Serious Mental Illness Program Sees Success With Judge’s Involvement

SAINT ANTONY – Eric Smith began life as a talented and gifted student, but severe bipolar disorder took over as a teenager.

Fast forward through a bout of addiction, which co-occurred with severe mental illness, and he ended up living out of his car and dealing with bouts of psychosis.

“I was arrested for a minor offence. I was in jail for a month without any treatment for my diagnosis,” Smith said.

That’s when Bexar County probate judge Oscar Kazen stepped in.

“He’s getting me transferred here to San Antonio State Hospital where I’m stabilized, and then immediately after stabilization I was transferred to assisted outpatient treatment,” Smith explained.

Assisted Outpatient Treatment (AOT) is a court-ordered program for people like Smith with serious mental illness who are caught in a cycle of hospitalizations, homelessness and incarceration.

“People like me who couldn’t perceive reality, couldn’t perceive our own illness, couldn’t understand our need for treatment, couldn’t understand the danger I was putting myself in,” Smith said, referring to those receiving assistance from the program.

Smith said the program’s success lies in “the black dress effect”.

“It uses the added layer of responsibility of a judge to ensure that the team itself – i.e. the psychiatrist, social worker, nurse, etc. – that they are held accountable to each other,” Smith said. “Something about the involvement of a judge never threatening punishment against me but holding a team accountable – that resonated with me. He’s a person in a position of power who has my well-being and interests to heart.

It’s a civil order, not a criminal order, and it lasts an average of six to 12 months.

“Part of the beauty of this one is not this cookie-cutter approach – where it’s like, ‘He’s fine, but it must be 12 months. They’re like, ‘Well, no, he’s doing great, and obviously he can get on with his life,” Smith said.

However, he explained that there are also no penalties if you do not complete the program.

“Once this order is terminated, there are individuals in the community that this person is in contact with to ensure that our treatment continues, that we ensure that we are set up for the best possible path to success, for health, for happiness,” Smith said.

Smith said AOT saved his life, but said he sees the positive effects from a societal perspective.

“The amount of money spent for the police to show up and be part of that scene or transport an individual, like they did with me when I was arrested. Being involved in the criminal justice system, paying for everything that to the judge, the time and energy spent by them, spent by society, spent by a hospital,” Smith explained.

He wants people to know that not everyone with serious mental illness needs something like this.

“Some people didn’t end up in FBI headquarters like me. I was like, ‘I broke the codes. I can help prevent World War III. I was awake for days at a time, all kinds of things that are just dangerous to a person,” Smith said.

Now he is healthy, taking the right medications and living a full life.

As an AOT advocate, Smith now travels to share his story. He became a speaker and consultant who has been featured on Oprah Daily, National Public Radio, Dr. Drew’s Podcast and Live Show, New York Daily News, and Yahoo! New.

He also speaks at events like the National AOT Symposium, held last month in San Antonio.

Bexar County has a strong AOT program, so it was chosen to host the latest national conference on the subject.

“We’ve heard from judges in the United States, stakeholders in the United States, family members just waiting to find out: ‘How can we get an AOT program in our area in the United States, like we have here in San Antonio?” Smith said.

Although 47 states have adopted AOT programs, some oppose them, saying it is coercive treatment.

“I can definitely say that I was never forced to do anything I didn’t want to do. My comments were appreciated. When I said, ‘I don’t like the side effects of these drugs,’ that changed,” Smith said.

Much of what he educates people is about a condition he has experienced called anosognosia, a symptom of severe mental illness experienced by some that can impair a person’s ability to understand and perceive their illness.

Experts report that anosognosia is the main reason people with schizophrenia or bipolar disorder refuse to take medication or do not seek treatment.

“It’s not a severe form of denial where someone just doesn’t want to accept reality. There are real changes in the brain, not much different from someone with Alzheimer’s disease. or dementia,” Smith said.

He offered an anecdote as an example:

“Imagine someone driving down a highway at 90 miles an hour. They know to one degree or another that they could get them pulled over and ticketed. They could be in a wreck. They did, even at levels the most basic, a risk-benefit analysis of what they do,” Smith explained. “Now imagine me driving down the highway at 90 miles an hour in the middle of an episode of psychosis, and I think, “I have to speed up, I have to get where I need to go. Spies are chasing me. I’m very paranoid and delusional about the whole thing.” If I’m stopped by the police, they’ll let me go because I’m working in cahoots with the FBI and the CIA.”

Although he’s vulnerable to put up with it all, Smith will continue to share his story to educate the public and help people like him.

At the request of lawmakers and other stakeholders, he has testified in Texas, Virginia, California, Washington, Massachusetts, and Maryland in support of AOT.

Smith also went back to school to get his master’s degree in social work and is already working with people experiencing homelessness at SAMMinistries.