According to the National Institute of Mental Health, nearly 1 in 5 adults in the United States (44.7 million adults aged 18 or older) lives with mental illness, defined as a mental, behavioral, or emotional disorder. Of those people, 4.2 percent of adults in the United States (an estimated 10.4 million adults) live with serious mental illness, defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment and which substantially interferes with or limits one or more major life activities. When one considers that approximately 84 million trial cases are filed each year in state courts, it is likely that individuals with mental illness will be encountered in the courtroom. Judges, lawyers, witnesses, court personnel and staff, jurors, and anyone who is a plaintiff or defendant in court can accordingly benefit from a better understanding of mental illness in the courtroom setting.
Appearing in court can provoke anxiety for anyone, and not everyone is prepared to navigate the complex judicial system, especially those who may have discomfort with the English language. However, there are observable indicators that, while not definitive, may indicate that a person in court might suffer from a mental illness and thus needs different judicial action and/or judicial attention by a mental health professional. The following non-exhaustive list should accordingly be consulted to determine whether an individual involved in a pending court preceding may suffer from a diagnosable mental illness:
- Wearing inappropriate clothing, such as multiple layers on a hot summer day.
- Trembling, shaking, or an inability to sit or stand still.
- Not understanding where one is.
- Seeming confused or disoriented.
- Memory gaps.
- Inappropriately answering questions.
- Keeping a distance from attorney or bench.
- Belligerent or disrespectful actions.
- Inattentiveness to proceedings.
- No eye contact.
- Appearing sad/depressed or extremely high-spirited.
- Suddenly switching emotions.
- Seeming indifferent to the severity of court proceedings.
- Speaking too quickly or too slowly.
- Missing words.
- Using vocabulary inconsistent with level of education.
- Stuttering or long pauses.
- Seeming to respond to voices or visions.
- Expressing racing, unconnected thoughts.
- Expressing bizarre ideas.
The individual asked to interact with and/or represent a person exhibiting a combination of the above factors should take into consideration the safety of oneself and others present, if there is someone present (such as a family member) who might be able to calm the individual, and if there are any noises or distractions that may have a negative effect on the individual. Persons who suffer from mental illness should be treated with respect, should be spoken to softly and calmly, and should still be provided with explanations regarding what is happening. This includes being afforded the opportunity to write down information or instructions. When possible and appropriate, a person engaging someone with a mental illness should express empathy, help focus the mentally ill person’s attention on how current behavior differs from desired behavior, avoid argument and confrontation, and try to understand that resistance may be a signal that the individual is not being defiant but rather views the situation differently because of his/her mental illness. Individuals who appear confused or disoriented may be demonstrating signs of Schizophrenia, Bipolar Disorder, Schizoaffective Disorder, Depression, Autism Spectrum Disorders, Traumatic Brain injuries, or issues associated with Substance Abuse and/or withdrawal from alcohol. Individuals who appear sad and or desperate may be demonstrating signs of Depression, Bipolar Disorder, Bereavement or Age-Related Cognitive Decline, Traumatic Brain Injuries, Substance Abuse, or withdrawal from amphetamines, meth, or cocaine, and they should be responded to by appropriately instilling hope, and where possible, establishing a personal connection. Individuals who appear angry, irritable, hostile, frustrated, or powerless may be demonstrating signs of Bipolar Disorder, Personality Disorders, Intermittent Explosive Disorder, Autism Spectrum Disorders, Traumatic Brain Injuries, Mental Challenge, or Substance Abuse. It is recommended that one who engages with these individuals seek to manage the situation by asking the individual why he/she is upset, by listening, by defusing, by deflecting, and by avoiding threats and confrontation. Individuals who appear anxious and/or panicky may be demonstrating signs of Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder (PTSD), Dementia, Traumatic Brain Injuries, Mental Challenge, or Substance Abuse. One who engages with these individuals should seek to understand, reassure, deflect, and calm down the agitated individual.
Whenever judges, lawyers, witnesses, or parties have concerns that an individual participating within the judicial system suffers from a mental illness, the concerned person should consider requesting a fitness or competency hearing before proceeding in court. Mental illness issues should accordingly be addressed early on in a court proceeding, and they may also give rise to additional discovery requests regarding the questionable fitness and/or competency of a party, judge, lawyer, or witness which should appropriately be addressed before any testimony is taken at trial.