May 14, 2025 • 31 mins
Dr. Jhilam Biswas, a board-certified adult and forensic psychiatrist, discusses how mental health issues intersect with the criminal justice system and the urgent need for reform.
She shares insights from her research and clinical experience working with incarcerated individuals with mental illness, explaining why mental health care in America's prisons is a humanitarian crisis.
• Director of Psychiatry Law and Society program at Brigham and Women's Hospital and co-director of Harvard Mass General Brigham Forensic Psychiatry Fellowship
• Research shows delays in psychiatric treatment lead to increased violence and worse outcomes in forensic settings
• Individuals with autism have higher comorbidity with serious mental illness and are more vulnerable in law enforcement interactions
• Mental illness evaluation processes vary based on setting, with court-ordered evaluations having strict timelines
• Three main pathways to incarceration: substance use disorders, traumatic brain injuries, and untreated mental illness
• America's largest jails have become de facto psychiatric hospitals, which Dr. Biswas calls "a human rights violation"
• Currently championing two legislative reforms in Massachusetts: the Timely Treatment Bill and Critical Community Services Bill
• Mental illness is treatable but often cyclical, requiring consistent medication and support
• When people suffer from psychotic disorders, they often lose insight into their condition, making treatment refusal a symptom rather than a choice
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to why Not Me ?
The World podcast, hosted byTony Mantor, broadcasting from
Music City, usa, nashville,tennessee.
Join us as our guests tell ustheir stories.
Some will make you laugh, somewill make you cry.
Their stories Some will makeyou laugh, some will make you
(00:28):
cry.
Real life people who willinspire and show that you are
not alone in this world.
Hopefully, you gain moreawareness, acceptance and a
better understanding for autismaround the world.
Hi, I'm Tony Mantor.
(00:53):
Welcome to why Not Me?
The World Humanity OverHandcuffs the Silent Crisis
special event.
Today we're joined by Dr JillamBiswas, a board-certified adult
and forensic psychiatrist.
She is the director of thePsychiatry Law and Society
program at Brigham and Women'sHospital and co-director of the
(01:15):
Harvard Mass General BrighamForensic Psychiatry Fellowship.
She chairs and contributes tonumerous psychiatric, forensic
and medical committees at bothstate and national levels.
Her research focuses onimproving mental health laws to
better support patients andfamilies, while advancing
criminal justice reform.
With her expertise in mentalillness risk assessment and more
(01:38):
, we're thrilled to have hershare her insights with us today
.
Thanks for coming on, thank you, I think you're doing such a
huge service.
Thanks for your kind words.
I really appreciate you takingthe time to be with us today.
It's truly inspiring to seeyour impact as a mental health
advocate and your leadershipacross various boards.
Can you share with us yourjourney and how you reached this
(02:00):
point in your career?
Speaker 2 (02:02):
A lot of what I've done is research.
So I worked at a forensichospital for many years and I
realized that it was very hardto get the courts to allow us to
provide medications forpsychotic illness in time if
somebody didn't have the insightinto knowing that they needed
it.
So what we ended up doing and Iwas the principal investigator
(02:25):
in this research project is ittook years to get all the
agencies to sign off on doing aresearch study in the carceral
setting on mental illness.
But what I did in the forensichospital this is all those
individuals you're talking aboutwith mental illness, but also a
lot of my patients did have anautism diagnosis Not all of them
(02:47):
, but certainly we do see acorrelation of individuals with
autism who might have a comorbid, serious mental illness like
bipolar disorder orschizophrenia or PTSD.
You know, because what happenswhen you have autism and you're
having difficulty with socialcues and having difficulty with
(03:07):
reading social situations?
It can't.
It just makes you morevulnerable to fall into
difficult situations meeting upwith law enforcement law
enforcement not necessarilyreading you right or reading you
well and it resulting insomething that's much bigger or
spiraling out of control.
(03:28):
And so a lot of times when Iwas working at the forensic
hospital in Massachusetts.
These individuals would havemental illness, but also have
this diagnosis of autism andalso a diagnosis of traumatic
brain injury.
That was another really commonthing that I would see in
individuals, and so we did aresearch study, because one of
the biggest issues that I foundin forensic hospitals and
(03:50):
working in the incarcerated, ina system with patients who are
incarcerated, is that it's verydifficult to get standing doses
of treatment for them.
Speaker 1 (04:00):
So, going over everything that you've done so
far, what was your next step tofinding more information?
Speaker 2 (04:07):
So we ran a study and we showed all of these
different adverse events thatoccur while we're waiting for
the courts to allow us to givetreatment, and those adverse
events you know were likepatient on patient assaults,
patient on staff assaults,climate incidences where you
know the individual is eithervictimized by others or, you
(04:29):
know, throwing things orbreaking things in the unit and
really just causing a lot ofdisruption.
And so what ends up happeningwith these delays to treatment
in carceral settings or forensichospitals and actually in
Massachusetts we see it even inour acute care settings is it's
not a healing environmentnecessarily for people.
Speaker 1 (04:50):
Can you expand on why that is?
Speaker 2 (04:52):
Because the other people are so sick around them,
or they themselves are so sickand there's this delay to care.
So anyway, all that to say, wedid this research study.
We found that when we doprovide treatment to individuals
in forensic hospitals, thingsimprove dramatically and these
adverse events decreasedramatically.
Actually, I'm going to bepresident of the Massachusetts
(05:15):
Psychiatric Society in April.
Speaker 1 (05:17):
Wow, that's awesome.
Speaker 2 (05:19):
Yeah, and I'm working with a group of other
organizations to really helpchange some of the laws in
Massachusetts to bring time.
It's called the timely treatmentbill and we're trying to bring
better psychiatric care topeople in inpatient settings and
in forensic hospitals and inprison settings antipsychotic
treatment when they havepsychotic illness.
(05:41):
The other thing we're doing andAnne Cochran, I know, connected
me to you for this is what myhope is is, rather than having
people get care in these lockedsettings, really bring that
level of care to the communitythrough assisted outpatient
treatment and wraparoundservices.
Individuals with autismdefinitely have a higher
comorbidity of serious mentalillness, but also are in
(06:05):
proximity to others with seriousmental illness due to living in
group homes or living invarious institutions with people
with serious mental illness.
And getting timely treatment tothese individuals, rather than
these delays to care, I thinkit's key to keeping individuals
with serious mental illness inthe community and with family
(06:25):
members and reducing sort of thehigh burden that caregivers
feel, I think, in providing carefor their loved ones who have
serious mental illness andcomorbid autism.
Speaker 1 (06:38):
When do you get involved with a patient that's
been incarcerated?
Do you step in before theyenter the court system, or only
after they're already in it?
Speaker 2 (06:48):
Yeah.
So when working in a forensichospital, they need charges.
They need criminal chargesactually to be in the forensic
system and then the court willhave clinicians within the court
determine you know what thisperson needs a higher level of
care and they'll get divertedinto a forensic hospital and
(07:09):
that's where we see them asforensic psychiatrists providing
care in that setting.
However, now I don't work in aforensic hospital.
I actually work in a regularacademic hospital in Boston
called Brigham and Women'sHospital and I still see a lot
of forensic issues that come upin the hospital setting.
(07:30):
You know people with criminalcharges who are needing medical
care but then also have apsychiatric illness.
We see it also in our inpatientpsychiatric units.
I also have a private practicecalled Psych Expertise where I
do evaluations for the court,for attorneys, for organizations
that may need a mental healthevaluation, for an employee, or
(07:51):
a school may need a mentalhealth evaluation for somebody
who might have been suspendeddue to some issue and then turns
out there's a mental illnessinvolved and we need to know
that it's treated in order forthem to come back to school.
So I end up in a lot ofdifferent situations thinking
about how did this person get introuble.
In which context did thisperson get in trouble?
Is it related to their mentalillness or their autism
(08:13):
diagnosis?
And how do I providerecommendations for them to
return safely into whateverinstitution that wants to have
them back?
And how do we do that?
Well, I also have doneevaluations for people who are
in a forensic hospital or a jailand then are going back into
the community.
How do we keep that individualsafe in the community with
(08:34):
services, so that they don't endup in this cycle of
incarceration?
So what ends up happening isbasically, I just think of
myself as giving mental healthconsultation to various social
systems, whatever they may be,because all of our social
systems are interacting withpeople with mental health issues
.
Speaker 1 (08:53):
When someone comes to you tells you they need someone
evaluated, what is thatevaluation process entail?
Speaker 2 (09:00):
Great question, the evaluation process.
I think, if I were to drill itdown, it's a psychiatric
evaluation.
A psychiatrist is a medicaldoctor.
We go through medical schooland we do a psychiatry residency
and then we have a subspecialtyin understanding how people
with mental illness may interactwith the law.
And so I use a lot of mytraining and experience to do an
(09:22):
evaluation.
But a lot of what I'm doing islooking at the psychological
factors, biological factors,environmental factors and social
factors, social determinants ofhealth that may have resulted
in the illness that I'm seeing.
And how do we intervene in allof those various factors so that
(09:43):
individual can be stabilizedfrom their crisis and then be
maintained in a lower level ofcare or in the community?
And the way that I do that is Iget a very deep social history,
developmental history,substance use history, mental
illness history, medical history, legal, you know, like there's
(10:04):
a lot of ways to get all thishistory and then we use all the
components that we have kind ofsussed out in the examination to
describe what we're seeing.
Speaker 1 (10:14):
Once you determine what you think is happening,
what is the next step after that?
Speaker 2 (10:21):
So the next step, after kind of thinking about
what is happening, you make adiagnosis.
If a diagnosis is available tomake or not, you can make a
diagnosis.
Sometimes it requires moretesting, depending on what the
issues we're seeing.
Sometimes it's a deep dive intothe past medical history and
legal history or, if it's a case, kind of going into the you
(10:44):
know the components of the courtcase and making a clinical
opinion on that diagnosis.
So saying there's thisdiagnosis and in my clinical
opinion this is what we need todo next.
And then in that clinicalopinion we offer treatment
recommendations also.
Speaker 1 (11:03):
How long does it take from the initial meeting with a
patient to assessing theircondition, making a diagnosis
and prescribing medications orother treatments they might need
to move forward?
Speaker 2 (11:16):
So it happens on a case-by-case basis.
It really depends on the storyand it really depends on the
situation.
Some stories are really hard tofigure out.
You know, somebody might bevery high, functioning and
they're living a very you knowfunctional life, but there's
just a missing link that resultsin a bad situation or a bad
outcome.
(11:37):
It may take a deep dive intothe history, doing interviews
with family members and friendsand institutions that they're
part of their caregivers, theirtreatment providers, and so that
can take some time.
The other thing I always sayabout a psychiatric diagnosis is
it's hard to make a diagnosisof psychiatric illness in one
(11:58):
snapshot.
You really need multipleevaluations and you need to see
someone over time or you need tobe able to retrospectively or
look backwards into theirhistory and say, okay, this is
what they looked like at thispoint in time and this point in
time, and then, through thatpattern, you can really say what
(12:19):
that diagnosis is.
All psychiatric diagnosesactually do need to occur over a
period of time and cannotreally just happen for one day
to get a diagnosis.
Speaker 1 (12:31):
When you're involved with the legal system and the
court requests an evaluation ofan individual, do they provide
enough time to conduct athorough assessment?
This would help explain why theperson acted as they did,
allowing the court to make an orthe necessary actions that they
(12:52):
may need to continue.
Speaker 2 (12:54):
Yeah, I mean, I think that's a great question.
So I think differentevaluations require different
periods of time.
It depends on the decision thatthe court is making.
One decision the court willmake is let's say, somebody
comes off the street after anassault and battery.
There's just some obviousmental illness signs that the
court is seeing like the personis not making sense, they're
confused, they're disheveled,their hygiene is bad.
(13:18):
You know they're talking tothemselves.
That's kind of a quick and dirtysnapshot view that someone in
Massachusetts we call them courtclinicians.
There are psychologists andsocial workers at every court
that will do a quick and dirtyevaluation and say, look, this
person needs a longer mentalhealth evaluation versus you
know what.
They can actually have theirday in court.
(13:39):
They can get arraigned, theycan go to a jail setting for a
pretrial period.
There is an evaluation that'sdone within the day in that
setting.
Then if there needs to be alonger evaluation, by statute in
Massachusetts law, in theMassachusetts general laws, it's
chapter 123.
We have lots of differentstatutes that describe how much
(14:00):
time you'll have to do apsychiatric, a forensic
psychiatric or psychologicalevaluation and once someone ends
up in a forensic hospital fromthe courts you have 20 days to
do that evaluation and then makea determination of whether they
need to stay in the hospital orif they can kind of go back
into the jail setting.
So that's what we see in theforensic setting.
However, a lot of situationsthe courts will allow the person
(14:23):
to go right back into thecommunity and have the
evaluation done in the community.
Now, as a private forensicpsychiatrist, I will do those
evaluations out in the communityover longer periods of time.
Or if someone's been able topay bail, they will be out to
have those evaluations done outin the community.
So it just sort of dependswhere the person ends up and
what their history is.
(14:44):
That determines how long wehave to do those evaluations.
Speaker 1 (14:48):
When you conduct an evaluation and propose a
hypothetical treatment plan, butthe individual is placed back
in an environment where theyregress, how do you support them
to regain stability?
If time constraints orunaddressed issues lead to new
challenges surfacing, how isthat situation managed to help
(15:09):
them get back on track?
Speaker 2 (15:12):
It's a big piece of detective work.
I think Every puzzle isdifferent and you have to put
the pieces of the puzzletogether to figure out what's
going on.
It depends on the kind ofmental illness we're seeing.
You know, if it's somebody withautism spectrum disorder, they
may be able to articulateeverything that's going on.
They're connected to theirfamily members.
We'll have direct contact witheverybody.
(15:33):
They will have some insightinto what their issues are and
we'll be able to provide careand treatment more quickly.
What I often will see withpeople with serious mental
illness, like a psychoticdisorder whether it's resulting
from schizophrenia spectrumdisorder or from bipolar
disorder or from substance usethat then causes a psychotic
(15:54):
disorder those are often thethree big pathways in which we
see a psychotic illness.
Those individuals might not havea lot of insight into what's
going on and will be.
You know, one of the symptoms ofpsychosis may be that they
don't have insight, they're notengaging in care and treatment
and they don't want treatment.
At that point we really do needto get the courts involved to
(16:15):
help us provide some psychiatrictreatment, which we call you
know there's various names forit, but we call them
antipsychotic medications thatevery state has laws around in
order to provide that care in away where the individual doesn't
have insight that they need thecare, and so it ends up being
somewhat compulsory, right, butwe need the court to mandate
(16:37):
that, and in those situations,they can just take a lot longer
because there's so manyprocedural hurdles.
And we need to protect the dueprocess, obviously, of the
patient themselves, especiallyif they are refusing treatment
and they do have insight.
And you know we're just missingsomething.
Certainly, due process isimportant, but the problem with
(16:58):
due process currently is ourcourt systems take a really long
time to hear the cases, and sothat's what my research showed.
In one of the forensichospitals in Massachusetts, it
took up to 61 days to getmedications to an individual who
had acute psychosis, which iswhy I have worked with multiple
other organizations theMassachusetts Behavioral Health
(17:20):
Services Organization to bring abill to the Massachusetts
legislature called the TimelyTreatment Bill.
Speaker 1 (17:27):
Can you expand on this bill that you brought to
the legislators and what it does?
Speaker 2 (17:32):
More timely medications to people with
psychotic illness, because rightnow in Massachusetts and I know
in other states because I talkto psychiatrists everywhere this
is a huge issue.
We cannot get care toindividuals with serious mental
illness who have an insightproblem, who can't tell that
they're ill, and that's a verycommon problem among people with
(17:53):
psychosis and that I do thinkresults is a multifactorial, but
it is a factor that results inthis cycle of homelessness and
incarceration, because if you'recoming off your meds and you
become sick and no one ismonitoring you and you don't
have ties to care and you'veburned bridges with your
caregivers, you do end up inthis cycle of losing your
housing, ending up on thestreets using substances, ending
(18:17):
up with head injuries and thenthat is this downward spiral
into interactions with lawenforcement and crime and then
ending up in the carceral system.
One of my deep sadnesses is thefact that some of our largest
jails in the country LA,chicago's, cook County and New
York Rikers are some of thebiggest psychiatric hospitals in
(18:38):
our country and that shouldn'tbe the case.
I think that's a human rightsviolation to have our carceral
systems provide psychiatric care.
Speaker 1 (18:46):
Yes, I've heard that the prisons are exactly that the
largest psychiatric hospitalsin the country, and it's up to
them to take care of them.
Speaker 2 (19:01):
And they really don't know how to take care of them,
which ultimately create moreissues Exactly, and so it is
important in those settings toreally get a forensic
psychiatrist to do an evaluationand provide recommendations.
It's very sad that so manypeople with mental illness do
end up in the carceral system.
But just having thatpsychiatric evaluation that
follows them, that people canread and say, oh, this person
has this diagnosis, oh, this isthis person's history, these are
(19:24):
the medications that might behelpful, or here are some ways
this individual can cope withtheir mental illness, that is
such an important report to havefor that individual and to have
that level of psychiatricanalysis done for that
individual who's in the carceralsystem, I really think that
that's so important.
Speaker 1 (19:44):
Many prisons aren't equipped to handle inmates with
mental illness or medicationneeds.
Guards often lack training torecognize these issues, mistaken
genuine distress for defiance.
This can lead to inmates beingdenied proper medication,
escalating problems and endingup in solitary confinement.
(20:04):
How do we create a bettersystem so that some of these
people don't fall through thecracks and wind up in places
they don't need to be, becauseit may just be a medication
issue rather than a personalityissue?
What do we need to do?
Speaker 2 (20:20):
This is such an important question.
It's one I personally strugglewith every day and think about
every day, because I think thereare some key things to educate
society about when it comes tomental illness and how people
end up in the criminal justicesystem.
(20:41):
One is substance use is likeone of the biggest issues that
results in violent behavior andthen results in someone with
mental illness or substance usedisorder to be incarcerated this
impulsive behavior that comesfrom substance use.
Another is traumatic braininjury.
Traumatic brain injury is areally big deal in the United
States.
(21:01):
People end up with concussionsand a series of concussions over
the course of their life,through sports, through fights,
through lots of different caraccidents.
This is an issue and it doesactually cause people to have
personality changes, to becomemore impulsive, to not
(21:22):
necessarily pick up on allsocial cues or to self-medicate
with substances their symptomsthat they're experiencing.
So that's another way where wesee violent behavior.
And, lastly, we see a lot ofviolent behavior when someone
has mental illness that isuntreated untreated mental
illness that results in a lackof insight and self-awareness
that somebody is ill.
(21:43):
That is the third way I thinkpeople do end up in the carceral
system due to having a mentalhealth issue and we know that as
psychiatrists.
When I'm doing that evaluationI know I see those factors and
those are three things we coulddivert back into the community
and provide intensive treatmentfor and help society understand,
look, that treatment might needto be mandated for a short
(22:06):
period of time until that persondevelops insight.
That's gonna be the way to keeppeople in the community.
But there are a lot of littleproblems we end up along the way
in being able to provide thatlevel of care.
I think in the United Statesand I think that is resulting in
a carceral system problem ofmental illness.
(22:26):
We need that medication,treatment and the therapy that
goes along with it, and housingthat goes along with it and
occupational therapy andphysical therapy that goes along
with it to be in the community.
And the community needs to havea deeper understanding of what
causes violence impulsiveviolence in individuals, not
necessarily premeditatedviolence.
Speaker 1 (22:45):
Now you said that you were involved in some type of
legislation.
Yes you were involved in sometype of legislation.
Yes, what type of legislationare you trying to get changed or
improved upon?
That needs to be under themicroscope and you think is just
really, really important?
Speaker 2 (23:02):
Yes, very important.
So different states end up withdifferent sets of issues that
result in the same problem,which is people with mental
illness end up incarcerated.
And in Massachusetts, I have tosay, we have the lowest number
of incarcerated individuals likerate of incarcerated
individuals in the country.
So not in terms of numbers butin terms of the rate of
(23:24):
incarceration, we had the lowestamount.
However, those who areincarcerated are more likely to
be mentally ill in Massachusettsand our judges have done a
great job of creating newstandards in Massachusetts that
they recently updated in 2024 toreally think about mental
illness as one of the thingsthey consider when they're
(23:46):
looking into a case.
And I was just involved in oneof their annual meetings and
provided some mental healtheducation at their annual
meeting because they're reallylooking into this issue.
But what I think is an issue inMassachusetts is that we're a
very rights-driven state wheretreatment is important, but to
(24:08):
maintain someone's rights torefuse medication is it takes
precedence in Massachusetts.
It's not the case in all states, but a lot of states do follow
the same thought process andwhile I think that's absolutely
important for people withdisabilities to have all of
their rights intact, whatsometimes happens is these
(24:30):
individuals in maintaining theirrights to stay off medications
and not get mandated treatment,they end up in the carceral
system because they end up in aviolent situation and then end
up in the carceral system withcriminal charges.
And so in Massachusetts, twothings we need to do to do we
(24:52):
don't have any assistedoutpatient treatment laws and we
do have one filed with thelegislature right now at the
statehouse, called the CriticalCommunity Services Bill that
we've just refiled in January tohelp us bring this level of
intensive psychiatric treatmentinto the community rather than
just in locked psychiatric units.
Speaker 1 (25:10):
That sounds like a great piece of legislation.
What do you see coming out ofthis?
Speaker 2 (25:16):
The hope is we can provide antipsychotic
medications to someone withserious mental illness and a
psychotic disorder in thecommunity, monitored, while
giving them all the otherservices.
They need to stay in thecommunity and the other thing
that we are trying to do inMassachusetts we have this
timely treatment bill that'salso in the legislature that we
(25:37):
just refiled in January toreduce that time that it takes
for the court hearing to happenin order to get medications to
an individual who has apsychotic disorder, is lacking
insight and is refusing care andtherefore has ended up in this
cycle of needing multiplehospitalizations or ending up
homeless, or ending up withmultiple criminal charges and in
(26:01):
the jail system.
Right now we have no safetynets in either of those two
spaces to provide medicationtreatment for people with
psychotic disorders inMassachusetts.
So those are the two bills thatI'm really hoping we can push
during the time that I ampresident of the Massachusetts
Psychiatric Society.
So that's one of my goals.
But what I will say is this is anationwide problem In the
(26:25):
nation, every state, whetherthey have those AOT laws,
assisted outpatient treatmentlaws or timely treatment laws in
the inpatient settings.
Sometimes they have majorstaffing shortages.
They don't have psychiatriccare necessarily available very
quickly, or they don't have thepsychiatric beds or they don't
have the wraparound servicesneeded in the community to keep
(26:46):
people off the street and in ashelter system with
psychotherapy, with other typesof community services needed for
people with serious mentalillness.
So every state has saw aversion of this problem.
Speaker 1 (26:59):
It seems that if you get this passed through, this
would be a good bill to take tothe House and try and make it
national.
Speaker 2 (27:07):
Yeah, I mean, I think what has happened is this issue
has become a state-by-statebasis issue and every state
makes their mental health lawsand their determinations of how
they're going to manage peoplewith mental illness.
You know, the hope is what theSupreme Court does is give the
bottom.
This is what you have to do,but states can have a higher
(27:43):
level of scrutiny than what theSupreme Court deems to be needed
.
That is a really importantlegislation to pass, I think, at
a national level to reallyrecognize this as an issue, that
this cycle of homelessness,constant psychiatric
hospitalizations and criminaljustice interactions is a result
of individuals with mentalillness either remaining
(28:04):
untreated or self-medicatingwith substances, also having
these other morbidities likeautism or traumatic brain injury
or other types of personalitydisorders.
They all play a role.
Speaker 1 (28:16):
Yeah, I definitely agree.
Now, what would you like totell the listeners that you
think they really need to knowabout what you're doing and, of
course, what you're trying to dowith legislation?
Speaker 2 (28:29):
That's a great question.
Serious mental illness istreatable.
Symptoms of autism can bealleviated with really good
therapy.
We do have treatments available.
Serious mental illness is awaxing and waning illness.
It can come back.
It's not necessarily curableand so people need to stay on
(28:50):
medications to stay well.
One of the issues we see withserious mental illness, which is
a biological illness it's adisease like any other disease
that we see in other organs inthe body needs maintenance and
needs treatment.
It doesn't just go away I meanit can for a period of time, but
(29:12):
it comes back, and when itcomes back it's unpredictable.
What I really want people tounderstand is when people can
get very sick from mentalillness.
They can lose insight intotheir well-being, into their
self-awareness and into realityin general, and that experience
a lot of times can be verydistressing.
(29:32):
So, even though if a person istelling you they don't want
treatment or they're not able togive you a very clear decision
of what they want, part of thatis the illness itself.
Part of that is the distress,the emotional distress that
they're experiencing from beingin psychotic illness.
And so, even though it feelssometimes really wrong to
(29:54):
provide psychiatric care to anindividual when they're refusing
it.
You can actually restore theirwellbeing and dignity much
faster with medications and Ithink we really need to
understand that and there's alot of resistance to that
understanding of mental illness,I think, in this country.
Speaker 1 (30:13):
Yeah, well, this has been a great conversation, great
information.
I really appreciate you comingon.
Speaker 2 (30:19):
Absolutely.
I really appreciate you havingme.
Thank you.
Speaker 1 (30:22):
It's been my pleasure .
Thanks again.
Thanks for taking the time outof your busy schedule to listen
to our show today.
We hope that you enjoyed it asmuch as we enjoyed bringing it
to you.
If you know anyone that wouldlike to tell us their story,
(30:45):
send them to TonyMantorcomContact then they can give us
their information so one daythey may be a guest on our show.
One more thing we ask telleveryone everywhere about why
Not Me, the world, theconversations we're having and
(31:06):
the inspiration our guests giveto everyone everywhere that you
are not alone in this world.
Welcome to why Not Me ?
The World podcast, hosted byTony Mantor, broadcasting from
Music City, usa, nashville,tennessee.
Join us as our guests tell ustheir stories.
Some will make you laugh, somewill make you cry.
Their stories Some will makeyou laugh, some will make you
(00:28):
cry.
Real life people who willinspire and show that you are
not alone in this world.
Hopefully, you gain moreawareness, acceptance and a
better understanding for autismaround the world.
Hi, I'm Tony Mantor.
(00:53):
Welcome to why Not Me?
The World Humanity OverHandcuffs the Silent Crisis
special event.
Today we're joined by Dr JillamBiswas, a board-certified adult
and forensic psychiatrist.
She is the director of thePsychiatry Law and Society
program at Brigham and Women'sHospital and co-director of the
(01:15):
Harvard Mass General BrighamForensic Psychiatry Fellowship.
She chairs and contributes tonumerous psychiatric, forensic
and medical committees at bothstate and national levels.
Her research focuses onimproving mental health laws to
better support patients andfamilies, while advancing
criminal justice reform.
With her expertise in mentalillness risk assessment and more
(01:38):
, we're thrilled to have hershare her insights with us today
.
Thanks for coming on, thank you, I think you're doing such a
huge service.
Thanks for your kind words.
I really appreciate you takingthe time to be with us today.
It's truly inspiring to seeyour impact as a mental health
advocate and your leadershipacross various boards.
Can you share with us yourjourney and how you reached this
(02:00):
point in your career?
Speaker 2 (02:02):
A lot of what I've done is research.
So I worked at a forensichospital for many years and I
realized that it was very hardto get the courts to allow us to
provide medications forpsychotic illness in time if
somebody didn't have the insightinto knowing that they needed
it.
So what we ended up doing and Iwas the principal investigator
(02:25):
in this research project is ittook years to get all the
agencies to sign off on doing aresearch study in the carceral
setting on mental illness.
But what I did in the forensichospital this is all those
individuals you're talking aboutwith mental illness, but also a
lot of my patients did have anautism diagnosis Not all of them
(02:47):
, but certainly we do see acorrelation of individuals with
autism who might have a comorbid, serious mental illness like
bipolar disorder orschizophrenia or PTSD.
You know, because what happenswhen you have autism and you're
having difficulty with socialcues and having difficulty with
(03:07):
reading social situations?
It can't.
It just makes you morevulnerable to fall into
difficult situations meeting upwith law enforcement law
enforcement not necessarilyreading you right or reading you
well and it resulting insomething that's much bigger or
spiraling out of control.
(03:28):
And so a lot of times when Iwas working at the forensic
hospital in Massachusetts.
These individuals would havemental illness, but also have
this diagnosis of autism andalso a diagnosis of traumatic
brain injury.
That was another really commonthing that I would see in
individuals, and so we did aresearch study, because one of
the biggest issues that I foundin forensic hospitals and
(03:50):
working in the incarcerated, ina system with patients who are
incarcerated, is that it's verydifficult to get standing doses
of treatment for them.
Speaker 1 (04:00):
So, going over everything that you've done so
far, what was your next step tofinding more information?
Speaker 2 (04:07):
So we ran a study and we showed all of these
different adverse events thatoccur while we're waiting for
the courts to allow us to givetreatment, and those adverse
events you know were likepatient on patient assaults,
patient on staff assaults,climate incidences where you
know the individual is eithervictimized by others or, you
(04:29):
know, throwing things orbreaking things in the unit and
really just causing a lot ofdisruption.
And so what ends up happeningwith these delays to treatment
in carceral settings or forensichospitals and actually in
Massachusetts we see it even inour acute care settings is it's
not a healing environmentnecessarily for people.
Speaker 1 (04:50):
Can you expand on why that is?
Speaker 2 (04:52):
Because the other people are so sick around them,
or they themselves are so sickand there's this delay to care.
So anyway, all that to say, wedid this research study.
We found that when we doprovide treatment to individuals
in forensic hospitals, thingsimprove dramatically and these
adverse events decreasedramatically.
Actually, I'm going to bepresident of the Massachusetts
(05:15):
Psychiatric Society in April.
Speaker 1 (05:17):
Wow, that's awesome.
Speaker 2 (05:19):
Yeah, and I'm working with a group of other
organizations to really helpchange some of the laws in
Massachusetts to bring time.
It's called the timely treatmentbill and we're trying to bring
better psychiatric care topeople in inpatient settings and
in forensic hospitals and inprison settings antipsychotic
treatment when they havepsychotic illness.
(05:41):
The other thing we're doing andAnne Cochran, I know, connected
me to you for this is what myhope is is, rather than having
people get care in these lockedsettings, really bring that
level of care to the communitythrough assisted outpatient
treatment and wraparoundservices.
Individuals with autismdefinitely have a higher
comorbidity of serious mentalillness, but also are in
(06:05):
proximity to others with seriousmental illness due to living in
group homes or living invarious institutions with people
with serious mental illness.
And getting timely treatment tothese individuals, rather than
these delays to care, I thinkit's key to keeping individuals
with serious mental illness inthe community and with family
(06:25):
members and reducing sort of thehigh burden that caregivers
feel, I think, in providing carefor their loved ones who have
serious mental illness andcomorbid autism.
Speaker 1 (06:38):
When do you get involved with a patient that's
been incarcerated?
Do you step in before theyenter the court system, or only
after they're already in it?
Speaker 2 (06:48):
Yeah.
So when working in a forensichospital, they need charges.
They need criminal chargesactually to be in the forensic
system and then the court willhave clinicians within the court
determine you know what thisperson needs a higher level of
care and they'll get divertedinto a forensic hospital and
(07:09):
that's where we see them asforensic psychiatrists providing
care in that setting.
However, now I don't work in aforensic hospital.
I actually work in a regularacademic hospital in Boston
called Brigham and Women'sHospital and I still see a lot
of forensic issues that come upin the hospital setting.
(07:30):
You know people with criminalcharges who are needing medical
care but then also have apsychiatric illness.
We see it also in our inpatientpsychiatric units.
I also have a private practicecalled Psych Expertise where I
do evaluations for the court,for attorneys, for organizations
that may need a mental healthevaluation, for an employee, or
(07:51):
a school may need a mentalhealth evaluation for somebody
who might have been suspendeddue to some issue and then turns
out there's a mental illnessinvolved and we need to know
that it's treated in order forthem to come back to school.
So I end up in a lot ofdifferent situations thinking
about how did this person get introuble.
In which context did thisperson get in trouble?
Is it related to their mentalillness or their autism
(08:13):
diagnosis?
And how do I providerecommendations for them to
return safely into whateverinstitution that wants to have
them back?
And how do we do that?
Well, I also have doneevaluations for people who are
in a forensic hospital or a jailand then are going back into
the community.
How do we keep that individualsafe in the community with
(08:34):
services, so that they don't endup in this cycle of
incarceration?
So what ends up happening isbasically, I just think of
myself as giving mental healthconsultation to various social
systems, whatever they may be,because all of our social
systems are interacting withpeople with mental health issues
.
Speaker 1 (08:53):
When someone comes to you tells you they need someone
evaluated, what is thatevaluation process entail?
Speaker 2 (09:00):
Great question, the evaluation process.
I think, if I were to drill itdown, it's a psychiatric
evaluation.
A psychiatrist is a medicaldoctor.
We go through medical schooland we do a psychiatry residency
and then we have a subspecialtyin understanding how people
with mental illness may interactwith the law.
And so I use a lot of mytraining and experience to do an
(09:22):
evaluation.
But a lot of what I'm doing islooking at the psychological
factors, biological factors,environmental factors and social
factors, social determinants ofhealth that may have resulted
in the illness that I'm seeing.
And how do we intervene in allof those various factors so that
(09:43):
individual can be stabilizedfrom their crisis and then be
maintained in a lower level ofcare or in the community?
And the way that I do that is Iget a very deep social history,
developmental history,substance use history, mental
illness history, medical history, legal, you know, like there's
(10:04):
a lot of ways to get all thishistory and then we use all the
components that we have kind ofsussed out in the examination to
describe what we're seeing.
Speaker 1 (10:14):
Once you determine what you think is happening,
what is the next step after that?
Speaker 2 (10:21):
So the next step, after kind of thinking about
what is happening, you make adiagnosis.
If a diagnosis is available tomake or not, you can make a
diagnosis.
Sometimes it requires moretesting, depending on what the
issues we're seeing.
Sometimes it's a deep dive intothe past medical history and
legal history or, if it's a case, kind of going into the you
(10:44):
know the components of the courtcase and making a clinical
opinion on that diagnosis.
So saying there's thisdiagnosis and in my clinical
opinion this is what we need todo next.
And then in that clinicalopinion we offer treatment
recommendations also.
Speaker 1 (11:03):
How long does it take from the initial meeting with a
patient to assessing theircondition, making a diagnosis
and prescribing medications orother treatments they might need
to move forward?
Speaker 2 (11:16):
So it happens on a case-by-case basis.
It really depends on the storyand it really depends on the
situation.
Some stories are really hard tofigure out.
You know, somebody might bevery high, functioning and
they're living a very you knowfunctional life, but there's
just a missing link that resultsin a bad situation or a bad
outcome.
(11:37):
It may take a deep dive intothe history, doing interviews
with family members and friendsand institutions that they're
part of their caregivers, theirtreatment providers, and so that
can take some time.
The other thing I always sayabout a psychiatric diagnosis is
it's hard to make a diagnosisof psychiatric illness in one
(11:58):
snapshot.
You really need multipleevaluations and you need to see
someone over time or you need tobe able to retrospectively or
look backwards into theirhistory and say, okay, this is
what they looked like at thispoint in time and this point in
time, and then, through thatpattern, you can really say what
(12:19):
that diagnosis is.
All psychiatric diagnosesactually do need to occur over a
period of time and cannotreally just happen for one day
to get a diagnosis.
Speaker 1 (12:31):
When you're involved with the legal system and the
court requests an evaluation ofan individual, do they provide
enough time to conduct athorough assessment?
This would help explain why theperson acted as they did,
allowing the court to make an orthe necessary actions that they
(12:52):
may need to continue.
Speaker 2 (12:54):
Yeah, I mean, I think that's a great question.
So I think differentevaluations require different
periods of time.
It depends on the decision thatthe court is making.
One decision the court willmake is let's say, somebody
comes off the street after anassault and battery.
There's just some obviousmental illness signs that the
court is seeing like the personis not making sense, they're
confused, they're disheveled,their hygiene is bad.
(13:18):
You know they're talking tothemselves.
That's kind of a quick and dirtysnapshot view that someone in
Massachusetts we call them courtclinicians.
There are psychologists andsocial workers at every court
that will do a quick and dirtyevaluation and say, look, this
person needs a longer mentalhealth evaluation versus you
know what.
They can actually have theirday in court.
(13:39):
They can get arraigned, theycan go to a jail setting for a
pretrial period.
There is an evaluation that'sdone within the day in that
setting.
Then if there needs to be alonger evaluation, by statute in
Massachusetts law, in theMassachusetts general laws, it's
chapter 123.
We have lots of differentstatutes that describe how much
(14:00):
time you'll have to do apsychiatric, a forensic
psychiatric or psychologicalevaluation and once someone ends
up in a forensic hospital fromthe courts you have 20 days to
do that evaluation and then makea determination of whether they
need to stay in the hospital orif they can kind of go back
into the jail setting.
So that's what we see in theforensic setting.
However, a lot of situationsthe courts will allow the person
(14:23):
to go right back into thecommunity and have the
evaluation done in the community.
Now, as a private forensicpsychiatrist, I will do those
evaluations out in the communityover longer periods of time.
Or if someone's been able topay bail, they will be out to
have those evaluations done outin the community.
So it just sort of dependswhere the person ends up and
what their history is.
(14:44):
That determines how long wehave to do those evaluations.
Speaker 1 (14:48):
When you conduct an evaluation and propose a
hypothetical treatment plan, butthe individual is placed back
in an environment where theyregress, how do you support them
to regain stability?
If time constraints orunaddressed issues lead to new
challenges surfacing, how isthat situation managed to help
(15:09):
them get back on track?
Speaker 2 (15:12):
It's a big piece of detective work.
I think Every puzzle isdifferent and you have to put
the pieces of the puzzletogether to figure out what's
going on.
It depends on the kind ofmental illness we're seeing.
You know, if it's somebody withautism spectrum disorder, they
may be able to articulateeverything that's going on.
They're connected to theirfamily members.
We'll have direct contact witheverybody.
(15:33):
They will have some insightinto what their issues are and
we'll be able to provide careand treatment more quickly.
What I often will see withpeople with serious mental
illness, like a psychoticdisorder whether it's resulting
from schizophrenia spectrumdisorder or from bipolar
disorder or from substance usethat then causes a psychotic
(15:54):
disorder those are often thethree big pathways in which we
see a psychotic illness.
Those individuals might not havea lot of insight into what's
going on and will be.
You know, one of the symptoms ofpsychosis may be that they
don't have insight, they're notengaging in care and treatment
and they don't want treatment.
At that point we really do needto get the courts involved to
(16:15):
help us provide some psychiatrictreatment, which we call you
know there's various names forit, but we call them
antipsychotic medications thatevery state has laws around in
order to provide that care in away where the individual doesn't
have insight that they need thecare, and so it ends up being
somewhat compulsory, right, butwe need the court to mandate
(16:37):
that, and in those situations,they can just take a lot longer
because there's so manyprocedural hurdles.
And we need to protect the dueprocess, obviously, of the
patient themselves, especiallyif they are refusing treatment
and they do have insight.
And you know we're just missingsomething.
Certainly, due process isimportant, but the problem with
(16:58):
due process currently is ourcourt systems take a really long
time to hear the cases, and sothat's what my research showed.
In one of the forensichospitals in Massachusetts, it
took up to 61 days to getmedications to an individual who
had acute psychosis, which iswhy I have worked with multiple
other organizations theMassachusetts Behavioral Health
(17:20):
Services Organization to bring abill to the Massachusetts
legislature called the TimelyTreatment Bill.
Speaker 1 (17:27):
Can you expand on this bill that you brought to
the legislators and what it does?
Speaker 2 (17:32):
More timely medications to people with
psychotic illness, because rightnow in Massachusetts and I know
in other states because I talkto psychiatrists everywhere this
is a huge issue.
We cannot get care toindividuals with serious mental
illness who have an insightproblem, who can't tell that
they're ill, and that's a verycommon problem among people with
(17:53):
psychosis and that I do thinkresults is a multifactorial, but
it is a factor that results inthis cycle of homelessness and
incarceration, because if you'recoming off your meds and you
become sick and no one ismonitoring you and you don't
have ties to care and you'veburned bridges with your
caregivers, you do end up inthis cycle of losing your
housing, ending up on thestreets using substances, ending
(18:17):
up with head injuries and thenthat is this downward spiral
into interactions with lawenforcement and crime and then
ending up in the carceral system.
One of my deep sadnesses is thefact that some of our largest
jails in the country LA,chicago's, cook County and New
York Rikers are some of thebiggest psychiatric hospitals in
(18:38):
our country and that shouldn'tbe the case.
I think that's a human rightsviolation to have our carceral
systems provide psychiatric care.
Speaker 1 (18:46):
Yes, I've heard that the prisons are exactly that the
largest psychiatric hospitalsin the country, and it's up to
them to take care of them.
Speaker 2 (19:01):
And they really don't know how to take care of them,
which ultimately create moreissues Exactly, and so it is
important in those settings toreally get a forensic
psychiatrist to do an evaluationand provide recommendations.
It's very sad that so manypeople with mental illness do
end up in the carceral system.
But just having thatpsychiatric evaluation that
follows them, that people canread and say, oh, this person
has this diagnosis, oh, this isthis person's history, these are
(19:24):
the medications that might behelpful, or here are some ways
this individual can cope withtheir mental illness, that is
such an important report to havefor that individual and to have
that level of psychiatricanalysis done for that
individual who's in the carceralsystem, I really think that
that's so important.
Speaker 1 (19:44):
Many prisons aren't equipped to handle inmates with
mental illness or medicationneeds.
Guards often lack training torecognize these issues, mistaken
genuine distress for defiance.
This can lead to inmates beingdenied proper medication,
escalating problems and endingup in solitary confinement.
(20:04):
How do we create a bettersystem so that some of these
people don't fall through thecracks and wind up in places
they don't need to be, becauseit may just be a medication
issue rather than a personalityissue?
What do we need to do?
Speaker 2 (20:20):
This is such an important question.
It's one I personally strugglewith every day and think about
every day, because I think thereare some key things to educate
society about when it comes tomental illness and how people
end up in the criminal justicesystem.
(20:41):
One is substance use is likeone of the biggest issues that
results in violent behavior andthen results in someone with
mental illness or substance usedisorder to be incarcerated this
impulsive behavior that comesfrom substance use.
Another is traumatic braininjury.
Traumatic brain injury is areally big deal in the United
States.
(21:01):
People end up with concussionsand a series of concussions over
the course of their life,through sports, through fights,
through lots of different caraccidents.
This is an issue and it doesactually cause people to have
personality changes, to becomemore impulsive, to not
(21:22):
necessarily pick up on allsocial cues or to self-medicate
with substances their symptomsthat they're experiencing.
So that's another way where wesee violent behavior.
And, lastly, we see a lot ofviolent behavior when someone
has mental illness that isuntreated untreated mental
illness that results in a lackof insight and self-awareness
that somebody is ill.
(21:43):
That is the third way I thinkpeople do end up in the carceral
system due to having a mentalhealth issue and we know that as
psychiatrists.
When I'm doing that evaluationI know I see those factors and
those are three things we coulddivert back into the community
and provide intensive treatmentfor and help society understand,
look, that treatment might needto be mandated for a short
(22:06):
period of time until that persondevelops insight.
That's gonna be the way to keeppeople in the community.
But there are a lot of littleproblems we end up along the way
in being able to provide thatlevel of care.
I think in the United Statesand I think that is resulting in
a carceral system problem ofmental illness.
(22:26):
We need that medication,treatment and the therapy that
goes along with it, and housingthat goes along with it and
occupational therapy andphysical therapy that goes along
with it to be in the community.
And the community needs to havea deeper understanding of what
causes violence impulsiveviolence in individuals, not
necessarily premeditatedviolence.
Speaker 1 (22:45):
Now you said that you were involved in some type of
legislation.
Yes you were involved in sometype of legislation.
Yes, what type of legislationare you trying to get changed or
improved upon?
That needs to be under themicroscope and you think is just
really, really important?
Speaker 2 (23:02):
Yes, very important.
So different states end up withdifferent sets of issues that
result in the same problem,which is people with mental
illness end up incarcerated.
And in Massachusetts, I have tosay, we have the lowest number
of incarcerated individuals likerate of incarcerated
individuals in the country.
So not in terms of numbers butin terms of the rate of
(23:24):
incarceration, we had the lowestamount.
However, those who areincarcerated are more likely to
be mentally ill in Massachusettsand our judges have done a
great job of creating newstandards in Massachusetts that
they recently updated in 2024 toreally think about mental
illness as one of the thingsthey consider when they're
(23:46):
looking into a case.
And I was just involved in oneof their annual meetings and
provided some mental healtheducation at their annual
meeting because they're reallylooking into this issue.
But what I think is an issue inMassachusetts is that we're a
very rights-driven state wheretreatment is important, but to
(24:08):
maintain someone's rights torefuse medication is it takes
precedence in Massachusetts.
It's not the case in all states, but a lot of states do follow
the same thought process andwhile I think that's absolutely
important for people withdisabilities to have all of
their rights intact, whatsometimes happens is these
(24:30):
individuals in maintaining theirrights to stay off medications
and not get mandated treatment,they end up in the carceral
system because they end up in aviolent situation and then end
up in the carceral system withcriminal charges.
And so in Massachusetts, twothings we need to do to do we
(24:52):
don't have any assistedoutpatient treatment laws and we
do have one filed with thelegislature right now at the
statehouse, called the CriticalCommunity Services Bill that
we've just refiled in January tohelp us bring this level of
intensive psychiatric treatmentinto the community rather than
just in locked psychiatric units.
Speaker 1 (25:10):
That sounds like a great piece of legislation.
What do you see coming out ofthis?
Speaker 2 (25:16):
The hope is we can provide antipsychotic
medications to someone withserious mental illness and a
psychotic disorder in thecommunity, monitored, while
giving them all the otherservices.
They need to stay in thecommunity and the other thing
that we are trying to do inMassachusetts we have this
timely treatment bill that'salso in the legislature that we
(25:37):
just refiled in January toreduce that time that it takes
for the court hearing to happenin order to get medications to
an individual who has apsychotic disorder, is lacking
insight and is refusing care andtherefore has ended up in this
cycle of needing multiplehospitalizations or ending up
homeless, or ending up withmultiple criminal charges and in
(26:01):
the jail system.
Right now we have no safetynets in either of those two
spaces to provide medicationtreatment for people with
psychotic disorders inMassachusetts.
So those are the two bills thatI'm really hoping we can push
during the time that I ampresident of the Massachusetts
Psychiatric Society.
So that's one of my goals.
But what I will say is this is anationwide problem In the
(26:25):
nation, every state, whetherthey have those AOT laws,
assisted outpatient treatmentlaws or timely treatment laws in
the inpatient settings.
Sometimes they have majorstaffing shortages.
They don't have psychiatriccare necessarily available very
quickly, or they don't have thepsychiatric beds or they don't
have the wraparound servicesneeded in the community to keep
(26:46):
people off the street and in ashelter system with
psychotherapy, with other typesof community services needed for
people with serious mentalillness.
So every state has saw aversion of this problem.
Speaker 1 (26:59):
It seems that if you get this passed through, this
would be a good bill to take tothe House and try and make it
national.
Speaker 2 (27:07):
Yeah, I mean, I think what has happened is this issue
has become a state-by-statebasis issue and every state
makes their mental health lawsand their determinations of how
they're going to manage peoplewith mental illness.
You know, the hope is what theSupreme Court does is give the
bottom.
This is what you have to do,but states can have a higher
(27:43):
level of scrutiny than what theSupreme Court deems to be needed
.
That is a really importantlegislation to pass, I think, at
a national level to reallyrecognize this as an issue, that
this cycle of homelessness,constant psychiatric
hospitalizations and criminaljustice interactions is a result
of individuals with mentalillness either remaining
(28:04):
untreated or self-medicatingwith substances, also having
these other morbidities likeautism or traumatic brain injury
or other types of personalitydisorders.
They all play a role.
Speaker 1 (28:16):
Yeah, I definitely agree.
Now, what would you like totell the listeners that you
think they really need to knowabout what you're doing and, of
course, what you're trying to dowith legislation?
Speaker 2 (28:29):
That's a great question.
Serious mental illness istreatable.
Symptoms of autism can bealleviated with really good
therapy.
We do have treatments available.
Serious mental illness is awaxing and waning illness.
It can come back.
It's not necessarily curableand so people need to stay on
(28:50):
medications to stay well.
One of the issues we see withserious mental illness, which is
a biological illness it's adisease like any other disease
that we see in other organs inthe body needs maintenance and
needs treatment.
It doesn't just go away I meanit can for a period of time, but
(29:12):
it comes back, and when itcomes back it's unpredictable.
What I really want people tounderstand is when people can
get very sick from mentalillness.
They can lose insight intotheir well-being, into their
self-awareness and into realityin general, and that experience
a lot of times can be verydistressing.
(29:32):
So, even though if a person istelling you they don't want
treatment or they're not able togive you a very clear decision
of what they want, part of thatis the illness itself.
Part of that is the distress,the emotional distress that
they're experiencing from beingin psychotic illness.
And so, even though it feelssometimes really wrong to
(29:54):
provide psychiatric care to anindividual when they're refusing
it.
You can actually restore theirwellbeing and dignity much
faster with medications and Ithink we really need to
understand that and there's alot of resistance to that
understanding of mental illness,I think, in this country.
Speaker 1 (30:13):
Yeah, well, this has been a great conversation, great
information.
I really appreciate you comingon.
Speaker 2 (30:19):
Absolutely.
I really appreciate you havingme.
Thank you.
Speaker 1 (30:22):
It's been my pleasure .
Thanks again.
Thanks for taking the time outof your busy schedule to listen
to our show today.
We hope that you enjoyed it asmuch as we enjoyed bringing it
to you.
If you know anyone that wouldlike to tell us their story,
(30:45):
send them to TonyMantorcomContact then they can give us
their information so one daythey may be a guest on our show.
One more thing we ask telleveryone everywhere about why
Not Me, the world, theconversations we're having and
(31:06):
the inspiration our guests giveto everyone everywhere that you
are not alone in this world.
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