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Visions of Justice VI
Mental Health and the Criminal Justice System: Opportunities for
Change
Co-sponsored by the Delaware Center for Justice (DCJ) and SURJ
April 22, 2005
Clayton Hall, University of Delaware
Click here to view
pictures from the event
Janet Leban, Executive Director
of the Delaware Center for Justice began the forum by thanking the
audience for their attendance and providing a short history of the
Visions of Justice forums. She also noted that the Delaware Center for
Justice was celebrating its 85th year of service. She introduced
Josh Templet, Executive Director of SURJ.
Josh discussed SURJ’s work and
presented a few facts and trends to the audience to sum up SURJ’s work
advocating for better mental health treatment in the criminal justice
system, and its work to reform the criminal justice system in other
vital areas: through sentencing reform (the repeal of mandatory minimum
drug sentencing laws); through advocating for better and greater access
to mental health and substance abuse treatment, both in our prisons and
in our communities; and by working towards sounder policies that support
better reintegration of ex-offenders back into our communities.
Josh noted a few alarming
facts:
·
Between 25% and 40% of all Americans with mental illness
will at some point pass through the
criminal justice system.
·
In the United States, there are three times more mentally
ill people in prisons than in mental health
hospitals.
·
Correction Commissioner Stan Taylor reports that 13% of
inmates have a serious mental
illness. 13% of 6,700 translate to some
870 inmates with a serious mental illness in our prisons.
·
A national report finds that “Only 6 in 10 state inmates
with a mental illness reported receiving
treatment since their
incarceration.”
He also noted that a 2003 Human Rights Watch report
states that: “The growing number of mentally ill persons who are
incarcerated in the United States is an unintended consequence of two
distinct public policies adopted over the last thirty years”:
·
First, many mental health hospitals have shut down in the
past few decades as part of a
“deinstitutionalization” effort that began
in the 1960s.
·
Second, elected officials have embraced punitive
anti-crime efforts that have contributed to an
increasingly
over-extended criminal justice system, through the creation of mandatory
minimum drug
sentencing laws, and other “tough-on-crime initiatives;”
which have had the greatest effect on non-
violent drug offenders or
other low-level offenders.
Josh explained SURJ’s work towards eliminating
mandatory minimum drug sentencing laws in Delaware. He explained that
these “one-size-fits-all” laws do not give judges the discretion to
identify mitigating and extenuating circumstances of each case before
them; such as mental health illness.
Janet introduced moderator, Jim
Lafferty, Executive Director of the Mental Health Association in
Delaware. Mr. Lafferty shared a letter that the Mental Health
Association received recently from an inmate in Delaware. This man; who
has been in prison since the age of 18 and who is about to complete a
thirty year sentence; expressed his fears about his upcoming release.
He explained that he has significant mental health problems and he
doesn’t know if he will be able to succeed outside of prison. Mr.
Lafferty explained that many incarcerated people with mental health
illness feel this frustration and fear; and this may explain why so many
cycle in and out of the criminal justice system.
Mr. Lafferty introduced Fred C.
Osher, MD, Director of the Center for Behavioral Health, Justice,
and Public Policy, and an Associate Professor of Psychiatry at the
University of Maryland, School of Medicine. Dr. Osher has published
extensively and provided comprehensive training in the areas of
homelessness, community psychiatry, co-occurring mental and addictive
disorders, and effective approaches to persons with behavioral disorders
who have contact with the criminal justice system.
Featured presenter, Dr. Osher, began
his hour-long presentation by challenging the audience with the
question: “Why do we care?” [about people with co-occurring disorders
who cycle in and out of the criminal justice system]. He expressed his
belief that we should care because “there are folks out there who need
help and their needs just aren’t being met.” He also explained that a
common goal towards the reduction of unnecessary incarceration and the
increased linkage to treatment and community-based alternatives would
also reduce excessive incarceration and associated costs.
Dr. Osher illustrated this point by
discussing two case studies:
·
Kevin, a 33-year-old, schizophrenic, homeless,
alcoholic male, had been in and out of Los Angeles jails on several
occasions for misdemeanor offenses. Four years ago he was arrested for
taking a shopping cart from a supermarket lot. He was ordered into four
points of restraints for “threatening behavior”. When the police
officers took a sandwich from him, Kevin began to kick and struggle. It
took eight minutes and nine LA Sheriff Department officers to strap him
down. Sometime during that process Kevin died of asphyxiation.
·
Helen, a 35-year-old, homeless woman with Bipolar
Affective Disorder and a drug addiction, had been released from prison
after serving 14 years behind bars. She was convicted of the murder of
her stepfather at age nineteen; a man who had sexually abused her from
the age of six until she left home at seventeen. She began to use heavy
drugs at age 15. While in prison she was diagnosed with mental illness
and was given Lithium. Upon release into a large city; with no place to
live, no one to turn to, no medication, and no money; Helen began to
look for a place to live. She attempted to look for temporary housing
with the YWCA, but they would not accept her. She began to panhandle on
the streets, and within a few days was stabbed in the stomach in an
attempted robbery. She was sent to the hospital and given an emergency
hysterectomy. Ironically, the YWCA was able to provide her with housing
at this point because of her medical condition. Her mental illness
caused her to hallucinate, hear voices and lose sleep. Soon she made
clear her intentions that she wished to go back to prison. Within
weeks, she was arrested for selling narcotics and was returned to
prison.
Dr. Osher explained that he used these case studies
to show that these kinds of stories are not unique. Both Kevin and
Helen did not have the resources to survive in the community. The
people who came across them, and probably others like them, did not
understand their conditions and how to effectively deal with them, which
consequently led to tragic conclusions for these two individuals. These
kinds of situations occur every day.
Dr. Osher explained the magnitude of
the problem by showing that skyrocketing incarceration rates have had
ill effects on vulnerable populations. He explained that:
·
The United States has the highest per capita incarceration
rate in the world;
·
1 out of 10 Black males age 20-29 are incarcerated;
·
There are 3-5 times more people with mental illness in
jails than in the general population;
·
¾ of those with mental illness who are incarcerated meet
the criteria for having co-occurring
disorders (mental health and
substance abuse disorders);
·
45% of people who first approach a mental illness center
have had some form of contact with the
criminal justice system;
·
Many of these people cycle in and out of mental health
institutions and criminal justice institutions
(trans-institutionalization);
He explained that this problem occurs because:
·
People with mental health illness are arrested at
disproportionately higher rates because:
o
Jails and prisons are sometimes used as last resort
housing to get homeless people off the
street;
o
They often have co-occurring disorders and are
consequently caught with illegal drugs;
o
“The War on Drugs” and other punitive drug sanctions have
led to a greater number of
people being incarcerated for drugs;
·
Those with mental health illness are generally
incarcerated for longer periods of time than others;
o
Corrections officers don’t understand the nature of the
illness and incarcerated environments
have many situations of high
stress that are particularly difficult for those with mental illness to
deal with. People with mental illness are more likely to act out and
disobey rules, so they
end up staying incarcerated longer;
·
They have high recidivism rates on reentry; and
·
Inadequate access and quality of mental health and
substance abuse treatment both within and
outside of correctional
settings leave them ill-prepared to support themselves in the community;
they
leave prison with little to no treatment, and upon release don’t
know where to go to get treatment,
can’t afford their medications, and
have difficulty finding employment because of their illness and the
stigma associated with their incarceration.
Dr. Osher explained that change is necessary, not
only because it is the right thing to do, but because not changing is
costly: in terms of money, public safety; and public health. Treatment
has been proven to work, Dr. Osher explained. Research has shown (Patty
Griffin, Philadelphia) that people move through the criminal justice
system in predictable ways, and along that path there are several points
of contact where “interception” can occur so that mentally ill people
are getting the treatment they need, and do not become a public safety
risk. Giving mentally ill people the treatment they need in the
correctional setting, better preparing them for reentry, and providing
adequate support upon release will lower recidivism rates, improve
public safety and decrease unnecessary incarceration.
Dr. Osher explained that a common
question is: “Diversion to what?” Dr. Osher explained that instead of
incarcerating these people we should find ways to direct them to
community based programs that will help them with their treatment, help
them find housing, provide them with their medical needs, and help them
find employment. Dr. Osher said that “problem solving courts” such as
Drug Courts and Mental Health Courts have reduced unnecessary
incarceration of mentally ill people and have helped these people find
ways to be successful in their communities. Dr. Osher also explained
that in some parts of the country police dispatchers and officers are
trained to recognize mentally ill individuals and have learned effective
de-escalation methods of dealing with them. Emergency rooms have also
improved the intake of these people when they are dropped off by police
officers. This has, in turn, significantly reduced the time police
officers have to spend on emotionally disturbed persons calls, and
allows them to get back to patrol much sooner.
In jails and prisons nation-wide, Dr.
Osher pointed out, correction officers and inmates are trained to
recognize mentally ill people in distress and constructively work with
these people so that crisis situations don’t occur. Some prisons have
inmates who are trained to recognize suicide warnings and signs of
depression.
Across the country, both federally and
in the states, policymakers and corrections professionals are working
towards better reentry initiatives and programs that would help in the
transition out of prison.
Dr. Osher concluded his speech by
suggesting that the best avenues to success would be to build a greater
scientific research base; to expand how the incarceration of mentally
ill individuals affects other larger societal issues; address the stigma
and discrimination against mentally ill individuals; and develop
meaningful partnerships with community-based programs, policymakers,
corrections officials and others to solve this problem.
Mr. Lafferty introduced joint
presenters Susan McLaughlin, Director of the Treatment Access
Center (TASC) and Judge Joseph F. Flinkinger, III, Mental Health
Court Judge.
Judge Flickinger and Ms. McLaughlin
discussed the many steps that were taken to initiate the creation of the
Mental Health Court Pilot Program, and thanked the many people who
contributed to seeing the proposed project become reality.
Ms. McLaughlin explained the basic
aspects of the court:
·
The Mental Health court is voluntary and requires the
forfeiture of trial. Some people who are
applicable for the program
take plea bargains with a preference for sentencing rather than go
through the program.
·
The Mental Health Court is part of the Court of Common
Pleas and deals only with misdemeanor
cases.
·
The offender is selected by a criminal justice screening
through the office of the Attorney General and
through a clinical
assessment by TASC. An addiction severity index is also created, and
data is
collected from community agencies that may have worked with the
offender in the past.
·
Entry hearings occur twice a month on Tuesday mornings
where the offender must agree to
participate for atleast 4 months.
·
The offender meets with a caseworker and they formulate a
custom-tailored plan specific to that
person’s needs.
·
The judge reviews this plan, accepts the plea, and defers
conviction while the offender is in the
program.
·
The offender immediately begins casework with TASC.
·
Status conferences are heard on Thursday afternoons in the
court. The judge hears the cases from
best to worst (in terms of
offender following their treatment plans). Judge Flickinger noted that
these
status hearings are times for encouragement, back patting, and
other very “un-judge-like” behavior.
As the most successful cases
leave, Judge Flickinger intentionally becomes sterner and harsher.
·
When the offender is not doing well in the program,
intermediate interventions are put in place:
o
Offender, caseworker and judge reevaluate case schedule
and plan;
o
Some offenders enter residential treatment;
o
Judge puts out a jeopardy contract that warns that unless
improvement is made, termination
from the program will occur.
·
Termination occurs when:
o
there is a failure to attend treatment;
o
there is a violation of program rules;
o
the offenders uses illegal drugs and/or alcohol; or
o
when there is a failure to observe or respond to
intermediate interventions.
·
The offender must pay $46.00 in court fees, $50.00 for the
public defender, and whatever restitution
is owed.
·
Graduation occurs when:
o
there is active involvement for a minimum of four months;
o
the goals laid out in the plan have been completed;
o
the offender has complied with treatment and medication
prescriptions;
o
the offender has shown a commitment to staying drug free;
o
and there is no other criminal activity.
·
At graduation the judge comes off the bench to
congratulate their successes and to offer them
certificates for their work.
Ms. McLaughlin noted that TASC has an open door
policy for these men and women after they graduate. TASC provides
clients with calendars so that they can stay organized, and encourage
them to continue the work that they started in the program. Ms.
McLaughlin noted that the TASC office sees many Mental Health Court
graduates long after they have completed the program. Similarly, Judge
Flickinger said, “We have yet to have someone say, ‘I’m graduated; I’m
done with treatment.’”
Of the 55 people who received services
in the last year: 26 successfully completed the program, 2 people were
terminated from the program, and none of the original graduates have
recidivated.
Judge Flickinger offered some
reflections on the Mental Health Court program. He gave credit to the
people who planned the program: the Public Defenders’ Office, the
Attorney General’s office, and the Treatment Access Center. He
explained that over time, he has seen incredible diversity in the
program; people from all walks of life. The crimes committed are most
often: resisting arrest, lewdness, public intoxication, prostitution,
petty theft, etc. These are not people who typically would go to jail,
he explained, unless they violated the conditions of their probation.
Many have problems with substance abuse. Judge Flickinger ended the
presentation by expressing his interest in seeing this program expand to
all three counties, and also expressed his interest in seeing felony
offenders get a chance to go into the Mental Health Court.
Mr. Lafferty introduced Jeremy
McEntyre next and explained that he and Don Napoli from First
Correctional Medical were called in to present on Dr. Martha Boston’s
behalf. She had some business that she had to attend to and could not
make the forum. Mr. McEntyre is the Acting Regional Supervisor for
First Correctional Medical.
Mr. McEntyre informed the audience that
of the roughly 6,600 inmates incarcerated in Delaware, 13% need some
kind of mental health treatment. First Correctional Medical employs 30
full time mental health staff that work in all of the correctional
institutions.
He explained that when an offender
first enters prison a nurse evaluates them for medical needs within two
days. Within fourteen days of arrival there is a more comprehensive
mental health assessment. Every thirty days those in need of mental
health treatment meet with a psychiatrist to receive counseling and
medication. Some institutions have an infirmary for very severe mental
health cases. For those people who become segregated from the rest of
the inmate population because of their mental health disease, the First
Correctional Staff will intervene and work with that inmate to find ways
for them to be feel less isolated. Mr. McEntyre explained that when
they can’t provide services for inmates with serious mental health
illness they refer them to the Delaware Psychiatric Center.
When the inmate is
scheduled to return to the community, the mental health staff does
psycho-educational training with the inmates to prepare them for
reentry. They also work with the Department of Correction and train
Correctional Officers to recognize important signs of mental health
illness. This collaboration with the Department of Correction also
ensures that inmates have a thirty day supply of their medications upon
release, and that they are connected with community treatment programs;
they have even done family sessions to make sure that families are aware
of the inmates needs. Mr. McEntyre did point out that there is a “large
and quick turnaround of many of these individuals” and that sometimes
they don’t have a chance to prepare for reentry. He also noted that a
particular challenge was treatment for sex offenders; they have
extremely limited services and resources for these men and women.
Don Napoli, Supervisor for First
Correctional Medical at Howard R. Young Correctional Institute (formerly
Gander Hill), spoke last. He explained that of the 1500 inmates in the
prison, 230 of these men have mental health problems. He expressed his
belief that some people get treatment for their illness for the first
times in their lives in prison. He explained that as Gander Hill is
both a jail (less than 6 months stays) and a prison, the turnover rate
is very large. This does not leave a great deal of time for either
mental health or substance abuse treatment. They do mental health
assessments every two weeks.
Mr. Napoli agreed that there was a need
to tighten up discharge planning. He explained that obstacles on the
outside make it hard for ex-offenders to succeed, so they often
recidivate (don’t have insurance, their medications run out, they can’t
make their appointments, they start abusing substances again). He
explained that a large number of the men have substance abuse problems
(co-occurring disorders).
Mr. Napoli cited data from the Delaware
Statistical Analysis Center that showed that offenders who participated
in the Key treatment program through Levels V, IV and III had a much
greater chance of success than those who did not get treatment. Those
who only received the treatment in the Level V institution did not show
much difference in recidivism rates than other offenders. This showed,
Mr. Napoli said, that the success was in the aftercare and in the
transition out of prison. “Wouldn’t it be great,” he asked, “if we
could have a seamless aftercare…the same psychiatrist throughout prison
and probation?”
The floor was then opened up for
questions to the presenters.
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