The following is an excerpt from Dr. Hal S. Wortzel’s chapter regarding early onset dementia and frontotemporal dementia in Representing People With Dementia, a Practical Guide for Criminal Defense Lawyers (Elizabeth Kelley, ed). Dr. Wortzel is a forensic neuropsychiatrist at the Rocky Mountain MIRECC, where he serves as Director of Neuropsychiatric Consultation Services and Co-director for the National Suicide Risk Management Consultation Program.

Dr Wortzel and Elizabeth will speak on a panel on Dementia at the International Academy of Law and Mental Health in Barcelona this July.

Frontotemporal Dementia (FTD) represents a group of neurodegenerative disorders that attack the frontal and temporal aspects of the brain, resulting in progressive decline in functioning, especially as it relates to behavior and language abilities. FTD is the third most common neurodegenerative cause of dementia after Alzheimer’s disease and dementia with Lewy bodies, and a leading cause of young onset dementia.

FTD is the most common cause of dementia among persons younger than age 60. FTD frequently presents with prominent behavioral changes, not infrequently leading to violations of both social norms and the law. It also causes impairment in language and higher order cognitive processes, often referred to as executive functions. Executive functions enable us to monitor our environment, come up with a plan to engage that environment, observe the success of that plan in relation to various goals, and make adaptations on the fly to optimize the plan.

Stated differently, executive functions enable us to deploy goal-directed behaviors in a manner that comports with societal norms and expectations. Unlike many other dementing illnesses, memory and visuospatial functions are relatively spared in the early stages of illness, a circumstance that often leads to delayed diagnosis, and even diagnostic error. The constellation of impairment seen early on in FTD, with prominent behavioral disturbances frequently accompanied by relatively intact memory, makes FTD particularly salient to forensics, and presents some relatively unique challenges.

Representing a client suffering from FTD undoubtedly involves many challenges, starting with the fact that people with that illness may be undiagnosed at the time of their initial legal encounter. Attorneys enhance their ability to serve such clients by being able to recognize circumstances that might suggest FTD, and arranging for appropriate forensic neuropsychiatric consultation.

Though there are very modest treatments available to address this progressive and devastating illness, the provision of a clear diagnosis, prognosis, and professional support can significantly improve quality of life and facilitate appropriate planning for patients and their families. Similarly, recognizing this illness may afford viable defense strategies when behaviors yield criminal charges, or legal remedies when decision-making born of illness runs contrary to well-established principles and values demonstrated throughout their healthy adult life.

If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley focuses on representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. 

Advocates Fight to Protect Texas Man With Intellectual Disability from Execution

In a new amicus brief, The Arc, Disability Rights Texas, and AAIDD urge Texas court to follow science, not stereotypes

WASHINGTON, DC – In a critical death penalty case, The Arc of the United States, The Arc of Texas, Disability Rights Texas, and the American Association on Intellectual and Developmental Disabilities (AAIDD), along with law firm Fried, Frank, Harris, Shriver & Jacobson LLP, have filed a “friend-of-the-court” brief urging the Texas Court of Criminal Appeals to protect people with intellectual disability from unconstitutional executions.

Police departments grapple with mental health

NASHVILLE, Tennessee — How police officers handle their own mental health and how they interact with individuals suffering from mental illness are the biggest concerns and risks for law enforcement departments, experts say.

Working conditions are becoming increasingly stressful for police officers as many departments are understaffed, they say.

And with shorter overall training periods, police officers need specific training on how to recognize when they are dealing with a person with mental health issues and how they should respond, they said during presentations at the Public Risk Management Association’s annual conference last month. 

Us & Them Encore: Mental Health Crisis Behind Bars In W.Va.

Overcrowding and understaffing have pushed West Virginia’s prisons and jails to what many believe is a crisis point.

On this episode of Us & Them, we hear what incarceration is like for someone in a mental health crisis. Hundreds of thousands of people with mental illnesses are caught up in a criminal justice system that was never intended to treat them.

In a recent special session, West Virginia lawmakers earmarked $30 million to address staffing shortages and provide pay raises and retention bonuses to correctional staff. There is also $100 million for deferred facility maintenance.

Meet the New Generation of Unarmed First Responders in This New Podcast Series

“The Fifth Branch,” a podcast from The Marshall Project and Tradeoffs, examines new, alternative ways to respond to 911 crisis calls.

One out of every five people shot and killed by police in the U.S. since 2015 was in the middle of a mental health crisis, according to tracking by The Washington Post. These deaths, along with pressure from activists, have prompted cities across the country to change their approach to emergency calls. Instead of armed police, a new generation of first responders, including EMTs and social workers, are handling 911 calls involving mental illness, addiction or homelessness.

My elderly father had dementia, anger issues, and many guns. What were we to do?

One underreported aspect of America’s firearms epidemic: armed seniors with memory problems. My family had few legal options for disarming our dad.

A few years ago, my 87-year-old father came into crisp focus one morning when I woke to his scratching at something in the step well of my parents’ motor home in Billings, Mont. From where I slept on the short, narrow couch in the living room of the old custom bus, he was just a barely visible, hunched figure up to his hips in the well at the RV door. I didn’t think much of it. I’d only barely been asleep anyway, because he’d been wandering around naked most of the night, turning stuff on and off, digging in sacks, opening the refrigerator.

The Supreme Court Just Opened the Door to the Criminalization of Disability

Photo illustration by Slate. Photos by Kevin Dietsch/Getty Images, Getty Images Plus, and supremecourt.gov.

In a 6–3 ruling, the Supreme Court just held that people experiencing homelessness could be subject to criminal and civil penalties for sleeping in public spaces. In City of Grants Pass v. Johnson, the court overturned a decision by the U.S. Court of Appeals for the 9^th Circuit, which had held that these penalties were unconstitutional under the Eighth Amendment’s prohibition on cruel and unusual punishment. This case stemmed from Grants Pass, Oregon, where local politicians were seeking to eradicate the homeless population through fines and jail time.