Carol Aiken, Probate Commissioner, 31st Judicial Circuit, State of Missouri

CURESZ interviewed Judge Carol Aiken from Greene County, Missouri. Over the years, Judge Aiken has seen many cases involving people with schizophrenia. She has noticed a general shift toward deinstitutionalization, and a lessening of the stigma.

Greetings from Missouri! I have served as a judge in the probate court in Greene County, Missouri for the past 23 years. In Missouri, the probate court handles adult guardianships cases. Many of my cases involve people with a schizophrenia diagnosis so I have become very familiar with the area’s mental health resources. Springfield, the county seat for Greene County, is a typical Midwestern city of about 175,000 residents and is widely respected for its many programs for the mentally ill.

In the past two decades that I have been on the bench, there has been an enormous shift away from institutionalization of individuals with a mental illness. Virtually all of the state hospitals have closed with an emphasis on independent supported living options and outpatient programs.

In Greene County, we are fortunate to have very progressive mental health services. The main provider is Burrell Behavioral Health. It provides numerous programs, including outpatient treatment, independent living options, and community activities. There are apartments designed for residents with mental health diagnoses with counselors and case managers on site. Recently, a retired physician funded the development of a tiny home community called Eden Village. It has provided stable housing for some of Springfield’s chronically homeless, almost all of whom carry a mental health diagnosis.

There has also been an emphasis on reducing the number of people who are involuntarily detained in a hospital’s psychiatric unit. The county, along with Burrell Behavioral Health, is funding a new rapid access mental health facility. The goal is to provide law enforcement and first responders with an around-the-clock mental health care center to take people to instead of transporting them to the hospital or jail. Unfortunately, the state has recently made cuts to budgets for treatment programs and housing assistance for the mentally ill. I fear that these cuts will greatly affect housing options for individuals with schizophrenia and other mental illnesses.

The guardianship laws in Missouri have also been recently amended to require that judges place as few restrictions as possible on a person who is in need of a guardian. Historically, when a person is placed under guardianship, they lose many of their personal rights. This includes the right to determine where they will live, the right to vote, marry, drive and enter into a contract. The emphasis now is to very narrowly carve out the restrictions placed on an individual.

This change is of great benefit for those with schizophrenia. It greatly reduces the stigma attached to a guardianship proceeding. The court can tailor the guardian’s powers to be used only when the mentally ill individual needs hospitalization and refuses to go. This situation usually arises when the person stops taking medication. The guardian then has the authority to admit the individual to the hospital to receive the needed assistance. With such restrictions in place, guardianships can be viewed in a much more positive light, to be used only in emergency situations.

I am hopeful in the coming new decade that great strides will be made not only in the treatment for individuals with schizophrenia but also in the services and assistance provided for them.

Carol Aiken
Probate Commissioner
31st Judicial Circuit
State of Missouri