I recently read a story on the front page of a major newspaper about the establishment of suicide hotlines aimed at soldiers returning from Iraq and Afghanistan. What I felt as I read can only be described as bittersweet: satisfaction that we are at least acknowledging, finally, the emotional suffering that is leading record numbers of our servicemen and women to end their lives, but anger that we’re not doing more to reach them before they find themselves standing on that precipice. A social worker answering a suicide hotline call from a person who has already reached that level of desperation should not be the first point of contact with the mental health system.

So I thought I would look at some numbers. As recently as 2007 suicide ranked as the 11th leading cause of death of Americans. It ranked eighth among American males and was the third leading cause of death in adolescents and young adults, ages 15 through 24. Perhaps most telling of all, a suicide occurs approximately every 17 minutes in the United States.

The U.S. Census Bureau reports that suicide accounts for more deaths in the United States than HIV disease, lymphoma, leukemia, Parkinson’s disease, or ovarian cancer. It accounts for almost twice as many deaths as homicide in the United States and for 75 percent of deaths compared with breast cancer or motor vehicle accidents. In short, it is a serious killer

A sign I see everyday on my way home says: “SUICIDE: SO DEADLY: SO PREVENTABLE.” Every time I pass it I think how great that billboard is, but also how it must hurt some people to see it all the time.

We like to think of ourselves as living in a caring society, and I believe we are, but if we are to be truly worthy of that self-assessment, we need to take a good look at those numbers. We can cure many diseases. We know a great deal—but certainly not everything—about the brain and the workings of the human mind. We now understand that mental illness is biologically based, and we know the cost of failing to treat it: dashed hopes, ruined lives, and even death.

Even so, knowing that doesn’t seem to have translated into having the will, as a community, to do what is necessary to prevent these deaths even as we spend millions of dollars to try to solve problems that kill far fewer people. We know that suicidal behaviors almost always occur in people with depression, bipolar disorder, schizophrenia, and alcohol dependence. We also know that it is very hard to get treatment for these diseases. The reasons for this are varied and are the subjects of many of my former and future blogs.

At the risk of sounding like a broken record, we need to look at the issues surrounding mental illness one problem at a time. We need to decide once and for all that what may seem too expensive or too divisive will, in the long run, save lives and save money. Any problem that resulted in 34,598 deaths in the year 2007 simply must be addressed.

If we don’t know enough about the issues, we need to educate ourselves. If we don’t have enough treatment centers, we need more. If we don’t have enough staff for those centers, we have to train more. Yes, it will cost money, probably a lot of money. But I would as this question: Where is that money better spent?

The mentally ill are easy to overlook. They are often odd and sometimes frightening. Their behavior is often provocative. Part of their diseases’ process is to resist or reject help. But failing to realize that our dismissal of this problem as a society is shameful and one of the great evils of our time leaves this group vulnerable and unassisted. It wrecks families and results in great tragedy and many needless deaths. It will only be addressed as more and more people speak out. I have decided to do just that. — Ann Renaud

If someone is injured in an auto accident what are their rights? In New Jersey, we are governed by the terms of our automobile insurance policies. As owners and operators of vehicles in New Jersey, we are required to have Personal Injury Protection, commonly referred to as PIP coverage. Coverage for medical and other expenses for drivers, passengers, and pedestrians involved in accidents is provided as part of our PIP benefits.

Personal Injury Protection coverage in New Jersey is somewhat flexible; motorists who receive accident coverage through health insurance policies should choose a different level of protection than those who do not have health insurance. New Jersey drivers who select either Full PIP Primary or Full PIP Health Primary policies also have the option of selecting APIP, or Additional Personal Injury Protection: the function of APIP is to make up for the injured parties’ loss of income and improve their quality of life while their injuries heal; when necessary, APIP also provides funeral expenses and death benefits.

Personal Injury Protection assists motorists regardless of which party is responsible for an accident, but there are limitations to its coverage. For instance, PIP does not cover the first $250.00 of auto accident medical expenses. Also, certain types of medical care must be pre-authorized by the auto insurance company. When reporting an auto accident to your auto insurance carrier, notify them of any injuries that either you or any passengers sustained; they will supply you with the necessary forms to fill out so that your medical expenses will be paid. As many of us know, not all injuries are immediately apparent when initially reporting an accident. If you do not experience pain when you report an accident to your automobile insurance company, you are not prohibited from reporting an injury that develops within the weeks following the accident. If an injury develops after filing a claim with your insurance company, contact them with the information of the newly discovered injury.

If a dispute over a medical expense arises between the injured party and their auto insurance company, a remedy is available. The injured party may file a claim against their own auto insurance company, which will then go to arbitration. If successful in arbitration, the injured party may have their attorney’s fees paid by their insurance company. An insured person in an auto accident must look to their own auto insurance company for the payment of their accident related medical bills. — Frank Hlavenka

What State Workers’ Compensation court should I bring my case in if I am hurt while working? The answer to this question may seem obvious but in New Jersey there are additional State courts where a claim may be brought. The answer to the above question is that a person injured while on the job in New Jersey has a right to bring a Workers’ Compensation claim here. There are exceptions to this basic rule, however.

For instance, an employee of a New Jersey company who is injured while on the job in another State may still bring a claim in New Jersey. Our Workers’ Compensation law permits the filing of a claim in New Jersey even if an employee is working outside the State. The key point is that the employee must be employed by a New Jersey based company. As an example, a truck driver who is employed by a New Jersey company is injured in a motor vehicle accident in New York still has a claim for New Jersey Workers’ Compensation benefits.

What if the injured employee is not hurt on the job in New Jersey and does not work for a New Jersey based company? Can the injured employee still bring a claim in New Jersey for Workers’ Compensation benefits? The answer to the foregoing question is yes depending on the facts of the case.

If the employee’s work has substantial contacts in New Jersey the injured employee may still be able to bring a Workers’ Compensation claim here. A truck driver who lives in New Jersey has a motor vehicle accident in Pennsylvania while working and is injured. His employer is located in New York and he was hired there. However, his job duties require the New Jersey resident employee to drive to Elizabeth, New Jersey to pick up his empty trailer. He then drives this trailer to Parsippany, New Jersey to have it loaded with materials. The employee then drives over the roads of New Jersey to Pennsylvania where he has an accident and is injured. Our court has held that this employee’s work had substantial contacts with New Jersey to allow his Workers’ Compensation claim to be brought in New Jersey.

Therefore an employee injured on the job may be able to bring a Workers’ Compensation claim in more than one state. Although there cannot be a duplication of benefits a claim maybe made in more than one jurisdiction for Workers’ Compensation benefits. — Frank Hlavenka

While we all expect fair treatment from those with whom we interact, many of us have had the negative experiences of breached contracts, accidents with uninsured motorists, or the purchase of a product that was defective. It is natural to become frustrated when basic expectations are not met and to want to have an unsatisfactory situation corrected. In many of these cases, the other party has a different viewpoint of their culpability.

Clients frequently approach me with disputes concerning either the exchange of goods and services or compensation for property damage. Many people, when in one of the situations I have described, try to reason with the party with whom they have a dispute. People adopt this approach because of its apparent rationality and simplicity; these factors contribute to its success. Unfortunately, not all individuals or businesses are receptive: some will refuse to admit to and rectify a wrongdoing. When informal dialogues fail, some people hire an attorney to help resolve their problem. Others, if the monetary amount in dispute is not substantial, choose to use the Small Claims Court.

Small Claims Courts only hear cases in which the disputed amount does not exceed a certain monetary limit. These limits vary from state to state. Small Claims Court procedures also allow the judges’ law clerks to mediate disputes between the parties and eliminate the need for a trial. The law clerks’ mediations are generally successful, but when they are not, the judge will try the case.

Sometimes trials are unavoidable because the other side is being so unreasonable. There are risks when going to trial. The possibility of losing what one could have obtained by settling the case is always a concern. At a trial the parties testify, call witnesses to testify, and introduce evidence so that the judge can make a fair and just decision. The judge will then apply the appropriate law to the facts and evidence in order to arrive at the correct result. — Frank Hlavenka

I write today about a case that I recently concluded. It baffled me, baffled my client, baffled my client’s family, baffled my client’s doctors, and needlessly caused a lot of heartache. It was one of those situations that I run into all too often and that raises eyebrows when I talk about them later.

I feel that when we use the criminal justice system to try to solve problems that are more medical in nature than they are legal, we frequently squander opportunities to do something positive for our community and for the people who are affected. I believe that our health care system and insurance companies are let off the hook when, instead of addressing some very hard and intractable issues with a creative and compassionate approach, we continue to revert to punishment as a way of solving the problem of behavior that appears criminal but originates from some other source.

My client was charged with simple assault under the domestic violence act. The police officer who was called to the scene felt he had to charge my client with a criminal act because there was a valid complaint by his wife: she had been punched in the eye and her injury was evident. Clearly, we have a domestic violence act to try to limit violence within the home and the need to deter that is great. However, in this case the officer had been informed of two key points: the perpetrator–her husband of 57 years–had never been violent in the past and he had been diagnosed with Alzheimer’s disease and was more agitated recently.

My client and his wife had been solid citizens in the town where this incident occurred for many, many years, but their standing in the community could not mitigate an ineluctable procedure. A no contact order was entered; in this case, that meant that the wife had to move out of the home, despite her role as the primary caregiver and despite the fact that she was innocent of any wrongdoing. But the husband was in no condition to be moved. Her two adult children, both living out of town, had to step in to fill the breach.

I gathered all of the relevant medical records then went to court on the first listing, almost a month later, expecting that the instant the prosecutor became aware that the defendant was a man suffering from a disease that is known to produce violent outbursts rather than a criminal, that the matter would immediately be dismissed. But that is not what happened. The prosecutor, intent on protecting the community at large from domestic violence, refused to dismiss. He also refused to recommend that the no contact order be lifted despite the “victim” pleading with him to do so. In light of the prosecutor’s position, the judge refused to lift the no contact order and attempted to orchestrate this family’s life by requiring a contract showing that there was a full time caregiver in the home and requiring the treating physicians to certify that he was on medication and no longer a danger. Since there is no such animal, this documentation was not easy to produce. Meanwhile, the wife was out of her home for over two and a half months before I was finally able to have the no contact order lifted. It was another month before I was able to get the entire case dismissed and all of this required four humiliating court appearances.

The potential for other families to find themselves in similar situations is alarming. There is a study that finds that within the first year after diagnosis, 16 percent of Alzheimer’s patients will experience a violent outburst, and agitation occurs in up to 70 percent of all Alzheimer’s cases.

Other studies have linked various factors that play a role in aggression among Alzheimer’s patients, including depression, delusions, and hallucinations. Some of these studies have shown that simple solutions were the most likely to be effective, and many clinicians who deal with Alzheimer’s patients advocate for readily available beds and trained staff to deal with aggressive behavior. Facilities in this country specializing in caring for aggressive Alzheimer’s patients have been shown to be effective, but their cost limits their accessibility. Defusing these behaviors requires specialized training and a highly engaged staff, but it can often be achieved by keying into the needs that are not being met and meeting them, by applying their knowledge of the patient’s nature and background to be able to soothe them and to redirect their attention when they become agitated and aggressive.

Many clinicians understand that the acting out is largely due to the inability to effectively communicate pain, discomfort, or other feelings or emotions; it is similar to trying to determine a baby’s needs by deciphering his cries or behaviors. We would never dream of hauling a baby into court because we couldn’t understand why he wouldn’t stop screaming.

I was not able to understand why my client was being brought before a court to answer in a punitive situation for a behavior that he did not recall and was largely unable to control. I have no reason to believe that both the prosecutor and the judge involved were doing anything other than what they perceived to be right, but they have no idea of the pain and humiliation they caused this family. While I think the court can be a place to make appropriate referrals in this situation, it is clearly not the place to deal with it. We need to do better than this. We need to insist that both the medical and legal establishments seek better ways to reduce these kinds of social ills. We need to understand the brain better than we do and make resources more accessible. We need to encourage people to study these issues and pursue careers in the fields that can make a difference. Until we do, we will continue to fill our courts and jails with the mentally ill. — Ann Renaud

I guess your perceptions of what should happen to the Rutgers postdoctoral student and his girlfriend who breached security at Newark Airport on January 3 depend on whether you were a horribly inconvenienced traveler or learned about it via the news. I am sure the last thing on that young student’s mind was that his actions were going to shut down the entire terminal for six hours and back up flights and passengers into the next day.

It seems to me that when we assess what should happen to him, we can’t just judge his behavior on what happened but also on what he was thinking and whether other individuals in his position might have behaved similarly. I am thinking also about a number of people of that age I know who might have made a similarly awkward mistake. Do we as a society want to ruin this young man’s career and make a criminal out of him when it seems very unlikely that he intended any harm at all?

I also question whether it is appropriate to charge him with more than a petty disorderly persons offense as a deterrent for others. We should protect the public from this kind of inconvenience and from individuals who intend to do harm. We need to be very careful, though, that we don’t begin to criminalize non-criminals. That would not be good social policy, nor would it be fair to the one being used as the example.

I caution anyone thinking about, or acting upon, this situation to clearly focus on the twenty something they know and imagine them sneaking past a rope to kiss a girlfriend goodbye. Then I ask if they still think the student and his girlfriend deserve being charged with a federal crime because they unintentionally caused a really big stir. — Ann Renaud

(This column originally appeared in the Star-Ledger).

During his campaign, Gov.-elect Chris Christie understandably focused primarily on the troubled state of New Jersey’s economy and the disastrous condition of state government.

But he also promised to bring New Jersey out of what he called “the Dark Ages” when it comes to one aspect of law enforcement.

In his campaign manifesto, “88 Ways Chris Christie Will Fix New Jersey” point No. 74 read in part: “I will make our streets safer and reduce recidivism by … requiring drug rehabilitation and vocational training for nonviolent drug offenders.

If he succeeds in carrying out this campaign promise, it could save the state tens of millions of dollars annually.

I have spent much of my career as an attorney as an advocate for people who have found themselves caught in the legal system either because of substance abuse, mental illness, or a combination of both. Many of my clients are people who would likely have benefited years earlier if our justice system had included a more compassionate and effective public drug rehabilitation and mental health care component.

Unfortunately, despite decades of good intentions — and hundreds of millions of dollars spent over the years — the system that exists today in New Jersey is not up to the task. Ask anyone in our legal system who has spent time dealing with individuals who find themselves caught in a seemingly hopeless spiral of drug abuse. They understand, as our governor-elect so clearly does, that we simply must find a better way to address the very real challenge that nonviolent drug offenders pose to themselves and to society.

Drug abuse exacts a price on both the abuser and on the community. And when an abuser breaks the law and winds up in prison, it costs nearly $50,000 a year to house that person.

New Jersey taxpayers are spending as much as $350 million a year to house the estimated 7,000 nonviolent drug offenders currently in our state prisons. That’s more than the entire budget of the state’s Departments of Agriculture, Community Affairs, Education, Health and Senior Services, Labor and Workforce Development, and Transportation combined. It’s also more than the entire budget of the Department of Children and Families.

And what do we get for that $350 million? Nowhere near as much as we should. These drug abusers receive little to nothing in the way of treatment while in prison. When they are released, as often as not they return to the very behaviors that landed them in prison in the first place. The state is running little more than a very expensive warehouse, with a revolving door, for people who have the potential to become productive members of society if they had access to treatment.

Providing a nonviolent drug offender with an intensive regimen of treatment costs about half as much as it does to keep that person in prison for a year. If we changed our laws and the focus of our system toward an emphasis on treatment, we could quickly save as much as $175 million.

We must also recognize that many of those who abuse drugs also suffer from an underlying mental illness. Many of the people I have represented are using illegal drugs as a form of self-medication, vainly and destructively attempting to address untreated underlying mental health problems.

That is why the governor-elect should consider expanding his commitment to drug treatment programs for nonviolent offenders to include the diagnosis and, if indicated, treatment for underlying mental illnesses.

In addition, I would hope our new governor will consider establishing mental health courts, based on the successful drug court model. Nationally, about 200 jurisdictions have established mental health courts, and these courts are making a positive difference. For example, in Allegheny County, Pennsylvania, mental health courts reduced recidivism rates from 67 percent among those in the regular prison system to just 14 percent among those who went through that county’s mental health court.

Treating nonviolent drug offenders — and those nonviolent offenders suffering from treatable mental illnesses — will pay real dividends to our state. It will make our communities safer and it will save lives. It will also save taxpayer dollars.

In the midst of a genuine economic crisis, such treatment offers one of the few win-win propositions available to our new governor. It’s good social policy, good criminal justice policy, and good fiscal policy. That’s why I urge governor-elect Christie to move it higher up his list of the 88 ways he will fix New Jersey.— Ann Renaud