Working with a client who suffers from a major mental illness can be challenging and frustrating for the client and yourself. Mental health issues manifest in many ways, but there a certain features that are often shared across disorders. Everyone can relate to having to work when you have a terrible cold. You have the “Seven Dwarves” syndrome: Sneezy, Dopey, Stuffy, Achey, Coughy, Grumpy, and (I-Should-Have –Seen-My) Doc. This translates into poor attention span, lack of focus, trouble with concentration, limited motivation, distractibility, short-tempered behavior and maybe even a little bit of performance anxiety. These types of impairments are common “side effects” of many psychiatric disorders and if you can keep the “Seven Dwarves” fresh in your mind; you will go a long way to understanding and being able to help your client negotiate their legal situation.
Attention, Focus and Concentration:
Many of the major mental health disorders can impact a person’s ability to focus on a topic, sustain his/her attention and concentrate and absorb needed information. Although prescribed medications are supposed to help treat the major symptoms of the illness, they can have unwanted side effects like drowsiness, anxiety or restlessness. They may be having hallucinations that distract them. This often manifests itself in ways that make your role as counsel quite difficult. Your client forgets appointments or court dates. He/she does not provide you with the necessary documents you requested. He/she makes impulsive, poorly reasoned decisions. He/she calls you constantly asking the same question over and over again. He/she seems to have missed essential communications during meetings or hearings,
To alleviate some of these deficits, first find out the names and doses of your client’s medications and do a quick search of the medication’s side effects and intended effects. Assess if your client is taking them as prescribed. If your client seems to be having untoward side effects from the medications; assist in calling his/her doctor to discuss the issue.
Second, create a “surrogate brain”. This might be a person, an electronic device or simply a notebook. Help your client organize themselves. Have your client designate a trusted friend or family member to accompany them to meetings and hearings; someone who can assist in tasks and recall important information. If there is no one who can serve that role, then write down important information or tasks that need to be done. Have your client keep a calendar of important dates. Call to remind them of these dates a few days before and maybe even the day of the appointments.
Next, keep distractions to a minimum. If you have a court hearing, ask that your case be the only one heard in court rather than the mass line-up of first-come-first-serve most judges seem to prefer to manage their busy calendar. The fewer people in the room (court or conference) the better. If you have to review important documents or discuss an important topic, do so in a quiet area. Allow plenty of time for your client to read and/or digest the information. Ask questions to insure that he/she understands what he/she has read or heard; such as asking them to summarize the information. Just asking , ”Do you understand ?” may not indicate the person really did comprehend. But asking someone to reiterate what they have learned not only insures that they did or did not understand, but also solidifies the information by repeating it. Give your client time to ask questions of you as well.
Be cognizant to speak English and not “legalese”. Remember you might know a habeas from a corpus, but your client may think you have some kind of unmentionable affliction.
Battling a chronic debilitating illness is hard work. It can be exhausting. To make matters worse, one of the symptoms of many mental illnesses is lack of motivation and energy. The triple “wammy” is that medications can cause fatigue or a foggy brain. Motivating someone to do something they like to do is hard enough, but, no one generally volunteers to take part in a legal battle(except you and me). For someone facing criminal charges, divorce, custody battle, or financial ruin, the mentally ill client hopes to just wish the problem away. Sometimes your client may feel they deserve to be punished as part of their illness or low self-esteem and will just not advocate for themselves.
You have to balance being a supportive force without being a therapist or social worker. You have to advocate for your client, but be realistic about the outcome or consequences. Trying to motivate someone by making promises you cannot keep or telling them of the fairytale ending to their case will only end in distrust and disaster. Take the time to establish a rapport with your client and realistically detail the process, time frames, risks and potential outcomes of the case. Many times the client cannot see the forest for the trees and has made a catastrophe of the case’s outcome to such an extent as to believe only the worst will happen. Continue to reiterate how important their active participation is in the proceedings and that you need their help to help them.
Legal issues create anxiety for the most stable person. Just remember how you feel right before a big trial or tricky deposition. This can be magnified greatly for people with a mental health issue. It can be so significant that your client may be unable to withstand just meeting with your or even speaking to you on the phone, yet alone appear in person. A solid rapport and good, thorough preparation can go far to allay your client’s fears. It boils down to spending time with your client reviewing the case, the details, and the expectations of the situation. You may have to do a lot of hand holding. (The surrogate brain often comes in handy here too.) You may need to do “mock” trials, for instance, or have your client attend a random proceeding just to get familiar with the process. Medication might be needed to help your client manage his/her anxiety, but make sure that your client can tolerate the medication before the proceeding to insure they do not have any unwanted side effects.
Poor or limited impulse control is another problem related to mental health disorders. This may come in the guise of making poorly reasoned, “snap” decisions, making unrealistic or idiosyncratic decisions, or simply being short-tempered or just plain aggressive an uncooperative. We all know that everyone is allowed to make bad decisions and despite all your best efforts of guiding your client on the right path, he or she may have his/her own agenda. Unfortunately, there is little that can be done to sway the mule-headed client. Do your best to lay out the pros and cons of a decision. Try not to be in a situation in which there is little time to ponder the question so that you client can “sleep on it” and you can discuss the situation thoroughly over several occasions.
If the impulsive decision making is related to psychotic thinking or the person conducts life in “an alternate reality”, you may need to have that person assessed for competency or decisional capacity. You may want to explore if he/she is taking medications as prescribed and attending appointments with their physician. Consider substance abuse as a possible problem. Your client may need professional assistance such as hospitalization or medication adjustment.
As for your just-not-nice client, set firm boundaries and rules of engagement. You and your staff do not need to be treated disrespectfully. You need to let your client know that his/her behavior is not acceptable. Clearly state what that behavior is (for example; profane language or screaming at your paralegal). Ask the client to leave or politely tell him/her you will not engage with him/her at this time and to call back or meet when the client is in a better calmer frame of mind. Often times, out of shock at being treated rudely, many of us will turn the other cheek and ignore the bad behavior. This gives the person tacit permission to continue to act this way. If you put your client on notice from the beginning that bad behavior will not be tolerated, you will go far to maximize your working relationship. If the client has a legitimate complaint, and he/she is responding to it with exaggerated behavior, once he/she is calm, listen and respond to the grievance. Letting a complaint fester will only interfere with your working relationship down the road.
Saving Your Own Sanity:
Working with a mentally ill client can be extremely challenging, but can also be rewarding. At times you may want to pull your hair out of your head or pull someone else’s hair. You probably fantasize about firing the client or passing this case off to your associate. Practice all your best techniques for maintaining your equilibrium and patience. You know the ones you use to get your six year old to wear pants to school and not her princess pajama nightie? Or maybe the ones you use to teach your 15 year old how to drive a car with a manual transmission.? Remember when the puppy ate you best pair of leather dress shoes the night before your big trial?
Do not take your client’s demeanor as a character flaw on his/her part or a personal affront on yours. To some extent their mental illness is to “blame”. It is often very difficult for someone who is consumed by their illness to have insight into how his/her behavior affects those around them and to be able to fully control of how he/she reacts to situations. That is not to say that mentally ill people are not responsible for their actions, but that they have less locus of control at times in making better choices.
It often helps to have someone in your office; a secretary, paralegal or assistant who has that warm, empathic social worker- type temperament to assist you on these types of cases. You stick to the “nuts and bolts” and let your wannabe Dr. Phil do the phone calls and contacts. I have seen this work very successfully in several groups since the ancillary staff often has more time to spend talking and “schmoozing” the client.
The most important advice I can give you is to keep your sense of humor at the forefront as well as your sense of wonder. It is amazing what the brain can manifest!
And remember “Hi ho! Hi ho! It’s off to work you go…”