Wednesday, October 18, 2006


In my line of work, I come into contact with a fair amount of people who are mentally ill. It may surprise some people that this is the case, but in a state like New Mexico, services for the mentally ill are extremely limited, especially if they are indigent. Thus, many people who are bi-polar, schizophrenic, and mentally retarded end up in the court system. They get arrested when, for example, they are asked to leave a restaurant and will not do so because they believe they own the restaurant. Or, they get into a fight with the manager of the restaurant because they believe the manager is trying to poison them. Or, the police try to write them a ticket for pan-handling but they believe the police officer is going to shoot them, so they fight with the police officer. Or they just simply have nowhere to go and no way to get there, so they are arrested for loitering.

Generally speaking, I like my "crazy" clients. They generally aren't what one thinks of as criminals. And, even if they are with it enough to figure out who I am, they like that I am trying to help them, even if they can't figure out what I actually do for them. The idea that someone is on their side is usually fairly foreign to most of my mentally ill clients.

Under the Constitution, and the laws of New Mexico, a person cannot stand trial if they don't have a sufficient concept of what is going on, or if they are not grounded in reality sufficiently to help their attorney. If they think I am a member of an anarchist society the purpose of which is to hurt them in some way, or if they have no idea (and cannot learn) that the reason that man on the tall throne is wearing a dress is that he is the judge, the State is prohibited from proceeding in the criminal matter. When this occurs the judge can either dismiss the criminal case, or send the defendant to the state mental hospital to be "treated to competence." Usually, the "treatment" consists of medicating the person (with or without his consent) until either he is capable of understanding what's going on or 9 months have passed and the person still cannot understand the proceedings or assist his attorney. Either way, the person then is sent back to jail and the judge can do one of four things: He can dismiss the case if the person remains incompetent to proceed. He can proceed with the case if the person is now competent. He can commit him "civilly" to the state mental hospital, i.e. with no disposition of his criminal case, if he remains incompetent but is dangerous. Or, if the client remains incompetent and is charged with one of 8 very serious crimes, the judge can have a mini-trial about whether the person committed the crime he's charged with and sentence him to the "criminal" side of the mental hospital if found guilty.

The problem is this: If the criminal case is ultimately dismissed, the court no longer has authority over the client. The court cannot supervise the person to help him apply for disability, get to a doctor, get his medication, check that he's taking his medication, or find a place to live. The client is back in the same position he was in when he picked up the criminal charges in the first place, whether for things like loitering or vagrancy, self-medicating with illegal drugs, or wandering into other peoples' houses thinking it was their house.

Even if the person becomes competent through this process, either by a trip to the mental hospital or just getting on medications while in jail, there's definitely no guarantee that he will remain on his medications. I had one client that was fine when she got back from the mental hospital, so the judge let her out as soon as she got back and ordered the criminal case to proceed. She immediately quit her meds, and picked up new charges. So, before the case could progress through the system at all, she was incompetent again, and is now set for another trip to the hospital. This could go on indefinitely! And it probably will.

I like my incompetent people. But there has to be some way that we can get services in Podunk, New Mexico so indigent mentally ill people can get medication, stay on medication, and not have to resort to stealing or pan-handling for their livelihoods!

I mean I've had one guy three different times in 4 years. When he's off his meds, he beats up his girlfriend and the cops when they come to arrest him. His girlfriend can keep him on his meds for about nine months at a stretch. After that, he either picks up battery charges against his girlfriend or the cops. Then he goes to jail. Then he goes to the hospital. Then he comes back from the hospital and his case gets dismissed, because if the medicate him to the point he's not talking to invisible people, he's unable to sit through court. Then he stays on his meds for a while. Then he gets off them. Then he picks up new charges. Repeat process ad nauseum.

It's so frustrating that the "system" is unable to cope with this poor guy, and all my other clients like him.


mozartmovement said...

Very articulate. Have you considered presenting such information to your state politicians? Will any groups unite to avococate for the mentally ill in NM?

Ruth said...

I really don't know how. We do have an ARC here, but my understanding is that they deal primarily with the mentally retarded, rather than those with other mental illnesses. What is primarily needed is more funding for the existing mental hospital and more funding and training for organizations like PMS who do assign caseworkers to moniter the mentally ill. Also, law enforcement needs much more training in dealing with the mentally ill. The problem is that no one wants to spend tax dollars on such people when both the education system and the healthcare system are currently in trouble in this state. I would love suggestions on who to contact!

Sircellan said...

One solution, of course, is to levy more taxes so the money can be spent, but I know how popular that would be. About the only feasible solution is to have a volunteer organization or a charity get involved in supporting and following up these clients.

123txpublicdefender123 said...

Oh, I hear you, sister! The revolving door of the jail and the state hospitals for the mentally ill is one of the most disheartening parts of being a public defender, IMO. At my old office in Texas, we got a grant a couple years ago to set up a little unit to represent MI/MR clients charged with felonies and misdemeanors. Right now, they have one attorney and two social workers who work to take care of the criminal case, but also to set up mental health services, housing, and other needs for when they get out of jail. They can't possibly represent all of the MI/MR clients we get in that office, but they are able to do a lot of good with those who they do work with.

Ruth said...


That is a very good idea. We actually do have PD mental health unit, but it services the entire state and is located nearly 200 miles away from me. Due to their budget crunch, we tend to save them for the mentally ill clients who are charged with very serious felonies for which they can be committed to the hospital for a period of years not to exceed the maximum sentence. We do call them up periodically for advice, though. Perhaps I could talk my boss into plugging for additional mental health offices throughout the state. Or even just additional social workers to focus on this problem.