Continued coverage of the American Academy of Psychiatry and Law (AAPL) conference. For Part 2, click here.
The first talk of the day was a discussion of SB1070, the Arizona law which required police officers to verify the citizenship status of anyone suspected of being an illegal alien. I learned that there were several parts to the law and that some parts were under injunction and were working their way through legal challenges. An immigration attorney talked about the ambiguity of the law and how it could be misapplied. For example, one provision barred anyone from picking up day laborers. In theory, it could be used against emergency medical personnel who transported illegal aliens. He also talked about the problems faced by mentally ill illegals who were deported to Mexico where they had no family support or access to mental health services.
I was planning to go the session about fMRI's in court, but I ended up getting invited on a trip to Tupac, AZ. Very cool little place with nice shops. Incidentally, Tupac is just past the Titan Missile Museum. I didn't go tour the museum because it creeped me out a bit but you can see a short video of the place on their web site.
I got back for the afternoon sessions. Dr. Ezra Griffith gave the Isaac Ray lecture entitled "Identity, Representation, and Oral Performance in Forensic Psychiary." I could never give it justice in a short summary. Fortunately you can read the full text of his talk here, because AAPL continues to be one of the few organizations that still keeps it's articles open to the public for free. Griffith talked about the role of perfomance in expert testimony. While most people would think of this solely in terms of communication skills, he put testimony in the context of the performing arts or literary narrative. The telling of the crime "story" is like drama, with behavioral elements and a physical context (the court room). The expert's purpose is to develop the facts as one would a character, so that the listener can hear the facts in a coherent way and is able to infer a line of understanding about the case. The jury then chooses between two competing narratives, the defense and the prosecution. Read the paper, Ezra explains it much better than I can.
The last session was about privacy in forensic psychiatry. I tweeted the highlights until my data coverage gave out. There was a lot of discussion about the "evils" of social media and the Internet, and how it could be used against you. There was no mention of any potential utility of Facebook, Twitter, blogs, etc. which I found highly ironic. Here I am using these same tools to (hopefully) provide a little public education while the speaker was cautioning the audience against them. The second speaker gave a great presentation about patient privacy rights in the emergency department. He presented literature that psychiatric patients get disrobed and searched in the emergency department twice as often as medical patients, although both patients are equally likely to bring weapons into the department (about 14% of all ED patients are found with weapons). Finally, there was an interesting talk about DNA privacy, legal cases challenging mandated DNA sampling (eg. sex offenders and violent offenders) and potential future misuse of current DNA samples. There have been two recent lawsuits challenging how hospitals store and use newborn blood samples drawn for routine disease screening. Read the details here.
So that's the end of day three. There is one more morning session tomorrow, but I may or may not have time to blog afterward. Hope you enjoyed this.
PS The support duck did not go to Tupac.
Thank you very much for the reports!
Interesting statistic about "disrobing" psych patients in the ER. I've experienced this multiple times, including once when they kept my clothes and made me stay in a "gown" for two days. Having experienced sexual abuse, it's quite traumatic to have a body cavity search done because I'm depressed!
""The second speaker gave a great presentation about patient privacy rights in the emergency department. He presented literature that psychiatric patients get disrobed and searched in the emergency department twice as often as medical patients, although both patients are equally likely to bring weapons into the department (about 14% of all ED patients are found with weapons""
It sounds like an issue of blatant discrimination to me against a group of people that everyone knows will most likely not fight back.
Let's say a minority group had the same statistics regarding found weapons. There would be an outrage of discrimination.
Obviously, people bringing weapons into ERs is not an issue that you can just ignore. But when people like anonymous end up spending two days in a gown and who are victims of sexual abuse, something is very wrong with this picture.
There has got to be some solution that doesn't end up making criminals out of everyone and further traumatizing people like anonymous. Yeah, that will make him/her want to get help in the future. Yes, I am being sarcastic.
What is psychiatry doing about this? You all keep talking about preventing stigmatization but I see no one speaking out against this.
Sorry, I didn't mean for this to be a rant but when I see a post like one from anonymous, this really upsets me. I haven't even had this experience (thank god) and it outrages me.
RE disrobing: it could be a question of directing ones natural sadism at those who are most vulnerable. Sure.
Another explanation is that people who are not mentally ill are easier for ED staff to “read.” If you are clearly lucid and not drunk or angry, there with a clearly physical injury, ED staff may be most likely to ask you to disrobe to check you for weapons if your injury is a gunshot wound. If your injury is a twisted ankle from skiing, less likely.
If you aren’t lucid it might be harder for ED staff to tell whether you are likely to be carrying a weapon. They might be perfectly aware that the overall odds are the same as for someone without a mental illness but have less intuition about whether you in particular are (or are not) likely to be armed.
Again, if you are in the ED because you have attempted to kill yourself or are threatening to kill yourself, it makes sense that they would want to be sure you weren’t going to be killing yourself in the ED.
If there are legitimate reasons for more intrusive intake procedures for people with mental illnesses in the ED, that is all the more reason for them to be handled with tact and with the greatest effort to ensure that the patient feels safe and secure. (If there aren’t legitimate reasons, by all means stop the practice.)
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