophrenia. Three moms in the trenches. From the place where schizophrenia and real life collide. East Coast, West Coast, Middle America. With Miriam Feltman, Mindy Greiling, and Randy Kaye. Welcome to episode 13. Part two of an hour-long conversation we had with Judge Lisa Wexler of Connecticut. In part one, we discussed a lot about her work, conservatorship, and more. And please take a listen to that one. We continue here with more of the discussion.

SPEAKER_02 0:37

Tell me more about this AOT. By the way, I was told that, and I don't know if it was NAMI, but it was a civil rights lobby in Connecticut before I became judge that fought this in Connecticut successfully, and that's why we don't have it.

SPEAKER_03 0:53

And I was part of the team that tried to convince them to have it. I went and spoke to the Hartford Papers. And we don't have it, but to my understanding, can either of you, Mindy or Mimi, explain it really well? I mean, it's a program, I think, where it is court ordered that there's certain treatment that they stay in. Is that about right?

SPEAKER_01 1:13

It's kind of like civil commitment, except it's in the community, assisted outpatient, outpatient treatment. Unfortunately, in Minnesota, in order for it to kick in, you first have to be civilly committed.

SPEAKER_02 1:25

So you're sure that that would be true in Connecticut too.

SPEAKER_01 1:27

I'm sure. You have to meet that bar. And then you um, if you're out in the community, then you're getting assistance, and that's a lower level, least restrictive environment. And but it yet it keeps you healthy, and you aren't going to be going off your meds or not doing what you should be doing for your health. So it's a way to have a continuum of care.

SPEAKER_00 1:52

Well, and it has it encompasses that black robe thing too, because they know that if they go off their meds, they're back in the hospital.

SPEAKER_02 1:58

That's the key. We have we have IOP all over Connecticut, intensive outpatient. And that's the discharge plan of all of the hospitals. They always have to go five days a week, but there's no stick, there's no, you know, carrot stick, there's no stick, there's no, there's no oomph. They have to, in order to get back to the hospital, they have to have an acute event, something which rises, and then they have to be so sick, and it's so traumatic to have an acute event.

SPEAKER_01 2:25

So AOT prevents that. It's uh there's things to do before you have to be acute again.

SPEAKER_02 2:32

So it's a conditional discharge, basically. The long arm of the law can come right back and say, if we've been told that you're not taking your meds, I don't have to make a whole hullabaloo, I can recommit you.

unknown 2:43

Correct.

SPEAKER_00 2:43

And well, that's exactly a conditional um discharge, it also is a wraparound treatment where you have a team that's helping you on a lot of different levels.

SPEAKER_02 2:54

Well, we have the team too, but they don't have as much teeth, not for compliance. We have mobile crisis teams, we have all kinds of teams, and some of them do very good work, but the non-compliance is the biggest thing. And I've been reading statistics and data, and the states that have this AOT with the long arm of the of the judge, they have a much higher rate of compliance, which means we which would mean we would have many fewer commitments in Connecticut, which would be a good thing, right?

SPEAKER_03 3:20

So that's why we would be in favor. Um, all right, Mimi.

SPEAKER_00 3:26

Well, I um I'm just wondering how, again, about um more about what you do, what how hard it is to make these decisions for people. I'm having a hard time with my wording. I mean, now, I mean, we have to make these awful sort of Sophie's choice decisions for our own kids, but to be the judge and to be have that kind of power and control, uh, how does that feel? And do you ever wish you had more power or less power in in terms of helping people and dealing with these people's lives?

SPEAKER_02 4:04

Well, I'll tell you, maybe, here's what goes into it. First of all, it has to be clear and convincing evidence. So I have overwhelming evidence from doctors. Um, although sometimes the doctors don't always agree, it's rare, but sometimes one of my two outside doctors doesn't agree. You know, it's really a question over time of trying to observe and understand the illness itself, schizophrenia. You know, there's positive symptoms and there's negative symptoms. So the positive symptoms are accompanied by delusions. Um, today I saw a person who came into the hospital and was convinced he was pregnant. He was the Shah of Iran, he was the president of Australia and New Zealand, he was a member of the Secret Service. These were just some of his delusions.

SPEAKER_03 4:56

And they were real to him, I'm sure. Very real.

SPEAKER_02 5:00

And so then the question becomes well, do the delusions make him dangerous? Sometimes, you know, a lot of doctors will say, No matter what we do, the fixed delusions are not going to go away. And so do they make him dangerous? Well, you know, he he was threatening and menacing, and he was aggressive, not in front of me, but it was in the medical notes. And the truth of the matter is he couldn't function. And so when the doctor testified that during the last admission where I didn't see him, that with the administration of an antipsychotic, a zyprexa, latuta, whatever one, take the menu, within seven days, he was completely clear thought. It's not that hard a decision, Mimi. It's not that hard.

SPEAKER_00 5:47

Well, can I just say that I wish there were more judges and people with the power out there like you? I mean, just to hear you say, to explain negative symptoms, positive symptoms, you know, I don't get a feeling when I'm dealing with the system, even within the medical system, but certainly outside of it, that that people in your position, that judges who are handling these cases, really bother to have much of an understanding of what the disease is.

SPEAKER_02 6:15

Well, as you can see, because you know, I have a radio show. Yeah, I had a radio show seven, eight years before I became a judge, and of course, I've been a lawyer a very, very long time. I am by nature a reader and a very curious person. I take it upon myself to use my radio show as a platform to interview some of the leading doctors on schizophrenia. And I just get a half-hour lecture on the air.

SPEAKER_00 6:37

I really just say thank you.

SPEAKER_02 6:40

Well, you're welcome. I I read the guy, I read the book, it was a wonderful book. I can't remember the title now, about Kendra's Law. He called it Kendra's Law at the time. 45 states had it, I guess 45, 48 do now. And that was an eye-opener for me. It was just extraordinarily. And then, of course, I don't want to make these decisions without doing my own grilling of the doctors. So I asked them, and the law requires me to ask them, but I do it anyway. So look, I don't want to blow my own horn, but I replaced a judge who used to do 15-minute hearings. My hearings are more like two hours by the time I'm done. Am I right, Mindy?

SPEAKER_03 7:19

Yep. You were so thorough and calm throughout the whole thing. Can we clone you and send one of you to everyone?

SPEAKER_02 7:28

It's not about me. It's just about the fact that I really want to know. I want, here's where the black robe thing is, Mindy. I feel like if the patient is given time in that setting and respected and listened to, then maybe there'll be a light bulb moment. I need that light bulb moment because we don't have your AIT. Once they leave the hospital, they don't take their medicine anymore. So I need a light bulb moment where maybe a patient will say, you know, maybe I don't want to repeat this all the time. Because I say to them sometimes, it depends what stage of acute illness they're in. I can usually tell whether they can listen to me. And you know, you ladies know what I'm talking about. Somebody's very sick, you can talk to the wall, you can talk to blue. They're too sick, they can't hear it. But sometimes they've taken intermittent doses, or they've, you know, or or they have, or something is in them that morning because they know that they're having the judge. So they think, well, if I start this morning, I'll tell the judge that I'm taking my medicine, and the judge will say, will not listen to the doctor who says, Your honor, he's only going to stop tonight. Um, but I do listen to my doctors. Anyway, so when they're in the courtroom, I'm in the conference room, I I talk to them and I say, sometimes, do you want to keep living like this? You know, is this what you want? Do you want to keep coming in and out of the hospital? Because if you stop taking your medicine, you know that you're just gonna come back in the hospital. And then I change the subject and I'll say, Did you go to high school? Did you know, did you graduate college? And I get them talking about their life and their accomplishments so they can touch the possibility that it doesn't have to continue to be this way, that maybe it can be a different way.

SPEAKER_01 9:22

Well, we definitely have to get you on a national uh program and national speaker and talking to two more judges. Um, so we you don't have AOT assisted outpatient treatment in Connecticut. I'll just say one really quick thing that we just passed in Minnesota last year. We actually have something called engagement, where if somebody is spiraling down, they're no longer committed, but they're on that road again, or a brand new person and they look like they're going to meet criteria. There can be assertive intervention three months ahead of time, up to three months to head off civil commitment. So that's on the What does that mean?

SPEAKER_02 10:04

What is assertive intervention? What is that?

SPEAKER_01 10:06

Um it would be the sort of thing you would get in AOT, but before commitment. So you would get an ACT team or you could get a social workers, and they would not be able to say as they right now do, there's nothing we can do because the person has their rights and they don't want to. Instead, they're duty bound by this law to intervene and do it concertedly, trying really hard to get the person to voluntarily engage so they don't end up being committed.

SPEAKER_02 10:34

So they come and they say to them, What? You have to take your medicine. Like my doctors are very cut and dry. They're like for schizophrenia. If you don't take your medicine, you can't get well. You're not going to recover, you're not going to recover touch with reality unless you take an antipsychotic. We don't know why the antipsychotic works, but we know that it works. I always ask them, like, how do you not know what it works? How do you give people stuff you don't even know why it works? I don't know, Your Honor, but it does work. So I don't understand with this engagement. Are they forcing them to take medicine against their will?

SPEAKER_01 11:06

No, it's voluntary. So they just have to do exactly what you're saying. Try to, right now we have this very hands-off philosophy that there's nothing we can do until they meet the civil commitment standard. I see. So but so now we have AOT and we have voluntary engagement ahead of time. But if you could say for Connecticut or for any state, what would be an important law or laws to change to make the mental health system better? What would you suggest?

SPEAKER_02 11:36

Well, I would like Connecticut to have this AOT because I think that it would decrease the amount of commitments and that that would be in the patient's best interest. That's a big thing.

SPEAKER_01 11:50

That's a big thing.

SPEAKER_02 11:51

I would say short of that, there have there has been talk in Connecticut of going to just one outside doctor instead of two, probably to save money. I don't think that that's necessary. I like hearing from two doctors personally. Uh, but some people feel it's not it's not necessary because they tend to be a rubber stamp of the in-house doctor and it costs money. So it's a it's a cost-saving thing. So, in terms of changing law and changing policy, I think it's very, very good that Connecticut's gun uh, we know the vast majority of people with mental health issues are not dangerous, but there is a subset that are, and I've seen them and I've been with them, and I'm very glad that conservators have an affirmative duty in Connecticut to remove a gun from someone's home if they have a conservator. However, there is a loophole in the law that I would like to see changed. And the reality is if somebody who is conserved lives in a home where someone else owns the gun, that technically the law is not clear about whether or not the conservator has the power to remove a gun from somebody else. I, however, in that situation, I had a situation in my courtroom where I had um one of four sons that was being committed, and he was being committed for menacing, threatening, dangerous behavior in the context of schizophrenia. And he lived with uh his parents, they were Spanish speaking in Bridgeport, so four sons and parents in an apartment. And I casually looked up before the hearing was over and I said, By the way, is there a gun here? And the father stiffened up and he said, Yes, I own the gun and it's in a safe. And I said, It's not safe enough. Really? And um, I want it removed. And I ordered that the father remove his own gun because I was not persuaded that in that household it was something that should be there. In fact, I was persuaded that it was too dangerous. And I followed up by having another hearing afterwards, 30 days later, where I got an affidavit that the gun had been removed and where it was. The father was angry with me, but I told the father he had a choice. He could keep his gun or he could have his son continue to live with him, but he couldn't have both. I didn't force him to have his son live with him. His son was 34 years old. His son could have had different housing, and then the gun wouldn't need to be removed. But I wanted that gun removed knowing that he was going back into that environment. Too, too much um possibility for inflammation in that house. I mean, that's why he had been committed. So the father was angry with me, but he did what I wanted to do. And at the end of that second hearing, the mother says to me in Spanish, because I speak Spanish, but proficiently, not fluently. She thanks me profusely. Quiet little mother, with four sons and a husband in that house. And she took me aside and she said, Thank you, Your Honor, thank you, Your Honor, thank you, Your Honor. Afterward, I found out that I might have exceeded my authority, that the current law in Connecticut doesn't precisely use the word access. It says a con a conserved person cannot have a gun. It doesn't say a conserved person shouldn't have access to a gun. I had made some noise about changing it, and I'm gonna tell you, I was told that.

SPEAKER_03 15:44

And this in the state where no we don't know if schizophrenia was involved, but where first graders were gunned down. Oh, somebody was mental issues.

SPEAKER_02 15:56

That's where the conservator law came to begin with after Adam Lanza. For sure. Mental illness, for sure.

SPEAKER_03 16:03

The guy was definitely a mother who had no right to be conservative for her son or whatever she was, because she and the guns were in the house.

SPEAKER_02 16:12

And of course, she was the first victim. I mean, the whole thing was a horror.

SPEAKER_03 16:15

Yeah.

SPEAKER_02 16:15

And she let him live in a room that didn't have windows, that had black wallpaper, and so he didn't see the daylight because he had such fears and sensitivities. I mean, he was beyond, and he was anorexically skinny. He was beyond needing help for anybody who was paying attention, but that's another huge story. That's another podcast for another time. And if this change in the law, which I have suggested to different legislators, comes to be, I will testify in favor of it. But I was advised not to leave the charge to change it. It sounds like you get just as frustrated as we do. So, you know, it is what it is. Luckily, I don't think it comes up too often, you know, but you asked me, so I'm telling you.

SPEAKER_03 17:04

I thank you. This has been so interesting. I can't believe the time has gone by. So, in the last few minutes, I just want to end with some concluding thoughts. And and Judge Lisa, I'm gonna let you have the last word. And your question is going to be what would you most want family members to know? So think about that for a second. And for we three moms in the trenches, the question would be, what do we most want judges to know? Yeah, it sounds like Judge Lisa already knows it. No, no, I have a lot to learn. Let me hear. Who's got who's got a thought?

SPEAKER_00 17:38

Okay, no, I would go ahead and say that, and I I don't feel like I have to tell you this because clearly you know this. But what I would say to judges and people with that kind of control and power over these lives is listen to us, the mothers, the family members, the loved ones, listen to us. We can help you, we can shed light. I think very rarely you're gonna have a hysterical mother who's giving you the wrong impression of how it is. We can help you. And when we say that our kids need something, trust us, we know.

SPEAKER_02 18:15

Amy, I always ask your opinion. And sometimes it's awkward and uncomfortable. At the hearing today, there was somebody who called in from Kenya, who's a registered nurse who knew this young man since he's eight, and she wanted to be the conservator as opposed to the court appointed. I allowed her to do it from Africa, believe it or not, because she was so well spoken and she knew this kid so well. But I asked her the question listening to him today, hearing the doctor's testimony. Do you think he's well and do you think he should stay? I want to hear her tell me.

SPEAKER_00 18:48

I think I'll revise my answer too. I think what the judges need to know is they need a lesson from you of how to do it.

SPEAKER_03 18:57

We're gonna send you on a national speaking tour. Mindy, what are your thoughts?

SPEAKER_01 19:01

Well, I'm similar to what Mimi started out with because um I think we don't have this encumbrance of who's going to be the conservator. You're not making that decision if you're a judge in Minnesota. But I would like the whole mental health system, including the judges and the legal system, to err on the side of involving the family. Too often, you mentioned the families that are gone when their kids are in their 50s, they're they've gotten worn out. The biggest reason that families get worn out, in my opinion, and I know a lot of families, and I'm currently the president of NAMI Ramsey County, which is our affiliate for NAMI, and I've been on the state and national boards here, the state board of Minnesota, the national NAMI. It's my opinion that the reason families get worn out is because they're not included, you know, beyond HIPAA, it's much more than HIPAA, it's the whole mentality of, you know, you must have done something wrong, or you are not capable, or the court buys into the family member's delusion. Our son is delusional, then his family is the enemy. When he's healthy, we're not the enemy, and he wants us involved. Of course, the health system and the court see the person when they're delusional oftentimes, and then the family is the enemy. But it's that's not the case when they're doing well all the time. So I would urge you to err on the side of including the family and assuming that the family is good. I think most families.

SPEAKER_02 20:46

So you know what? Here's something where there's here's something where once again you go outside the lines once in a while, uh, things are not so clear, or you break a rule. So, what is the right of notice to these hearings? Right? That's a big thing for me.

SPEAKER_03 21:02

What's right of notice?

SPEAKER_02 21:04

What is the right, in other words, I get a petition from the hospital that someone's being committed. Who has the right to be noticed about that commitment? It's rather important, right?

SPEAKER_01 21:15

Right. And the family doesn't get have a right to be noticed unless they're the ones bringing the petition. Which they never are in my case. Our son shares that with us, so then we find out, or he leaves the papers lying around and we see it. But yes, often families have no idea, so then they're not.

SPEAKER_02 21:33

So one thing that I think should be changed or should be codified is that the family should have the right to be noticed for hearings. And so what I do is I find out if there's family. Now, sometimes the hospital knows, sometimes they don't know, but we try. And what I do is I notice them, which doesn't necessarily mean they have the right to be there, and we tell them that because if their counsel and And they that day are very adamantly opposed to the presence of someone who doesn't technically have a legal interest, right? If they're adults and they're not conserved, then they're not there. But I've notified the family. And I see no harm in that. I think that's the right thing to do. We do. So do we. So do we. I mean it. It's you know, I don't think I'm violating anybody's civil rights to let you know that there's a hearing. First of all, your son or daughter may come out, and then you very often need to know that. Like, where's he gonna stay? Like, hello, where's he gonna be? So that to me is very pragmatically important. And secondly, I just think you ought to know. You just ought, even if you can't be at the hearing, at least you knew the hearing happened. And you know, we have these things called probable cause hearings. Do you have something like that in your states where if someone is brought in on an acute situation to the hospital, the hospital can only hold them in Connecticut for a maximum of 15 days, but during the 15-day period, they have a right to get in front of a judge to leave because they're being committed against their will. And so that's called a probable cause hearing. They're entitled to a hearing within 72 hours of telling the hospital I want to leave. So I come in within 72 hours, they have an attorney, and they have to show me. Well, actually, it's the hospital. The burden is still on the hospital, technically, but it is a hearing in which the impetus for the hearing is brought by the patient as opposed to the hospital.

SPEAKER_00 23:39

That's how it is here in Washington and California, I believe.

SPEAKER_02 23:43

Okay. So during these special hearings, we call them probable cause because if the judge finds probable cause to believe that they would be subject to confinement, in other words, not clear and convincing evidence, but merely probable cause that they're either dangerous to themselves or others or gravely disabled, then the judge can continue to have them stay, but only through the end of the 15-day period. It isn't an indefinite commitment. So I would say many times, maybe one out of every three times, I let them go because very often they are there, but they are well enough to ask to leave, and they are well because as soon as they got in the hospital, they start taking their medicines. I see them and they can leave. Query who should have notice of a probable cause hearing. Don't you think the family should know if somebody in there is petitioning to leave? Like, doesn't that make sense? I'm a mother. I think that helps. I think it helps a lot. It definitely helps. So notice is something. Notice is something that you guys should focus on. Definitely. Because even if it isn't a right to appear, and I understand that, you know, you may not be able to be there for the hearing. Okay, I get that. We respect people's confidentiality, but notice that there isn't even a hearing, I think that that's okay.

SPEAKER_01 25:02

Yeah. Yeah. That's and I actually also find out because our son assigned a release of information. Oh, lucky. Oh, they have his providers have to inform me of everything.

SPEAKER_02 25:13

Oh, you're lucky. But Mindy, not every family has such a thing.

SPEAKER_01 25:17

No, not every family gets that. But um, but but his him's providers wouldn't get that either if I didn't encourage them to ask him. I don't think they ask, they just assume things about families and they don't press the person to sign those releases. So I always say, you know, he always signs the releases if you ask him. So since he hasn't, I know you haven't asked him. Could you ask him? And then they do, and then he signs. So I think it's this mentality families are bad, or they take up time, they talk and talk and talk, and we don't have that maybe.

SPEAKER_02 25:51

So from my point of view, it's not a problem. But from doctor's points of view, it might be a problem. But from my point of view, it's not a problem. It's only help because I'm only seeing them once for one thing. Right.

SPEAKER_03 26:02

So uh the only thing I would add to what you two other mom, well, we're all moms, but I mean uh the three moms in the trenches, I would add that I had the privilege of once doing a ride along with the uh Fairfield, it's another town in Connecticut, right near Westport for you know our other listeners, with police department there. And just a huge shout out of thank you for CIT training for crisis intervention training. Because I have been fortunate enough, we have been fortunate enough to have police officers trained in this. And my son has avoided jail and any things that could have happened because they were well trained. And in this particular ride-along, the officer was revisiting a family that it's the day after their son had been brought to the hospital. And he went to check up on the family and see how the family was and make sure the family had support and education. And so when I speak to people about my son's situation, I say families need search, support, education, acceptance, resilience, communication, and hope or humor. But you know, support and education when the families have access to that or to resources, that helps us a lot. So any last words, Judge?

SPEAKER_02 27:14

Oh, you're right about well, you're right about that. I am always so pleasantly, in a way, surprised but happy how many people with mental illness end up in our hospital when they could so easily have gone a different way. And I really do give a shout out to really well-trained police officers because they're on the front lines and they see behavior that is threatening, that is intimidating, that is scary to the people around them, but they acknowledge it for what it is and they don't elevate it to a criminal situation. And we really do have to thank them for it.

SPEAKER_03 27:46

I think we'll do a show on that one of these days on crisis intervention training because there are police departments that go, oh, we can't afford it, but it's a moneymaker. Any last words from you, Judge Lisa, the amazing? Would you what would you most like family members to know other than what you've already shared?

SPEAKER_02 28:04

Uh family members, family members. Um or anybody. I I I honestly um I think schizophrenia is a terrible disease.

SPEAKER_00 28:15

No argument here.

SPEAKER_02 28:17

No, we're not gonna dispute that one. And um sometimes I sit in my car after a hearing and I say there, but for the grace of God, and go my go my children, my nieces, my nephews, whatever. And um I think that you guys are fabulous.

SPEAKER_03 28:37

Thank you. Now you have a newsletter also that people can subscribe to to get information. You want to tell us a bit about that?

SPEAKER_02 28:44

And then so uh I write it every quarter, although I'm late now. I think I'm late. It's just the Lisa Wexler Westport Western probate court newsletter, and I write about um whatever it is I feel like you need to know. It's very much centered on Connecticut, it gives you insight. But we, you know, Connecticut probate judges, we do everything. We do all the powers of attorney and the guardianships, conservatorships, mental illness hearings, and obviously will contests, you know, your bread and butter, you know, will litigation over wills and trusts. That's what we do. So if you want to subscribe to the newsletter, just shoot me a quick email at Lisa at Lisawexler.com and I'll put you on the list. It's free. And I let you know what's happening and what's up to date. And I usually have a good cartoon, so you get a laugh.

SPEAKER_03 29:30

Wonderful. Well, I can't thank you enough for joining us. This has been so informational, and you've been great. Thank you so much. Andy, you're thank you.

SPEAKER_02 29:40

You're really you are wonderful, a wonderful judge.

SPEAKER_03 29:43

And join us next time. We will be talking with Suzanne Robinson, who is with NAMI National now and part of their education. And we'll talk a lot about family to family and how that started and her personal story and how support and education can be given to families in this way. Thank you for joining us. Hey, thanks for joining us for this episode of Schizophrenia Three Moms in the Trenches with Randy Kay, Mindy Gryling, and Miriam Feldman. To get in touch with us or to learn more about our books, please visit our websites at MiriamHyphenfeldman.com, mindygryling.com, or randyk.com.