Helping mentally ill criminals: jailing offenders with mental illnesses serves no one, but new policies and funding are bringing about needed changes.
Fifty-year-old Eddie has spent much of his life in and out of prison for crimes that included drug possession, larceny larceny, in law, the unlawful taking and carrying away of the property of another, with intent to deprive the owner of its use or to appropriate it to the use of the perpetrator or of someone else. and burglary. Often homeless, he recalls his stints in jail as a respite from the overwhelming task of taking care of himself. Last fall, Eddie, a grandfather, reached an important turning point in his life. He became the first client discharged from a mental health court in Santa Fe Santa Fe, city, Argentina
Santa Fe, city (1991 pop. 341,000), capital of Santa Fe prov., NE Argentina, a river port near the Paraná, with which it is connected by canal. , N.M. Similar to drug courts, the specialized courts are designed to help people like Eddie get mental health treatment, manage their lives and stay out of jail.
"It's amazing to see the changes in some one over a year with the services and supervision of this court," says Lupe Sanchez, program manager for the court in the First Judicial District in Santa Fe. Most clients are probation violators. A tough customer, Eddie spent as much as 20 years behind bars, Sanchez said. "Mental health services health services Managed care The benefits covered under a health contract and case management can help a guy like him go from having no structure and responsibility to being able to live self-sufficiently. No doubt he otherwise would be in jail."
THE NUMBERS ARE STAGGERING
A recent report by the federal Bureau of Justice Statistics Noun 1. Bureau of Justice Statistics - the agency in the Department of Justice that is the primary source of criminal justice statistics for federal and local policy makers
BJS said that more than half of all prison and jail inmates have a mental health problem. That works out to be 705,600 offenders in state prisons and 479,900 in local jails. Mental disorders mental disorders: see bipolar disorder; paranoia; psychiatry; psychosis; schizophrenia. are increasingly common in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , but their prevalence in criminal justice systems is estimated at three times the rate of the general population. Convicts also are more likely to suffer from more than one illness, in particular schizophrenia, bipolar disorder bipolar disorder, formerly manic-depressive disorder or manic-depression, severe mental disorder involving manic episodes that are usually accompanied by episodes of depression. , major depression or acute psychosis "co-occurring" with substance abuse.
The deinstitutionalization de·in·sti·tu·tion·al·i·za·tion
The release of institutionalized people, especially mental health patients, from an institution for placement and care in the community. of the mentally ill in the 1960s was designed to care for those with acute mental health needs in the community instead of in state-run asylums. But the movement to be more compassionate and cost-effective in treating those with mental illness has had a down side. In the generation since many state mental hospitals closed and treatment approaches shifted to the community, many people with serious mental illnesses have failed to get the treatment they need. For some, that means homelessness and crime, and advocates now decry de·cry
tr.v. de·cried, de·cry·ing, de·cries
1. To condemn openly.
2. To depreciate (currency, for example) by official proclamation or by rumor. what they call the "criminalization crim·i·nal·ize
tr.v. crim·i·nal·ized, crim·i·nal·iz·ing, crim·i·nal·iz·es
1. To impose a criminal penalty on or for; outlaw.
2. To treat as a criminal. of the mentally ill."
It is estimated that as many as 40 percent of people in this country with mental illness are not receiving treatment. Some are prone to substance abuse and nuisance or "quality of life" crimes such as trespassing, disorderly conduct disorderly conduct
Conduct likely to lead to a disturbance of the public peace or that offends public decency. It has been held to include the use of obscene language in public, fighting in a public place, blocking public ways, and making threats. and public intoxication Public intoxication, also known as "drunk and disorderly conduct" (sometimes, incorrectly, as "drunken disorderly"), is a summary offence in many countries.
The laws regarding drunkenness vary wildly from one legislative body to the next and are open to a certain amount of . Some drift into property crimes or prostitution, while others may become serious and even dangerous offenders.
Only about one third of offenders with mental health needs receive treatment, according to the Bureau of Justice Statistics survey. Released without care, many such offenders remain in a cycle of crime and incarceration Confinement in a jail or prison; imprisonment.
Police officers and other law enforcement officers are authorized by federal, state, and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes. that often starts with juvenile arrests and persists into adulthood.
Police encounters with the mentally ill are frequent and unpredictable. On a routine basis, police deal with cases of vagrancy vagrancy, in law, term applied to the offense of persons who are without visible means of support or domicile while able to work. State laws and municipal ordinances punishing vagrancy often also cover loitering, associating with reputed criminals, prostitution, and and nuisance crimes. They also respond to incidents in which people with mental illness are victims of crime. Officers must make quick determinations of a person's danger to themselves or others, and try to defuse situations that endanger them or escalate into "suicide by cop Suicide-by-cop is a suicide method in which someone deliberately acts in a threatening way towards a law enforcement officer, with the goal of provoking a lethal response, such as being shot to death. " or other tragic scenarios.
Training and experience help police officers recognize signs of mental illness and adapt their response. Symptoms like hallucinations Hallucinations Definition
Hallucinations are false or distorted sensory experiences that appear to be real perceptions. These sensory impressions are generated by the mind rather than by any external stimuli, and may be seen, heard, felt, and even and incoherence incoherence Not understandable; disordered; without logical connection. See Schizophrenia. may be fairly recognizable; other disoriented dis·o·ri·ent
tr.v. dis·o·ri·ent·ed, dis·o·ri·ent·ing, dis·o·ri·ents
To cause (a person, for example) to experience disorientation.
Adj. 1. , delusional and depressed behaviors may be less conclusive. Many people that police deal with are high on drugs or alcohol, which can contribute to erratic behavior and be confused with signs that a person is suffering from a mental illness.
Police departments around the country have developed "incident management" response and training to deal with individuals exhibiting symptoms of mental illness. Some include training a specialized group of officers to respond to mental health crisis calls and partnerships with the health community to provide emergency psychiatric intervention and follow though services.
A MOVE TO TREATMENT
A growing number of jurisdictions are diverting suitable offenders with mental illness from jails to treatment services. The district court mental health program in Santa Fe that Eddie took part in is just one of many around the country using court supervision to divert and treat mentally ill offenders.
The exploding interest in mental health courts is seen in numbers compiled by the Bureau of Justice Assistance Noun 1. Bureau of Justice Assistance - the bureau in the Department of Justice that assists local criminal justice systems to reduce or prevent crime and violence and drug abuse
BJA (BJA Noun 1. BJA - the bureau in the Department of Justice that assists local criminal justice systems to reduce or prevent crime and violence and drug abuse
Bureau of Justice Assistance ). In 1997 there were four known mental health courts in the country. By 2004 the number was 70 in 29 states; and by 2006 there were 120 mental health courts in 35 states. BJA administers grants to 37 of these courts around the country.
One, in Reno, Nev., began in 2001 with no additional money but with judges willing to give up their lunch hour to try to connect mentally ill defendants with the minimal services available in the community, according to Sheila Leslie, the Assembly's majority whip and chair of the Health and Human Services Noun 1. Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Department of Health and Human Services, HHS Committee. Leslie also is the specialty courts coordinator for the District Court in Reno.
Quickly, Leslie says, police, other judges and advocates for the mentally ill were on board. The Reno court supervises mental health court participants for one to three years, depending on the seriousness of the charge, which can include felonies as well as misdemeanors.
"The person is much more important than the charge," says Leslie. Some of their actions, like assault with a deadly weapon Assault with a Deadly Weapon is the term used to describe the act of threatening to harm one or more people by using a weapon (usually a firearm). Here, assault must be differentiated from battery as they are often confused. Assault is threatening to use force. , sound horrible, Leslie said, "but when you really look at the incident and individual, you sometimes see a very acute mental illness more than a violent offender," she says.
Leslie acknowledges that some of her colleagues in courts and in the Legislature question how many specialty courts are necessary. But she distinguishes the approach of mental health courts from that of drug courts, even when the defendant is one of many who abuse drugs and have a mental illness.
"It is easier to get people off meth meth
Methamphetamine hydrochloride. in our mental health courts than in drug court," Leslie said. Once mentally ill defendants are stabilized with proper medications to treat their condition, she said, the lure of meth or other harmful substances subsides. "With supervision, we are keeping many of them off illegal drugs."
The Legislature has appropriated about $2.3 million for mental health courts in Nevada since 2002, with increases each year. Funds have provided prompt evaluation of and ongoing services for defendants, including housing options.
It's been money well spent, according to Leslie, who says the prison and jail savings are more than offsetting the infusion of funds for better mental health services in the state.
Those savings give the approach broad support on both sides of the aisle, Leslie says, because lawmakers see that "it holds both the defendant and the system accountable."
"Government has a responsibility to help those who cannot help themselves," Leslie says, "And I'm a believer in changing systems to make that happen."
The Reno court is one of the Justice Department's "learning sites," which help develop and share best practices among these relatively new courts.
The Department of Justice's support for mental health courts has followed two acts of Congress to help improve the way the
criminal justice system addresses the needs of people with mental illness. America's Law Enforcement and Mental Health Project signed into law in 2000 provided funding to mental health courts with a $10 million appropriation for FY 2001-2004. In 2005, the Mentally Ill Offender Treatment and Crime Reduction Act funded a range of related programs under a Justice and Mental Health Collaboration Program. An initial appropriation of $50 million for FY 2004 and 2005 has been followed by an additional $5 million for 2006 and 2007.
"We know this is a funding issue as well as a policy issue," says Delegate Phil Hamilton, who chairs the Health and Human Services subcommittee of the House Appropriations Committee in Virginia. Last year, the Virginia General Assembly The Virginia General Assembly is the legislative body of the Commonwealth of Virginia. Its existence dates from the establishment of the House of Burgesses at Jamestown in 1619. It became the General Assembly in 1776 with the ratification of the Virginia Constitution. increased by $26 million the funding to 40 community service boards that administer crisis intervention crisis intervention Psychiatry The counseling of a person suffering from a stressful life event–eg, AIDS, cancer, death, divorce, by providing mental and moral support. See Hotline. and case management services.
An objective of that funding is a better community mental health infrastructure that can divert offenders to treatment, according to Hamilton.
"We hope the result of this will be to at least reduce the numbers of mentally ill people in prisons and jails and relieve some of the pressure on the corrections system," Hamilton says. "Prisons and jails were never meant to be mental health facilities."
In Indiana several years ago, lawmakers created a seven-county pilot "forensic diversion program" to provide community mental health and addiction services to non-violent offenders. Those programs now are being reviewed to identify the most effective common elements, according to Senator Joe Zakas, the Senate majority whip.
State divisions of community corrections and mental health and addiction are working together to oversee the locally run programs as a prison alternative for suitable offenders.
"These people have struggled," says Deana McMurray, director of the Community Corrections division. "They don't have good jobs and health insurance. Many have alienated their families, as well," she says.
Most of the felony defendants in Indiana's program are offenders who have substance abuse problems as well as a mental health condition, according to McMurray. Untreated, she says, this population reoffends at a high rate.
"Decreasing recidivism recidivism: see criminology. was the primary motive for the forensic diversion programs," Senator Zakas says. "The cost of prison housing is enormous. Using community corrections is much less expensive."
The study group looking at the pilot programs is recommending a $13 million increase in community corrections programs to continue and expand forensic diversion. The money is for treatment, case management and supervision of these offenders in the community, McMurray says.
She says that collaboration between community corrections and mental health providers is not just for those sent to a diversion program, but also when offenders coming out of prison need mental health services.
There are two big things in corrections today, McMurray says. One is "evidence-based practices," or programs that have research to support their effectiveness. The other is re-entry RE-ENTRY, estates. The resuming or retaking possession of land which the party lately had.
2. Ground rent deeds and leases frequently contain a clause authorizing the landlord to reenter on the non-payment of rent, or the breach of some covenant, when the , which includes policy and programs to help move offenders from prison back into the community. Both share the common goal of reducing recidivism, she says, and mental health services contribute effectively to both.
"We can do only so much with an offender if we can't address the issues that put him here," McMurray says. "This is creating opportunity to meet needs and help keep people out of the corrections system."
PAYING FOR MENTAL HEALTH SERVICES--FACTS AND FIGURES
* In any given year, about 5 percent to 7 percent of adults have a serious mental illness. A similar percentage of children--about 5 percent to 9 percent--has a serious emotional disturbance This article requires authentication or verification by an expert.
Please assist in recruiting an expert or [ improve this article] yourself. See the talk page for details. .
* In 2001, $85 billion was spent on the treatment of mental disorders
* Between 1996 and 2001, the average annual increase for mental health spending was 6.7 percent, a rate comparable to the 6.4 percent rate for general health costs.
* About a fifth of people who use mental health services have Medicare coverage, about 10 percent use Medicaid as their primary source of coverage, and private insurance covers just over half. As many as one in five people with a mental health need is uninsured.
* Public money plays a greater role in financing mental health services than in health care generally and its role as a payer is increasing relative to other payers. In 1991, Medicaid accounted for 19 percent of expenditures, private insurance for 22 percent, and Medicare for 3 percent. In 2001, Medicaid accounted for 27 percent of mental health expenditures, private insurance held steady at 22 percent, and Medicare accounted for 7 percent. State payments to mental health providers outside the public or private insurance systems made up 27 percent of expenditures in 1991 and 23 percent in 2001.
* With responsibilities for Medicaid, state mental health payments, and other smaller funding sources, states manage most of the public money that supports mental health services.
* The types of services provided to people with mental health needs have shifted away from inpatient care inpatient care Managed care Services delivered to a Pt who needs physician care for > 24 hrs in a hospital in recent years. Outpatient, residential and especially prescription drug prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, services account for an increasing share of mental health expenditures. Prescription medicines represented one of every $14 spent on mental health in 1991, but one in five in 2001, a share equal to that now spent on inpatient care.
* Public health care financing programs do not provide reliable funding for housing, employment and other support services support services Psychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services needed in a community setting. States are trying a variety of ways to finance community support services and to connect them with medical services, but significant service gaps remain.
--Donna Folkemer, NCSL NCSL National Conference of State Legislatures
NCSL National College for School Leadership
NCSL National Conference of Standards Laboratories
NCSL National Council of State Legislators
NCSL National Computer Systems Laboratory (NIST)
Remembering Victims When Defense Is Insanity
When people with mental illness commit crimes, their victims are often left frustrated with the criminal justice system. Legal procedures surrounding the insanity defense A defense asserted by an accused in a criminal prosecution to avoid liability for the commission of a crime because, at the time of the crime, the person did not appreciate the nature or quality or wrongfulness of the acts.
The insanity defense is used by criminal defendants. are confusing and victims' rights victims' rights, rights of victims to have a role in the prosecution of the perpetrators of crimes against them. Nearly all U.S. states have enacted some victims' rights legislation. can be diminished.
"In many instances, victims don't receive notices of hearings or even of a release," says John Gillis, director of the federal Office for Victims of Crime The Office for Victims of Crime (OVC) is a part of the Office of Justice Programs, part of the U.S. Department of Justice.
The OVC's mission is to provide aid and promote justice for crime victims. . "When an offender becomes a mental patient, you have two different agencies with different interests involved," he says. "It's important that victims not get lost in that."
Although many criminal offenders have mental health problems, insanity pleas are used in relatively few cases, and successful in even fewer. The legal test for insanity varies from state to state, but generally involves a severely abnormal mental condition that significantly impairs a person's perception of reality and understanding of the charges faced. A defendant's mental health is decided by a judge or jury after evaluation and testimony by experts, usually psychiatrists.
State legislation in recent years has begun to address what victim advocates consider a gap in providing appropriate rights and services to crime victims.
* Alabama, Arizona, Arkansas, Indiana Maine, Minnesota, Pennsylvania and Tennessee require notifying a victim of a defendant's release from a mental institution.
* North Dakota gives victims the right to prompt notice if their offender is transferred to a mental heath facility. Virginia requires notice to the victim if the offender is allowed an unescorted community visit from the institution.
* Laws in Arizona, Connecticut, Maryland, Missouri and Pennsylvania allow victims to present and make statements at any applicable court or board hearings regarding the release of a mentally ill offender.
* Illinois allows victims to pursue a cause of action against a defendant who has committed a crime against them but has been found not guilty by reason of insanity not guilty by reason of insanity n. plea in court of a person charged with a crime who admits the criminal act, but whose attorney claims he/she was so mentally disturbed at the time of the crime that he/she lacked the capacity to have intended to commit a crime. or guilty but mentally ill. The case may be tried and damages recovered as any other civil case.
Whether a defendant is "not guilty by reason of insanity," or "guilty but mentally ill," these policies represent steps to see that the rights of victims are not discarded.
More information on victim rights and services is available in NCSL's recently published Victims Rights Laws in the States. You can reach NCSL's bookstore by calling (303) 364-7700 x 1621 or by logging on at www.ncsl.org/bookstore/index.htm.
--Sarah Hammond, NCSL
Donna Lyons heads NCSL's Criminal Justice Program in Denver, Colorado.