hopeless feelings about the daughter’s condition. He believed that she was incurably mentally ill, possibly “genetically tainted,” and that she would never be able to live a normal life. He reported her pleading with him to put her out of her misery. It was apparently in response to those hopeless feelings about his daughter’s illness that he killed her and himself. In a subsequent meeting with the mother, it was learned that family friends were not surprised at the father’s action. Knowing the closeness between father and daughter, they viewed the father’s act as a gift of love. Murder-suicide is an unusual occurrence, but it happens. Therefore, psychiatric clinicians should be alerted to the possibility of it under certain circumstances. A review of the literature reveals that such crimes almost always occur in domestic settings. They are more often committed by a man than a woman. And 15 per cent of those who commit murder-suicide have themselves made previous suicide attempts. West divided persons who commit murder-suicide into two groups-the “sane” and the “insane.” Among the “sane” offenders, the most common motivation is altruism. The victims are almost always relatives; and occasionally the victims are willing participants who are in some way sick or disabled. Depression in a parent, coupled with real or imagined physical or emotional defects in a child, is a clinical constellation associated with child murder by parents (3). The case reported here certainly matches the clinical circumstances associated with murder-suicide. Unfortunately, the patient’s initial psychopathology and then her marked suicidal ideation overshadowed the depth of her father’s distress. During her initial brief hospitalization, one family session was held, but the focus was principally upon the problems of the patient and not on the family dynamics or the family’s response to her illness. After hospitalization, the patient was seers with her father, but the focus was again upon the patient’s syrnptomatology. The father’s willingness to provide personal support and home supervision seemed to provide the least restrictive alternative to hospitalization. In considering preventive measures, the current philosophy of psychiatric care bears mention. There is increasing emphasis today on brief hospitalization following the medical model and emphasizing neuromedical work-ups and aggressive use of psychotropic medications. The duration of hospitalization is often dependent upon the patient’s willingness to be hospitalized. With such an orientation, the patient’s family situation, the psychodynamics of the family members, and the stresses attendant upon them may receive less attention than was formerly the norm when hospitalizations were longer. Respect for the privacy of an adult patient may also contribute to decreased communication with the family about the nature of the patient’s illness. It is clear from the case presented here that the current emphasis on brief hospitalization and home treatment can put a tremendous burden upon a patient’s caretakers. Even if a family is willing to assume the responsibility of caring for an actively disturbed patient
at home, their ability to handle the stress requires both a thorough initial evaluation and continued monitoring and information exchange with the patient’s therapist. There has been much recent emphasis on the harm that families may do patients by involuntarily cornmitting them to mental institutions. Possible problems, including murder-suicide, that may arise when families are permitted or encouraged to take too much responsibility for severely ill patients have, perhaps, received too little attention. REFERENCES
1) D. J. West, Murder Press, Cambridge, 1987. 2) P. J. Resnick, “Child
Followed
by
Suicide,
Harvard
University
Murder by Parents: A Psychiatric Review of Filicide,” American Journal of Psychiatry, Vol. 126, September 1969, pp. 325-334. 3) M. Rodenburg, “Child Murder by Depressed Parents,” Casiothan Psychiatric Association Journal Vol. 16, February 1971, pp. 41-
48.
NIGHT COURT: OF LEGAL AND James Jeffrey
It P. Fraser, E. Froelich,
A COLLABORATION MENTAL
HEALTH
SYSTEMS
Ph.D. J.D.
#{149}While the cases seen in a municipal courtroom and in a mental health center’s crisis department often are nearly identical, the description of the problem and the actions of the agency differ drastically. Too frequently, the invo!ved parties either are inducted into the roles and processes of the criminal justice or mental health system to their detriment, or are refused help with a problem because it is outside the range of one system or the other. What has been needed for some time is a model tlat meshes the elements of both systems. In Dayton, Ohio, such a model has been developed through the collaboration of the City Prosecutor’s Office, the University of Dayton Law School, and the Good Samaritan Community Mental Health Center. Potential misdemeanor charges involving generally predetermined classifications of statutoly offenses, such as intrafamily, inteipersonal, or neighborhood disputes, are referred to a nonlegal hearing for negotiation of a resolution and a plan to avoid future problems without court proceedings. Parties to interpersonal difficulties who have filed complaints are channeled into the program. All cornplaints must first be made to police who, in the district covered by the Good Samaritan Community Mental Health Center, have the option of calling a mental health crisis therapist to the site to try to solve the problem immediately. If this option is not chosen, or in Dr. Fraser is director of the crisis and brief therapy department of the Coed Samaritan Community Mental Health Center, 2222 Philadelphia Drive, Dayton, Ohio 45408. He is also an assistant clinical professor University
director
VOLUME
of psychiatry in Dayton.
in
the
School
of
MedICine
Mr. Froelich is an assistant of the law school clinic at the University
30 NUMBER
8 AUGUST
1979
at professor
Wright State of law and
of Dayton.
559
police
districts
port
the
where
complaint
it is not directly
available, to
the
the
police
prosecutor’s
reoffice.
The prosecutor then decides whether to file the complaint in court or to summon all parties to appear for a hearing in the night prosecutor’s court within one week. The hearing officers, who conduct the hearings, are actually law students who have been trained by crisis therapists from the mental health center in techniques of crisis intervention, conflict management, and negotiation. Two crisis therapists are in night court each evening. All cases are discussed before each hearing, during a brief recess, and afterward with one of the therapists. In difficult or unusual cases, therapists also serve as hearing co-officers. Hearings are scheduled in the evening between 6 and 10 p.m. so that they don’t interfere with the clients’ normal
working
hours.
One
hearing
is scheduled
each
hour in each of four courtrooms; participants sit around tables placed in front of the bench. The hearing officer notes the outcome of each case, and mental health center staff administer a follow-up telephone questionnaire to all parties at least three months after the hearing to assess the effect of the intervention and the client’s satisfaction with the proceedings. The basic goal of the hearings is to obtain a “winwin” negotiated settlement (as opposed to the “winlose” polarized settlements of litigation), and to devise a plan to avoid future difficulties. The strategies used in the hearings are simple and direct and continually focus on
resolving
the
client’s
presenting
problem,
under-
standing the circumstances leading up to it, and offering methods of dealing with other similar events. The over-all crisis model from which the hearing process has been extrapolated, and upon which training has been based, is a combination and extension of several
models
that
have
been
used
extensively
by
the
crisis and brief therapy department at the Good Samaritan Community Mental Health Center over the past six years. It is a three-step, six-phase model. The three steps, or crisis ABCs, are achieving contact, boiling the problem down to its essentials, and coping creatively and actively with the problem. The six phases within the three steps are establishing a trusting relationship, gathering information, agreeing on the prob1cm, taking a recess, solving the problem, and doing a summary. Each phase is aimed at specific goals, with time between phases to assure solid groundwork for the next phase. This crisis model has been translated into a hearing process; the hearing officer makes an introductory statement to set the scene. The use of the night prosecutor’s court is less costly than
regular
court
processing.
case to the city is about $100 for $10 for night court. In the night from incident to hearing is seven resolutions within seven to 30 court, the average time is roughly depending on such variables as and docket size. Court processing
560
HOSPITAL
The
average
a court court, days days. six pleas, often
trial and about the average time or less, with final In the regular months or more, pretrial motions, involves arrests,
& COMMUNITY
cost
per
PSYCHIATRY
jailings, and bail bonds, and always involves a criminal or legal record, attorneys’ fees, court costs, and often a loss of work time and money for those involved. The night court avoids all those elements. Furthermore, night court processing decreases rather than increases crowded municipal court dockets, thereby allowing speedier trials and more preparation time for city prosecutors. Finally, comparing outcome options, court proceedings may lead to one year or less of jail, a fine, probation, or a warning. Night court op’ tions are negotiated resolutions, counseling by or referral to a social agency, or, in a few instances, referral to the court. In its first year, operating two evenings each week, the night prosecutor’s program has handled about 1500 cases. A sample of 198 of those cases showed that the mean age of clients was 30 years; they were equally divided between males and females and blacks and whites. About 65 per cent were employed; the others were unemployed and were receiving public assistance or pensions. Nearly 70 per cent of those who were employed were skilled or unskilled laborers. Based on a sample of 90 cases, we can report the following about the nature of the hearings. Eighty per cent of all charges consisted of assault, aggravated menacing, or menacing. Most cases represented rather violent disputes. About half of the conflicts occurred between relatives, spouses, or boy- and girl-friends. About one quarter of the disputes occurred between neighbors, co-workers, or landlords and tenants, and the other quarter consisted of conflicts between casual acquaintances. Mutually agreed upon reconciliations or separation agreements each accounted for nearly 40 per cent of the hearing outcomes (and combined to account for nearly 80 per cent of the total). About 10 per cent of the outcomes involved agreed upon restitution, 10 per cent involved social agency referrals, and 7 per cent were ultimately referred to some branch of the courts. Clearly, the aim of these interventions is not character restructuring. As in crisis intervention, the idea is to intervene rapidly and intensively in a pressing problem using
structured,
goal-oriented
stabilize
escalating,
minimal
but
problems
that
significant
might
vicious changes
tactics.
cycles that
The
and may
to
goal
is
to
implement
offset
similar
occur.
The program also has an impact on prevention and on the system. Law students who are being trained and supervised in concepts and practices of preventive mental health and problem-solving will soon be among the community’s primary caretakers. The concepts and skills they develop in the program are likely to have even broader positive effects in their future dealings with clients. The night court has also created a change in the criminal justice system in Dayton; prosecutors are now beginning to distinguish between problems ap.. propriate to bring to court and problems that are better resolved through mutual problem-solving among the parties involved. Most individuals with interpersonal difficulties are being directed to the dispute-settlement program; prosecution is now seen as the exception.
at home, their ability to handle the stress requires both a thorough initial evaluation and continued monitoring and information exchange with the patient’s therapist. There has been much recent emphasis on the harm that families may do patients by involuntarily cornmitting them to mental institutions. Possible problems, including murder-suicide, that may arise when families are permitted or encouraged to take too much responsibility for severely ill patients have, perhaps, received too little attention. REFERENCES
1) D. J. West, Murder Press, Cambridge, 1987. 2) P. J. Resnick, “Child
Followed
by
Suicide,
Harvard
University
Murder by Parents: A Psychiatric Review of Filicide,” American Journal of Psychiatry, Vol. 126, September 1969, pp. 325-334. 3) M. Rodenburg, “Child Murder by Depressed Parents,” Casiothan Psychiatric Association Journal Vol. 16, February 1971, pp. 41-
48.
NIGHT COURT: OF LEGAL AND James Jeffrey
It P. Fraser, E. Froelich,
A COLLABORATION MENTAL
HEALTH
SYSTEMS
Ph.D. J.D.
#{149}While the cases seen in a municipal courtroom and in a mental health center’s crisis department often are nearly identical, the description of the problem and the actions of the agency differ drastically. Too frequently, the invo!ved parties either are inducted into the roles and processes of the criminal justice or mental health system to their detriment, or are refused help with a problem because it is outside the range of one system or the other. What has been needed for some time is a model tlat meshes the elements of both systems. In Dayton, Ohio, such a model has been developed through the collaboration of the City Prosecutor’s Office, the University of Dayton Law School, and the Good Samaritan Community Mental Health Center. Potential misdemeanor charges involving generally predetermined classifications of statutoly offenses, such as intrafamily, inteipersonal, or neighborhood disputes, are referred to a nonlegal hearing for negotiation of a resolution and a plan to avoid future problems without court proceedings. Parties to interpersonal difficulties who have filed complaints are channeled into the program. All cornplaints must first be made to police who, in the district covered by the Good Samaritan Community Mental Health Center, have the option of calling a mental health crisis therapist to the site to try to solve the problem immediately. If this option is not chosen, or in Dr. Fraser is director of the crisis and brief therapy department of the Coed Samaritan Community Mental Health Center, 2222 Philadelphia Drive, Dayton, Ohio 45408. He is also an assistant clinical professor University
director
VOLUME
of psychiatry in Dayton.
in
the
School
of
MedICine
Mr. Froelich is an assistant of the law school clinic at the University
30 NUMBER
8 AUGUST
1979
at professor
Wright State of law and
of Dayton.
559
police
districts
port
the
where
complaint
it is not directly
available, to
the
the
police
prosecutor’s
reoffice.
The prosecutor then decides whether to file the complaint in court or to summon all parties to appear for a hearing in the night prosecutor’s court within one week. The hearing officers, who conduct the hearings, are actually law students who have been trained by crisis therapists from the mental health center in techniques of crisis intervention, conflict management, and negotiation. Two crisis therapists are in night court each evening. All cases are discussed before each hearing, during a brief recess, and afterward with one of the therapists. In difficult or unusual cases, therapists also serve as hearing co-officers. Hearings are scheduled in the evening between 6 and 10 p.m. so that they don’t interfere with the clients’ normal
working
hours.
One
hearing
is scheduled
each
hour in each of four courtrooms; participants sit around tables placed in front of the bench. The hearing officer notes the outcome of each case, and mental health center staff administer a follow-up telephone questionnaire to all parties at least three months after the hearing to assess the effect of the intervention and the client’s satisfaction with the proceedings. The basic goal of the hearings is to obtain a “winwin” negotiated settlement (as opposed to the “winlose” polarized settlements of litigation), and to devise a plan to avoid future difficulties. The strategies used in the hearings are simple and direct and continually focus on
resolving
the
client’s
presenting
problem,
under-
standing the circumstances leading up to it, and offering methods of dealing with other similar events. The over-all crisis model from which the hearing process has been extrapolated, and upon which training has been based, is a combination and extension of several
models
that
have
been
used
extensively
by
the
crisis and brief therapy department at the Good Samaritan Community Mental Health Center over the past six years. It is a three-step, six-phase model. The three steps, or crisis ABCs, are achieving contact, boiling the problem down to its essentials, and coping creatively and actively with the problem. The six phases within the three steps are establishing a trusting relationship, gathering information, agreeing on the prob1cm, taking a recess, solving the problem, and doing a summary. Each phase is aimed at specific goals, with time between phases to assure solid groundwork for the next phase. This crisis model has been translated into a hearing process; the hearing officer makes an introductory statement to set the scene. The use of the night prosecutor’s court is less costly than
regular
court
processing.
case to the city is about $100 for $10 for night court. In the night from incident to hearing is seven resolutions within seven to 30 court, the average time is roughly depending on such variables as and docket size. Court processing
560
HOSPITAL
The
average
a court court, days days. six pleas, often
trial and about the average time or less, with final In the regular months or more, pretrial motions, involves arrests,
& COMMUNITY
cost
per
PSYCHIATRY
jailings, and bail bonds, and always involves a criminal or legal record, attorneys’ fees, court costs, and often a loss of work time and money for those involved. The night court avoids all those elements. Furthermore, night court processing decreases rather than increases crowded municipal court dockets, thereby allowing speedier trials and more preparation time for city prosecutors. Finally, comparing outcome options, court proceedings may lead to one year or less of jail, a fine, probation, or a warning. Night court op’ tions are negotiated resolutions, counseling by or referral to a social agency, or, in a few instances, referral to the court. In its first year, operating two evenings each week, the night prosecutor’s program has handled about 1500 cases. A sample of 198 of those cases showed that the mean age of clients was 30 years; they were equally divided between males and females and blacks and whites. About 65 per cent were employed; the others were unemployed and were receiving public assistance or pensions. Nearly 70 per cent of those who were employed were skilled or unskilled laborers. Based on a sample of 90 cases, we can report the following about the nature of the hearings. Eighty per cent of all charges consisted of assault, aggravated menacing, or menacing. Most cases represented rather violent disputes. About half of the conflicts occurred between relatives, spouses, or boy- and girl-friends. About one quarter of the disputes occurred between neighbors, co-workers, or landlords and tenants, and the other quarter consisted of conflicts between casual acquaintances. Mutually agreed upon reconciliations or separation agreements each accounted for nearly 40 per cent of the hearing outcomes (and combined to account for nearly 80 per cent of the total). About 10 per cent of the outcomes involved agreed upon restitution, 10 per cent involved social agency referrals, and 7 per cent were ultimately referred to some branch of the courts. Clearly, the aim of these interventions is not character restructuring. As in crisis intervention, the idea is to intervene rapidly and intensively in a pressing problem using
structured,
goal-oriented
stabilize
escalating,
minimal
but
problems
that
significant
might
vicious changes
tactics.
cycles that
The
and may
to
goal
is
to
implement
offset
similar
occur.
The program also has an impact on prevention and on the system. Law students who are being trained and supervised in concepts and practices of preventive mental health and problem-solving will soon be among the community’s primary caretakers. The concepts and skills they develop in the program are likely to have even broader positive effects in their future dealings with clients. The night court has also created a change in the criminal justice system in Dayton; prosecutors are now beginning to distinguish between problems ap.. propriate to bring to court and problems that are better resolved through mutual problem-solving among the parties involved. Most individuals with interpersonal difficulties are being directed to the dispute-settlement program; prosecution is now seen as the exception.
