WEBVTT - Episode 4 – Faking It? 0:00:04.000 --> 0:00:08.200 Clifton T. Perkins Hospital in Jessup, Maryland is a sprawling, 0:00:08.440 --> 0:00:13.680 nondescript building, surrounded by forests and located on forty five acres. 0:00:14.000 --> 0:00:17.640 The forensic psychiatric hospital has grown in size since its 0:00:17.640 --> 0:00:21.960 construction in nineteen fifty nine. Today, the nearly three hundred 0:00:21.960 --> 0:00:25.800 bed facility is mostly home to patients who are charged 0:00:25.880 --> 0:00:29.600 with a violent felony and have been either deemed incompetent 0:00:29.680 --> 0:00:34.000 to stand trial or not criminally responsible, or an inmate 0:00:34.240 --> 0:00:37.800 too mentally ill to be in prison. One of those 0:00:37.840 --> 0:00:40.880 patients is Catherine Hoggell. 0:00:41.080 --> 0:00:43.800 She's a patient at this point and not a prisoner. 0:00:44.640 --> 0:00:48.400 Troy Turner is right, Perkins, as it's known, isn't a prison, 0:00:49.120 --> 0:00:52.559 but the mostly maximum security hospital would sure feel like 0:00:52.600 --> 0:00:56.400 one of you lived there. Maximum security patients can have 0:00:56.560 --> 0:01:00.000 limited ability to roam the building and grounds, and all 0:01:00.120 --> 0:01:05.040 patient buildings are surrounded by security fences. Even with this 0:01:05.120 --> 0:01:09.280 focus on security, last year, Perkins made the news after 0:01:09.360 --> 0:01:13.240 a union representing workers at the hospital claim that assaults 0:01:13.240 --> 0:01:18.640 on both patients and staff had become routine. But despite 0:01:18.720 --> 0:01:23.000 the conditions the restrictions on Catherine's movement, Troy Turner, the 0:01:23.080 --> 0:01:25.919 father of the two children Catherine is accused of killing. 0:01:26.400 --> 0:01:29.360 Doesn't think Perkins is where his ex partner should be. 0:01:30.880 --> 0:01:34.920 I think that she should be punished to the greatest 0:01:34.920 --> 0:01:36.880 extent that the law would allow. I think that she 0:01:36.880 --> 0:01:40.160 should stand trial like anyone who murders two children should 0:01:40.200 --> 0:01:41.920 stand trial. And I think that she should go to 0:01:42.040 --> 0:01:44.040 jail and go to prison. 0:01:45.400 --> 0:01:49.040 In earlier episodes, we talked about the complications police can 0:01:49.120 --> 0:01:52.640 run into when they are investigating a crime, especially when 0:01:52.680 --> 0:01:56.200 missing children are involved, that they have to balance the 0:01:56.280 --> 0:01:59.800 rights of the suspect with the urgency of solving the crime. 0:02:00.440 --> 0:02:03.560 And in Catherine's case, it was even more complicated because 0:02:03.560 --> 0:02:06.760 of her mental illness as police tried to find out 0:02:06.800 --> 0:02:10.040 where she had taken her children, three year old Sarah 0:02:10.080 --> 0:02:14.200 and two year old Jacob. But that added complication doesn't 0:02:14.240 --> 0:02:17.760 stop once a person is arrested. It just continues as 0:02:17.760 --> 0:02:20.440 they make their way through the justice system, and there 0:02:20.480 --> 0:02:22.799 is a sense that it's at this point, as the 0:02:22.880 --> 0:02:25.960 accused is forced to answer for their crimes, that justice 0:02:26.000 --> 0:02:29.080 will be meted out. But that's not how things have 0:02:29.160 --> 0:02:33.359 gone in this case. For nine years, Troy has been 0:02:33.400 --> 0:02:36.880 living at the intersection of these systems as he contests 0:02:36.919 --> 0:02:41.239 Catherine's incompetency and advocates for what he considers justice for 0:02:41.320 --> 0:02:45.760 his children. He wants Catherine found competent to stand trial. 0:02:46.320 --> 0:02:51.160 He wants the evidence against her presented in a courtroom. 0:02:51.360 --> 0:02:55.720 I'm Beth Karas and this is Unrestorable, an original podcast 0:02:55.840 --> 0:02:59.120 from Anonymous content and iHeartRadio. 0:03:06.240 --> 0:03:09.560 We come from this very puritan kind of heritage in 0:03:09.600 --> 0:03:11.640 our culture, and we're very punitive. 0:03:12.240 --> 0:03:15.959 This again, is tes Neil, a forensic psychologist at Iowa 0:03:16.080 --> 0:03:20.320 State University who researches how the justice system copes with 0:03:20.400 --> 0:03:21.240 the mentally ill. 0:03:21.919 --> 0:03:25.200 We have just an extraordinarily high rate of incarceration in 0:03:25.240 --> 0:03:29.520 this country and a kind of political narrative that we 0:03:29.560 --> 0:03:32.520 are tough on crime and we want to make sure 0:03:32.560 --> 0:03:35.120 that people don't get away with things. Then we also 0:03:35.160 --> 0:03:38.400 have this still pretty stigmatizing view of mental illness. 0:03:38.840 --> 0:03:42.160 I agree with Tess. For eight years as a prosecutor 0:03:42.200 --> 0:03:44.520 in New York City, I was on the front lines 0:03:44.560 --> 0:03:48.000 of this problem. Our prisons are full of people who 0:03:48.000 --> 0:03:52.200 are mentally ill. In fact, the National Alliance on Mental 0:03:52.240 --> 0:03:55.800 Illness says that two million people with mental illnesses are 0:03:55.800 --> 0:04:01.080 admitted to US jails each year. Is not in jail. 0:04:01.280 --> 0:04:04.440 She's in a hospital, and until she can be declared 0:04:04.480 --> 0:04:07.480 healthy enough to help her defense attorney, she's not going 0:04:07.600 --> 0:04:10.680 to have to defend herself against criminal charges before a 0:04:10.760 --> 0:04:14.360 judge or jury or face the threat of a prison sentence. 0:04:15.080 --> 0:04:18.160 And for Troy, that's the only way to get any justice. 0:04:19.360 --> 0:04:23.000 But you have to wonder why, why isn't being locked 0:04:23.080 --> 0:04:26.600 up in a maximum security institution where your freedom is 0:04:26.640 --> 0:04:31.520 definitely restricted. Why isn't that a form of justice, especially 0:04:31.560 --> 0:04:34.520 since it's very clear that Catherine does suffer from mental 0:04:34.520 --> 0:04:35.240 health issues. 0:04:36.320 --> 0:04:37.840 You know, I know, one of the questions raised by 0:04:37.839 --> 0:04:41.560 this case in other cases involving competency, is whether the 0:04:41.600 --> 0:04:46.200 criminal justice system adequately protects us from the mentally ill. 0:04:46.920 --> 0:04:49.520 My co host Sarah Trelevin was with me when we 0:04:49.600 --> 0:04:50.839 interviewed tes Neil. 0:04:51.600 --> 0:04:54.480 But there's also clearly another question to be asked about 0:04:55.279 --> 0:04:58.400 whether the criminal justice system served the interests of and 0:04:58.440 --> 0:05:01.560 protects the mentally ill themselves. What do you think about 0:05:01.560 --> 0:05:03.599 the balance of those two ideas. 0:05:04.480 --> 0:05:09.120 So, on the one hand, lawyers and the system has 0:05:09.160 --> 0:05:12.719 this kind of foundational assumption of how the process works, 0:05:12.720 --> 0:05:15.200 that we're in an adversarial system and the way we 0:05:15.240 --> 0:05:18.599 work is that each party gets to offer their best 0:05:18.680 --> 0:05:21.880 version of the facts with a narrative, and I get 0:05:21.880 --> 0:05:25.000 to provide their evidence, and the truth will out right. 0:05:25.080 --> 0:05:27.400 So through that process, whatever the truth is, it's going 0:05:27.440 --> 0:05:29.599 to come to the fore. But when you have a 0:05:29.640 --> 0:05:33.320 situation where somebody is not a great advocate for themselves, 0:05:33.360 --> 0:05:35.680 whether it be because of mental illness or other reasons, 0:05:35.960 --> 0:05:40.839 sometimes that attorney is in a difficult philosophical ethical dilemma 0:05:41.040 --> 0:05:44.080 between whether they're advocating for what the client is asking for, 0:05:44.279 --> 0:05:46.080 which may not be in their best interests as a 0:05:46.200 --> 0:05:49.159 human being, right, and so like, maybe they do need treatment, 0:05:49.279 --> 0:05:55.039 maybe they are mentally ill, and so there's definitely parentalistic 0:05:55.160 --> 0:05:59.160 legal representation where maybe that's in the best interest of 0:05:59.440 --> 0:06:02.919 the but it's not consistent with the system of justice 0:06:03.000 --> 0:06:06.560 as we have designed it. And so that's a hard 0:06:06.680 --> 0:06:08.240 problem and it's not solved. 0:06:10.160 --> 0:06:14.040 This hard problem is not new. The insanity defense has 0:06:14.080 --> 0:06:16.279 been used in the US since at least the mid 0:06:16.360 --> 0:06:20.640 nineteenth century. Since then, the laws have been reformed and 0:06:20.760 --> 0:06:25.479 case law has been codified. But remember, Catherine is not 0:06:25.600 --> 0:06:29.360 asserting an insanity defense. She can't do that or won't 0:06:29.400 --> 0:06:33.200 do that until she's before a judge preparing for trial, 0:06:33.880 --> 0:06:36.720 and she has to be found competent before that can happen. 0:06:37.800 --> 0:06:42.040 For years, Catherine appeared before judges who accepted reports from 0:06:42.120 --> 0:06:46.240 doctors that she was responding to medication and could likely 0:06:46.320 --> 0:06:50.520 become competent in the foreseeable future. After all, that was 0:06:50.560 --> 0:06:53.640 the goal to restore her to competence so she could 0:06:53.640 --> 0:06:59.279 go to trial. This distinction, this idea that one cannot 0:06:59.320 --> 0:07:02.520 be tried one cannot help with one's own defense, comes 0:07:02.520 --> 0:07:06.080 from a nineteen sixty U. S Supreme Court decision. It 0:07:06.160 --> 0:07:08.960 involved a man with a history of mental illness named 0:07:09.040 --> 0:07:12.480 Milton Richard Dusky, who was found guilty of the attempted 0:07:12.600 --> 0:07:16.080 rape of a young girl and sentenced to forty five years. 0:07:16.680 --> 0:07:20.880 He appealed. In ordering a new competency hearing, the US 0:07:20.960 --> 0:07:24.320 Supreme Court laid out the test that is still used today. 0:07:25.080 --> 0:07:29.200 A defendant must properly understand the proceedings against him and 0:07:29.480 --> 0:07:32.880 possess the present ability to assist counsel in his defense. 0:07:33.760 --> 0:07:38.200 Dusky was retried, reconvicted, and his new sentence reduced to 0:07:38.240 --> 0:07:39.040 twenty years. 0:07:41.080 --> 0:07:43.600 Incompetence is a present state. 0:07:44.480 --> 0:07:47.120 This is Catherine's lawyer, David Felson. 0:07:47.280 --> 0:07:52.000 Someone is incompetent now, which means that they can't make 0:07:52.200 --> 0:07:57.320 for the for whatever reason, can't make the various decisions 0:07:57.360 --> 0:08:02.760 necessary to assist in their defense, or that they understand 0:08:02.760 --> 0:08:06.280 what's going on in court. We don't try those people 0:08:06.400 --> 0:08:10.000 for any crime because they can't defend themselves. They don't 0:08:10.080 --> 0:08:13.200 know what's going on. Relative to the legal process. 0:08:13.640 --> 0:08:17.640 Rules around mentally ill criminals continue to evolve, and in 0:08:17.720 --> 0:08:21.280 nineteen seventy two, the US Supreme Court held that you 0:08:21.360 --> 0:08:25.160 cannot hold someone for an indefinite amount of time in 0:08:25.200 --> 0:08:27.640 the hopes of restoring one's competency. 0:08:28.320 --> 0:08:31.640 There's a statute that now limits and I think most 0:08:31.680 --> 0:08:34.480 states have in this, but there's a limited period of 0:08:34.520 --> 0:08:37.480 time that you have to restore somebody to confidence. 0:08:38.400 --> 0:08:42.079 John McCarthy is the state's attorney in Montgomery County, Maryland. 0:08:42.800 --> 0:08:47.960 That timeframe has been more severely limited in Maryland in 0:08:48.040 --> 0:08:51.400 more recent times. For instance, it used to be ten years, 0:08:51.640 --> 0:08:53.920 now it's five years. On felonies. 0:08:54.960 --> 0:08:58.319 For misdemeanors, it's three, which is why Catherine has been 0:08:58.320 --> 0:09:01.600 held for so many years now. She was initially held 0:09:01.640 --> 0:09:05.000 on misdemeanor charges for almost three years, but before that 0:09:05.080 --> 0:09:08.480 three year window had expired. A grand jury indicted her 0:09:08.520 --> 0:09:12.560 for murder, and the state dismissed the lesser charges. Catherine 0:09:12.600 --> 0:09:16.200 was soon found incompetent to stand trial again, and that 0:09:16.360 --> 0:09:19.560 started a five year clock which has loomed ever since. 0:09:20.360 --> 0:09:22.640 And this is where Troy finds himself. 0:09:23.280 --> 0:09:25.520 We're going, okay, we have this slock ticking. 0:09:26.200 --> 0:09:29.960 If Catherine cannot be restored to competence, then she will 0:09:30.000 --> 0:09:32.960 either be civilly committed if a judge finds her to 0:09:33.000 --> 0:09:37.000 be a danger to herself or others, or released, but 0:09:37.080 --> 0:09:40.640 she will not face murder charges for now because those 0:09:40.679 --> 0:09:41.599 will be dismissed. 0:09:42.760 --> 0:09:45.600 It's hard to kind of look at her and know 0:09:45.960 --> 0:09:48.760 what she did and know that she might be accountable for, 0:09:49.040 --> 0:09:52.600 you know, and that there's a good chance that she'll 0:09:52.640 --> 0:09:55.079 never be held accountable the way the system's working right now. 0:09:55.160 --> 0:09:57.600 And I'm just looking at her, going this is crazy, 0:09:58.640 --> 0:10:00.880 and there's nothing that we can do about it at 0:10:00.880 --> 0:10:01.760 this point right now. 0:10:03.200 --> 0:10:06.559 But it has to be made clear. Catherine is an outlier. 0:10:07.280 --> 0:10:11.120 Most defendants who are found incompetent are restored and end 0:10:11.200 --> 0:10:14.080 up in a courtroom. Most of them do not run 0:10:14.080 --> 0:10:14.720 out the clock. 0:10:15.559 --> 0:10:19.439 The best estimate we have is that something like seventy 0:10:19.480 --> 0:10:22.720 five percent of people will be restored within I think 0:10:22.760 --> 0:10:28.160 a year, and typically that is through taking psychotropic medication. 0:10:28.360 --> 0:10:30.320 And typically it's even faster than a year. Typically it's 0:10:30.360 --> 0:10:33.320 within six months because medication typically works, you know, within 0:10:34.080 --> 0:10:34.800 a month or two. 0:10:35.800 --> 0:10:39.040 For Troy, the father of Sarah and Jacob, the man 0:10:39.080 --> 0:10:42.839 who nine years ago lost his two youngest children and 0:10:42.920 --> 0:10:46.080 still today has no idea where they are or what 0:10:46.280 --> 0:10:49.360 happened to them, none of this sits well with him. 0:10:49.720 --> 0:10:53.040 She manipulated the system. She manipulated the staff at Perkins. 0:10:53.800 --> 0:10:55.760 The nursing knows. The nurse say that she knows that 0:10:55.800 --> 0:10:59.800 they The nurses are like, she's manipulating you guys. Basically 0:11:00.040 --> 0:11:01.880 they are writing to the purpose doctors that they're being 0:11:01.920 --> 0:11:05.439 manipulated as she's lying and just doesn't matter. 0:11:14.880 --> 0:11:18.360 According to Troy and other members of the family, Catherine 0:11:18.400 --> 0:11:22.280 has been almost brazen about her plans to remain incompetent 0:11:22.400 --> 0:11:25.280 long enough to see the murder charges against her dismissed. 0:11:26.840 --> 0:11:31.160 Do you think it's possible for someone to fake incompetency, 0:11:31.440 --> 0:11:33.760 and I mean just anybody. 0:11:33.760 --> 0:11:34.880 I think it's possible. 0:11:34.960 --> 0:11:38.760 Sure, I'm speaking with Catherine's attorney, David Felson. 0:11:39.360 --> 0:11:42.920 I mean not in this case, not with these symptoms, 0:11:43.240 --> 0:11:46.719 not for this period of time, not under these circumstances, 0:11:46.720 --> 0:11:50.280 not taking these medications, not getting these therapies. But could 0:11:50.320 --> 0:11:54.160 somebody fake it? Sure, Beth, you could fake it. 0:11:56.520 --> 0:11:59.920 I asked Catherine's lawyer to describe the symptoms he's talking about. 0:12:00.679 --> 0:12:03.200 He wouldn't go into great detail, but told me he 0:12:03.280 --> 0:12:06.480 had represented her in the past for a minor traffic infraction, 0:12:07.200 --> 0:12:10.440 and the contrast between Catherine then and when he met 0:12:10.440 --> 0:12:13.800 her right after her arrest in twenty fourteen was profound. 0:12:14.600 --> 0:12:17.800 That there was a clear disconnect between the circumstances that 0:12:17.840 --> 0:12:20.440 she found herself in and the way she would react 0:12:20.480 --> 0:12:23.800 to people. That Catherine's eyes were darting around the room, 0:12:24.200 --> 0:12:26.920 that she spoke in hushed tones, and that she was 0:12:27.000 --> 0:12:30.840 obviously paranoid and delusional. Her hair was so messy it 0:12:30.880 --> 0:12:33.160 looked like she had been living on the street for days. 0:12:34.920 --> 0:12:38.800 Catherine knew she was facing murder charges because that part 0:12:38.840 --> 0:12:42.040 of competency she passed. I mean she understood it. 0:12:42.120 --> 0:12:46.480 Yeah, we conceded that, yes, Catherine is not stupid. I 0:12:46.480 --> 0:12:50.840 think that most people have a profound misconception of incompetency 0:12:51.760 --> 0:12:55.400 to stand trial. They think of incompetency when they hear 0:12:55.480 --> 0:13:02.800 that word. Their initial vision is someone who is incoherent, 0:13:03.520 --> 0:13:07.920 unable to communicate, sitting in the corner of a room, drooling, 0:13:08.480 --> 0:13:11.559 banging their head against the wall, and looking at imaginary 0:13:11.600 --> 0:13:17.400 butterflies and soiling themselves. That person would clearly be incompetent. 0:13:17.600 --> 0:13:22.120 But that is not the only definition of incompetence, and 0:13:22.240 --> 0:13:31.040 competence to stand trial is a much more complicated, nuanced circumstance. 0:13:32.120 --> 0:13:35.560 And here again we bump into the intersection of two 0:13:35.679 --> 0:13:37.960 competing systems. 0:13:38.040 --> 0:13:42.000 It's a perennial question in forensic cases like this, where 0:13:42.000 --> 0:13:44.160 there's some question of mental illness, it's intersecting with the 0:13:44.240 --> 0:13:45.040 legal issue. 0:13:45.679 --> 0:13:48.760 It's something that test Neil has spent a lot of 0:13:48.800 --> 0:13:49.960 time thinking about. 0:13:50.679 --> 0:13:54.280 Malingering is when somebody is thinking some kind of mental 0:13:54.280 --> 0:13:57.360 illness in an effort to have their criminal charges dismiss. 0:13:57.880 --> 0:14:01.080 When clinicians are trying to assess from a one of 0:14:01.080 --> 0:14:03.080 the things you're trying to assess for is well, what's 0:14:03.080 --> 0:14:03.640 the motivation? 0:14:04.760 --> 0:14:07.920 Troy says he definitely knows Catherine's motivation. 0:14:08.960 --> 0:14:09.720 She knows is action. 0:14:09.880 --> 0:14:10.840 What's going on there? 0:14:11.160 --> 0:14:13.040 And I'm not saying that, you know, just as the 0:14:13.040 --> 0:14:15.200 father of these kids who wants justice. I'm saying that 0:14:15.760 --> 0:14:20.200 as someone who knows her, who has spoken with her 0:14:20.400 --> 0:14:22.560 since she has been locked up. You know, at times, 0:14:23.320 --> 0:14:26.400 and she doesn't appear to be any less cognizant of 0:14:26.400 --> 0:14:29.720 the situation than she was whenever she was explaining the 0:14:29.840 --> 0:14:31.880 entire system to me and telling me a rundown of 0:14:32.520 --> 0:14:34.440 how long she has to wait and be incompetent to 0:14:34.440 --> 0:14:34.800 get out. 0:14:36.600 --> 0:14:40.200 It's a complicated problem. The medical system Catherine is in 0:14:40.480 --> 0:14:43.920 is actively trying to get her healthy, healthy enough to 0:14:43.960 --> 0:14:48.160 stand trial. But that system is supported by doctors and nurses, 0:14:48.640 --> 0:14:52.560 and it raises questions about doing no harm. Should mental 0:14:52.600 --> 0:14:56.960 health professionals help make incompetent people well just so the 0:14:57.000 --> 0:14:58.920 system can prosecute them. 0:14:59.160 --> 0:15:02.400 What are the ethics of treating somebody a human being 0:15:02.760 --> 0:15:07.200 to then enable the legal system to prosecute that person. 0:15:07.920 --> 0:15:11.720 It gets even more complicated when you consider the death penalty. 0:15:12.000 --> 0:15:15.400 Catherine is not facing the death penalty. It was abolished 0:15:15.400 --> 0:15:19.640 in Maryland in twenty thirteen, only one year before Catherine 0:15:19.720 --> 0:15:23.480 is accused of killing her kids, But the American Psychiatric 0:15:23.520 --> 0:15:27.880 Association has weighed in on the question of restoring someone's competency. 0:15:28.000 --> 0:15:31.160 If there is a threat of execution, that person. 0:15:30.920 --> 0:15:33.400 Has to be restored to competency before they can be executed. 0:15:33.840 --> 0:15:38.240 The American Psychiatric Association has come out very firmly against 0:15:38.360 --> 0:15:41.040 physicians being involved in that process. They have said it 0:15:41.120 --> 0:15:44.880 is against the hippocratic oath. It is unethical for a 0:15:44.880 --> 0:15:48.480 psychiatrist to provide treatment in that situation, to aid a 0:15:48.480 --> 0:15:53.200 person to restore their confidence to become competent for execution. 0:15:54.400 --> 0:15:58.040 But it's still a thorny ethical problem because sometimes people 0:15:58.040 --> 0:16:02.120 who are very psych practically ill are suffering, and so 0:16:02.400 --> 0:16:05.160 there's also this hippocratic oath problem of not helping the 0:16:05.160 --> 0:16:08.920 person when they are suffering. So it gets very complicated 0:16:08.920 --> 0:16:12.040 at these intersection of systems, especially in that situation. 0:16:14.400 --> 0:16:17.440 And again, while Catherine is not facing the death penalty, 0:16:17.840 --> 0:16:21.280 Troy does believe that the doctors at Perkins are protecting her, 0:16:21.720 --> 0:16:25.400 helping her maintain incompetency rather than treating her. 0:16:26.120 --> 0:16:29.400 There is no therapy for them at Perkins until they 0:16:29.400 --> 0:16:32.240 are competent. So if you're profoundly mentally I don't know 0:16:32.240 --> 0:16:33.760 how they expect to bring you to competence or have 0:16:33.880 --> 0:16:35.720 you get better if they're not giving you therapy. That 0:16:35.800 --> 0:16:36.560 makes no sense to me. 0:16:37.840 --> 0:16:42.360 At Catherine's latest competency hearing, the evaluating doctor from Perkins 0:16:42.480 --> 0:16:45.480 testified that Catherine was not in one on one therapy 0:16:45.960 --> 0:16:49.320 since that's usually reserved for patients who have resolved their 0:16:49.400 --> 0:16:54.080 legal situation. We reached out to the Maryland Department of 0:16:54.120 --> 0:16:57.680 Health to find out more about why an ist patient, 0:16:58.120 --> 0:17:02.280 that is, someone incompetent to stay trial at Perkins might 0:17:02.320 --> 0:17:05.119 not receive one on one therapy and an effort to 0:17:05.160 --> 0:17:08.480 restore them to competency. We were told that it depends 0:17:08.520 --> 0:17:12.480 on the patient and their treatment plan. But Lucy and Parsley, 0:17:12.600 --> 0:17:15.880 an attorney with disability Rights Maryland, has a different take. 0:17:16.680 --> 0:17:21.280 Based on her experience. She believes Perkins may actually discourage 0:17:21.320 --> 0:17:24.640 individual therapy for patients being restored to competency. 0:17:25.280 --> 0:17:30.520 Perkins believes that the individual might say or do something 0:17:31.040 --> 0:17:35.920 with respect to their case that might cause the staff 0:17:35.960 --> 0:17:40.960 to be subpoenaed and testify against them, and they don't 0:17:40.960 --> 0:17:43.400 want to do anything that could put the person at 0:17:43.880 --> 0:17:45.520 more risk of being convicted. 0:17:46.680 --> 0:17:49.440 Parsley is troubled by this lack of therapy. 0:17:50.280 --> 0:17:53.480 We see people who are really suffering because many of 0:17:53.520 --> 0:17:56.840 them have experienced traumas in their life. They're not getting 0:17:56.880 --> 0:18:02.719 trauma therapy, they're not getting PTSD therapy, they're you know, 0:18:03.600 --> 0:18:06.960 getting medication if they would agree to take it in 0:18:07.040 --> 0:18:12.160 the hospitals, but they're also kept on the most restrictive 0:18:12.880 --> 0:18:14.480 levels in the hospitals. 0:18:15.320 --> 0:18:19.399 This illustrates that complicated intersection of the justice system and 0:18:19.440 --> 0:18:22.840 the treatment of the mentally ill, and a conflict even 0:18:22.880 --> 0:18:26.760 with those presumably on the same side. It's so interesting 0:18:26.800 --> 0:18:30.760 because your organization, Disability Rights Maryland is interested in the 0:18:30.840 --> 0:18:33.920 individual and getting them the care they need if they're suffering, 0:18:33.960 --> 0:18:35.879 like you say, from trauma, but they're not getting that 0:18:35.960 --> 0:18:40.200 proper care. But the hospital Perkins also feels like they're 0:18:40.400 --> 0:18:43.840 doing something in the best interests of the patient by 0:18:43.880 --> 0:18:46.360 withholding treatment so that they're not prosecuted. 0:18:47.600 --> 0:18:50.240 Yeah, I think that is probably true. 0:18:50.880 --> 0:18:54.480 But to Troy, this is all irrelevant. The real truth 0:18:54.520 --> 0:18:57.600 of the matter is Troy does not believe Catherine is 0:18:57.640 --> 0:19:01.240 incompetent at all. He believed that she is in fact 0:19:01.400 --> 0:19:04.320 well aware of the situation and is waiting things out, 0:19:04.840 --> 0:19:07.400 and he says she's being very deliberate about it. 0:19:09.359 --> 0:19:12.520 So on one side, you have inconfident, it goes to treatment, 0:19:13.000 --> 0:19:13.800 it goes down. 0:19:14.040 --> 0:19:17.639 Troy is describing a sort of drawing that Catherine made. 0:19:17.840 --> 0:19:20.879 It was on a handout that Perkins gave Patience to 0:19:20.960 --> 0:19:24.520 explain the legal process. At the very top, there's a 0:19:24.560 --> 0:19:28.280 cartoonish drawing of a police officer blowing a whistle, his 0:19:28.359 --> 0:19:31.800 baton raised in the air like he's chasing down a suspect. 0:19:32.880 --> 0:19:35.760 Just below there's a drawing of an inmate wearing the 0:19:35.800 --> 0:19:40.119 classic striped prison guard, looking dejected behind bars in a 0:19:40.160 --> 0:19:44.320 concrete cell. Troy wants me to notice what Catherine added. 0:19:45.080 --> 0:19:48.200 If you look on there, even in terms of incoonfident, 0:19:48.760 --> 0:19:50.240 where it says not guilty, and there's a home she 0:19:50.240 --> 0:19:54.240 actually wrote streets on there, and then you have where 0:19:54.840 --> 0:19:58.240 being convicted, Lisa Jell NCR leads to where you would 0:19:58.280 --> 0:20:00.439 be home by then as an incompetent person. 0:20:01.119 --> 0:20:05.119 NCR stands for not criminally responsible, what we commonly know 0:20:05.280 --> 0:20:09.359 as not guilty by reason of insanity. For the pathways 0:20:09.359 --> 0:20:12.760 that lead Catherine out of jail and eventually out of Perkins. 0:20:13.119 --> 0:20:16.119 Katherine has drawn a cute little house, a curl of 0:20:16.160 --> 0:20:17.600 smoke coming from the chimney. 0:20:18.080 --> 0:20:20.720 It's literally just laid out as instructions, here's how you 0:20:20.760 --> 0:20:21.800 get home at some point. 0:20:22.720 --> 0:20:26.159 According to this drawing, the paths are clear. Being found 0:20:26.200 --> 0:20:30.920 competent and then guilty leads to prison. Remaining incompetent and 0:20:30.960 --> 0:20:35.280 receiving ongoing treatment. Never facing the court system leads to 0:20:35.359 --> 0:20:38.160 that cute cartoon house look. 0:20:38.720 --> 0:20:42.040 When they give you a diagram, literally give you a 0:20:42.119 --> 0:20:46.119 diagram that basically says paths to get out of jail 0:20:46.400 --> 0:20:47.679 and a path to go to prison. 0:20:48.200 --> 0:20:51.280 It doesn't sit well with Montgomery County State's Attorney John 0:20:51.320 --> 0:20:52.240 McCarthy either. 0:20:52.840 --> 0:20:56.439 And they explain to you on a diagram that she 0:20:56.600 --> 0:21:00.919 color codes that was an exhibit, and she discussed it 0:21:00.960 --> 0:21:05.920 with her husband. She knew exactly which road would keep 0:21:05.920 --> 0:21:06.639 her out of jail. 0:21:14.960 --> 0:21:17.800 What are the some of the signs that that practitioners 0:21:17.840 --> 0:21:21.600 look for that someone is malingering. What would be a tell. 0:21:23.200 --> 0:21:28.800 Just behavioral consistency across time and across context and situation. 0:21:29.080 --> 0:21:32.600 So what's the person acting like in their conversations and 0:21:32.640 --> 0:21:35.760 behaviors with family members and friends if they're in custody. 0:21:35.800 --> 0:21:38.400 What is their behavior like in custody? What are the 0:21:38.480 --> 0:21:42.080 treatment providers who are seeing them in that environment? And 0:21:42.800 --> 0:21:45.439 the people who are seeing them on the unit all 0:21:45.480 --> 0:21:47.920 the time, what are their notes like on a daily basis. 0:21:48.240 --> 0:21:51.200 If you find consistency that the person is struggling across 0:21:51.240 --> 0:21:54.000 all of those domains, that's much more compelling than if 0:21:54.000 --> 0:21:57.600 they're only having a problem when you're interviewing them. There's 0:21:57.800 --> 0:22:03.359 really good kind of psychometrically solved, scientifically based tools measures 0:22:03.400 --> 0:22:05.480 that we have as clinicians that can that can tap 0:22:05.520 --> 0:22:07.960 into the lingering like it's been studied quite a lot. 0:22:08.000 --> 0:22:09.920 We know what it looks like typically from people who 0:22:09.960 --> 0:22:12.600 are genuinely ill and people who are faking ill. The 0:22:12.640 --> 0:22:14.840 only people who are really successful at lingering would be 0:22:14.880 --> 0:22:18.919 somebody who's very sophisticated about what mental illness genuinely looks like. 0:22:19.880 --> 0:22:23.920 And yet, is it possible for somebody to appear lucid, 0:22:24.160 --> 0:22:27.840 to appear like a good advocate for herself, to appear 0:22:28.520 --> 0:22:33.399 self interested and capable of strategic thought, and still be 0:22:33.600 --> 0:22:37.000 not competent to stand trial for serious charges? 0:22:38.000 --> 0:22:43.439 Yes, I can give an example. Sometimes delusional disorder is 0:22:43.480 --> 0:22:46.920 a it's a type of psychotic disorder, but it doesn't 0:22:46.960 --> 0:22:49.880 have the same presentation as like a schizophrenia or something 0:22:49.880 --> 0:22:52.240 would have, so with a delusional disorder, a person doesn't 0:22:52.280 --> 0:22:54.800 have hallucinations. You don't see things that aren't there, they 0:22:54.800 --> 0:22:57.679 don't hear things that aren't there. So their main symptom 0:22:57.680 --> 0:23:00.920 with a delusional disorder is some kind of circumscribe fixed 0:23:01.119 --> 0:23:04.480 false belief, some belief that they truly think is real 0:23:04.760 --> 0:23:09.560 that is objectively not true. If that's significant enough, it 0:23:09.600 --> 0:23:13.320 can really derail things and really like mess up people's lives, 0:23:13.560 --> 0:23:17.160 and those are hard to treat sometimes, like psychotropic medication 0:23:17.200 --> 0:23:22.240 can't always treat that well. So if a person is 0:23:22.760 --> 0:23:26.280 very sophisticated, a smart human being who's like doing just 0:23:26.320 --> 0:23:29.560 fine in life, but they have this like resistant and 0:23:29.840 --> 0:23:34.520 intrusive and problematic delusional disorder, that can that can be 0:23:34.560 --> 0:23:38.120 a situation where the person might be lucid and this 0:23:38.160 --> 0:23:42.240 person could be perfectly capable of doing almost everything else 0:23:42.320 --> 0:23:46.399 in a life. That could be a reason why somebody 0:23:46.480 --> 0:23:49.800 might be found incompetent and might not be restorable, because 0:23:49.800 --> 0:23:52.359 delusional disorder can be pretty resistant to treatment. 0:23:52.440 --> 0:24:07.280 Sometimes, is it customary for an evaluator of competency to 0:24:07.359 --> 0:24:10.919 talk to the friends and family of that individual to 0:24:11.160 --> 0:24:17.080 get their perspective on whether the individual is malingering yeah. 0:24:16.400 --> 0:24:18.920 Although again it depends on the seriousness of the case, 0:24:19.000 --> 0:24:21.760 It depends on the training of the evaluator, it depends 0:24:21.840 --> 0:24:24.679 on how good of a job they're doing. So in 0:24:24.720 --> 0:24:28.600 a system that is incentivizing quick and sloppy work, which 0:24:28.640 --> 0:24:31.280 sometimes is the case. If there's a contract, for example, 0:24:31.320 --> 0:24:34.080 for the evaluators, and they get paid by the case 0:24:34.240 --> 0:24:36.400 and nobody is paying attention to the quality of what's 0:24:36.440 --> 0:24:38.600 coming in, then the incentive is no, you don't do 0:24:38.600 --> 0:24:40.440