The Woes of Treatment Court

I blogged some time ago about the mental health court a judge was intending to start. Well, it has been started, more or less. The basic premise of the thing (contrary to my suggestion) is to make the mental health court a "special condition" of probation, similar to drug court. The participants are required to come to court weekly, attend individual and group counseling sessions throughout the week, show proof of taking medication as prescribed, do community service or keep a job if able to, and take drug tests. Initially, they are required to see a psychiatrist who would (hopefully) prescribe medication and/or adjust it as needed. As we initially had no (read "zero") funding from any source for this program, we began with five participants. Of the five participants, three were "non compliant" with the program. Two went to a 28 day drug treatment facility, and one disappeared before he actually began the program and is pending probation violation procedures.

Now, warning bells should go off. If 60% of the participants cannot "make it" in this program, there is either something wrong with the screening process to admit them into the program, or something wrong with the program itself. There are a couple reasons I see for what is going on. First, the most successful of those in the program (the 2 who both showed up and didn't end up in drug treatment) have traumatic brain injury, as opposed to an illness related to brain chemistry such as schizophrenia or bipolar disorder, which can be treated with medication. The only reason the two of them could not make it in regular probation is that they have memory and cognitive problems and just cannot process how to show up once a month at probation. These people do not need their medications monitored, etc. Further more, we (the committee) had decided at the beginning that a mental health court would not be of assistance to people with such a disability. They probably could make it through the program fine, but the program would not help them.

The people the program is intended to help are those other three people, two of whom are bipolar and one is schizophrenic. They get into trouble because they either self-medicate (usually with meth), or steal (for the thrill when they're manic, because they believe the things to be theirs, or because they can't hold a job due to their disability), or both. So, the program intended to help the mentally ill get back on track with their meds and housing and SSI is turning out to be simply drug court with extra conditions. The irony is that the service provider is the same as for drug court. My question: Why not just put them in drug court, since that's what's happening anyway? The personnel involved are exactly the same, it's just the participants that are different. This way, the federal grant we just got can be used for a diversionary type of program, which is much more acutely needed anyway.

Here's what I think a mental health court should look like: When a criminal defendant is transferred to district court "on competency," they might be referred to mental health court, especially if they are only facing charges for resisting an officer or battery on an officer. (Many of my competency clients have the police called on them because they are acting strange or creeping people out, the cops show up and they freak out.) If it is decided that such a defendant would be fine if properly treated, they would start the program. Their criminal case would be dismissed without prejudice. They would get a caseworker (which we do have available) to help them apply for SSI and set up housing. They would see a doctor to give prescriptions and monitor the meds and check in with someone to be sure they're on their meds. They would only have to give drug tests after they're meds are fully adjusted and have been allowed to take effect (say a couple or 3 months). Only then would they be punished for using meth or other drugs. The program would last 6 months to a year, and if they completed, their criminal case would remain dismissed. If not, it would be refiled, and we would deal with the competency issue at that point. The incentive to the client would be that they wouldn't have to sit in jail for 3 to 9 months waiting for evaluations or risk a 9 month trip to the state hospital to be treated to competence. (i.e. forcefully medicated) (Note: SSI is discontinued if a person is incarcerated for more than 30 days. Thus, if they had SSI before their arrest, they no longer have it when they're finally released.) The incentive for everyone else would be that we would save the county money by not having them in jail, we would save the state money by not sending them to the hospital, and (with any luck) we would help them break the cycle of committing new crimes as soon as they get released from jail on the old ones. If a defendant is found incompetent, the cases are ultimately dismissed anyway, except for the most heinous.

I mean, it makes no sense for my little competency guys to keep getting arrested, their cases (mostly misdemeanors, property crimes, or tangling with police or jail guards) dismissed once they're found incompetent, released from jail, then arrested again for the same or similar charges with no treatment in the interim. The best example I have of this is my guy that steals cars. He's clearly schizophrenic: he has auditory hallucinations (apparently quite a benevolent person, as my guy laughs a lot when listening to the voice). His cases (he stole 2 cars the same day) got dismissed when he was found incompetent and not dangerous (mandated by statute). Six hours after his release from jail, he stole another car, led the cops on a chase, and returned the car to the police parking lot. He also was arrested for the charge of "pedestrians in roadway," because he was apparently caught when whe was walking down the middle of the road, talking to his invisible friend after dumping the car. He has not been on meds since 2004, when he was committed to the state hospital. Now, there are two solutions to this: Either we can get the cops to quit arresting him no matter how many cars he steals, or we can give him an incentive to take his meds, and adjust them if they make him too listless (his problem with taking them is he doesn't like being sleepy all the time.)

Here's my main point (finally). We don't need "drug court plus" (as I've taken to calling it). We need some way to help my guy with the car problem to stay on his meds so he will quit stealing cars!

End of sermon.