Tuesday, March 31, 2009

Improving Outcomes for People with Mental Illness Under Community Corrections Supervision

From the Council of State Government's Justice Center: Improving Outcomes for People with Mental Illness under Community Corrections Supervision: A Guide to Research Informed Policy and Practice.

The Council of State Governments Justice Center announced today the release of Improving Outcomes for People with Mental Illnesses under Community Corrections Supervision: A Guide to Research-Informed Policy and Practice, which was supported by the John D. and Catherine T. MacArthur Foundation and the National Institute of Corrections, U.S. Department of Justice. The Guide reviews the body of recent research on community corrections supervision for people with mental illnesses and translates the findings to help officials develop effective interventions.
The number of people under community corrections supervision is at an all-time high nationwide-a March 2009 report from the Pew Charitable Trusts' Public Safety Performance Project confirms that more than 1 in 45 adults are on probation or parole. Based on other recent prevalence studies, the Guide indicates that an unprecedented number of these individuals have serious mental illnesses. These individuals are more likely than others to have their community sentences revoked, return to jail or prison, and become more deeply involved in the criminal justice system. This first-of-its-kind guide helps program planners and policymakers apply research on promising practices to improve outcomes for people with mental illnesses under community corrections supervision.

"More than 1.5 million people released from jail each year have serious mental illnesses and many will require special supervision strategies and treatments to safely and successfully rejoin their communities," said Nevada Assemblywoman Sheila Leslie, the specialty courts coordinator of the state's Second Judicial District and Justice Center board member. "State lawmakers in Nevada, as is the case everywhere, are concerned about the costs and public safety issues associated with high probation and parole revocation rates among people with mental illnesses. In particular, we need to improve how this population is supervised, and this report highlights the research we should use to inform state policy and funding decisions."

The Guide indicates that community corrections and mental health officials are increasingly aware that they are serving the same individuals without positive effect. It explores the extent to which people with mental illnesses become involved in the community corrections system, and why traditional supervision and treatment strategies are not generally effective for this population. It also summarizes evidence-based and promising programs, strategies, and techniques to improve results for the justice system and people with mental illnesses. The Guide discusses how the current body of knowledge can help shape agency operations, program design and implementation. Research questions that should be investigated further to expand the evidence base are also identified.

"Community corrections agencies and mental health treatment providers are trying to figure out the best ways to coordinate or integrate their efforts to better serve people with mental illnesses and tailor new programs in ways that reduce recidivism and encourage recovery," said Morris Thigpen, Director of the National Institute of Corrections. "The Guide is an exciting new resource for two systems that are coming together around commonly defined goals to tackle these challenges."

Friday, March 27, 2009

Mentally ill a threat in nursing homes (Soap Box Alert)

I've thought of many reasons to increase funding for those with mental illness, but I hadn't thought of this one:

CHICAGO — Ivory Jackson had Alzheimer's, but that wasn't what killed him. At 77, he was smashed in the face with a clock radio as he lay in his nursing home bed.

Jackson's roommate — a mentally ill man nearly 30 years younger — was arrested and charged with the killing. Police found him sitting next to the nurse's station, blood on his hands, clothes and shoes. Inside their room, the ceiling was spattered with blood.

"Why didn't they do what they needed to do to protect my dad?" wondered Jackson's stepson, Russell Smith.

Over the past several years, nursing homes have become dumping grounds for young and middle-age people with mental illness, according to Associated Press interviews and an analysis of data from all 50 states. And that has proved a prescription for violence, as Jackson's case and others across the country illustrate.

Younger, stronger residents with schizophrenia, depression or bipolar disorder are living beside frail senior citizens, and sometimes taking their rage out on them.

"Sadly, we're seeing the tragic results of the failure of federal and state governments to provide appropriate treatment and housing for those with mental illnesses and to provide a safe environment for the frail elderly," said Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform.

read the whole story here.

I honestly believe the argument that states that we need to do away with state hospitals and long term involuntary treatment is fallacious. You have the convergence of two ideological platforms - the conservatives who do not like public spending of social programs and the ultra liberalists who believe that all treatment should be voluntary and at the home, then you have the Szaszists who believe that mental illness is a fallacy. Each of these groups are outspoken to the legislature. However, my informal poll suggests the majority of us believe in something totally different, we're just not willing to pay for it.

In a perfect world, our communities would be free from drugs, have plenty of compassionate citizens willing to care for and fund treatment in the community, families would be able to care for and supervise their loved ones 24 / 7, patients would not have side effects and would always take their medication as ordered. Heck, while we're dreaming, we might as well wish for a cure!

But we don't live in a perfect world and, if you don't want your grandmother in the same placement as the 40 year old with schizophrenia, then be willing to pay for it! You've probably heard the saying, "As one door shuts, another opens;" if you shut the doors to the placements then you open the bars to the jail cells.

Some argue that we have become more humane by doing away with the old style insane asylums. I argue we've replaced them with jails and prisons. Shock treatments? Now we have tazers executed by mere H. S. graduates and shock belts. Gassing? Now the same use pepper spray. Straight Jackets? Now we have restraint chairs. Cold Wet Sheet Packs? Now we just take their clothes off and give them concrete to lay on. This is therapeutic treatment in the jails that you and I pay $100+ a day for these hardened criminals that commit the offenses of criminal trespass, criminal mischief, disorderly conduct.

Jail is not free, it is costly to the taxpayers. To house someone with mental illness costs anywhere from $80 - $140 / day.

Wouldn't it make much more sense to pay much less to house in an assisted living facility, group home, consumer ran group home, or an adult foster care? Why not be proactive rather than reactive. If you agree, let your legislators know. NOW is the time. We only have about 70 days, give or take, for the budgets to be determined. Tell them to fund mental health, re-entry bills, and mh parity bills.

Thursday, March 26, 2009

Wednesday, March 25, 2009

The Insanity Defense and Game Theory

In researching the proposed changes to 46C in HB 1150 & SB 168 I came across a journal editorial that compares Nash's Equilibrium in Game Theory to how the Insanity Defense COULD be utilized. It is worth the time to read. Having been printed in 2002, it is before Yates' original verdict was overturned, but that has little impact on the gest of the article.

Gov. Perry Appoints Four to Texas Board of Criminal Justice on Offenders with Medical or Mental Impairments Advisory Committee

From the Governor's Office News Section:

AUSTIN – Gov. Rick Perry has appointed four members to the Advisory Committee to the Texas Board of Criminal Justice on Offenders with Medical or Mental Impairments for terms to expire Feb. 1, 2013. The committee provides a formal structure for criminal justice, health and human service, and other organizations to communicate and coordinate on policy, legislative, and program issues affecting offenders with special needs.

John Bradley of Georgetown is the Williamson County District Attorney. He is a board member of the Texas District and County Attorneys Association and Williamson County Children’s Advocacy Center, and a member of the State Bar of Texas. He is also a past member and secretary of the Williamson County Bail Bond Board and a past member of the State Bar of Texas Committee on Crime of Victims and Witnesses. Bradley received a bachelor’s degree from the University of St. Thomas and a law degree from the University of Houston. He is being reappointed and will continue to serve as chair.

Kathryn J. Kotrla of Georgetown is associate dean of the of the Texas A&M University Health Science Center College of Medicine and chair of the Department of Psychiatry and Behavioral Science. She is a member of the Texas Medical Association, American College of Psychiatry, Society for Neuroscience, and Williamson County Medical Society. She serves on the Mental Health Transformation Work Group and Local Authority Network Advisory Committee. Kotrla received a bachelor’s degree from Rice University, a master’s degree in biology from Stanford University and a medical degree from the Texas A&M College of Medicine. She is being reappointed.

John L. Moore of Denison is a retired U.S. Marshal. He is a member of the Texas Sheriff’s Association, and a life member of the Texas National Guard Association, U.S. Disabled Veteran’s Association, and Texas Mounted Police Association. He is also a charter member of the National World War II Historical Museum. Moore served in the U.S. Army and Texas National and State Guard, and received the Bronze Star Medal by the U.S. Army, the Adjutant General’s Individual Award by the Texas National Guard and the Texas Medal of Merit by the Texas State Guard. He received an associate’s degree from Amarillo College and a bachelor’s degree from Wayland Baptist University. He replaces Lisa Kaufman of Georgetown.

Eulon R. Taylor of Austin is clinical director of Austin State Hospital. He is a member of the American Psychiatry Association, Texas Society of Psychiatric Physicians and Hastings Center of Bioethics. He served in the U.S. Navy as a staff psychiatrist, and received a bachelor’s degree from Southern Methodist University and a medical degree from the University of Texas Health Sciences Center San Antonio. He is being reappointed.

These appointments are subject to Senate confirmation.

Tuesday, March 24, 2009

Smith County DA, Matt Bingham, Speaks Out Against Postpartum Depression Defense

Matt Bingham does not support HB 3318 that provides that postpartum depression is a defense to infanticide with the penalty being 2 years in a state jail facility.

I would have to agree with him on this one, folks. If the mother meets the legal standards for insanity then 46C applies, if her mental health is a mitigating circumstance, then use it as such. This law provides for no standard definition of the level of mens rea. It makes no mandate for mental health treatment in the state jail facility or afterwards. This law sets a mother up for suicide. If mental health treatment is not mandated, nobody is going to donate it!

However, it gets Matt Bingham on the news talking about mental health issues which is an anomaly in itself!

Postpartum depression could be used as legal defense for mothers

Click here for the video.

By Courtney Lane - bio | email
Posted by Ellen Krafve - email

TYLER, TX (KLTV) - Texas could become the first state to have an infanticide law. Democratic state representative Jessica Farrar of Houston filed the bill earlier this month.
If the bill is passed, a mother who killed her baby and suffered from postpartum depression, would get a maximum sentence of two years in jail.

In 2003, Deanna Laney used rocks to stone and kill two of her sons. She was found "not guilty by reason of insanity." Smith County D.A. Matt Bingham says this new bill would not affect cases like Laney's. Instead, it would apply to mothers who suffer from Postpartum Depression - a far less severe illness.

"I think 80 percent [of new mothers] suffer from some form of Postpartum Depression after birth but most of them do not kill their children," said Bingham.

If they do suffer from depression, Bingham says jurors can already take that into consideration.

"But, they could never access two years in state jail facility, which is the same punishment you get if you write a 1500 hot check," said Bingham. "To me that's just ridiculous."

That's right. If the bill passed, a woman suffering from depression who killed her baby within 12 months of birth could only be sentenced to two years.

"When parents do such things to babies who are one day old to 12 months in this bill and they know it's wrong to do it, and they do it anyway, they should be prosecuted and they should be punished severely whether it's the death penalty or life without parole," said Bingham.

He says passing the bill would be a slippery slope because murder suspects already try to plead insanity. With this, mother's could use a far less severe illness, and one that's more prevalent to get away with a crime.

"If mothers know that this is out there, there's always a possibility that they can do something horrific like kill their child that's 12 months or younger and try to use this as a defense," he said.

Bingham believes the bill is too far fetched and will never pass. Postpartum Depression is recognized as a legal defense in some other nations, but nowhere here in the United States.

Shock Belt Pro Se

From the Dallas News Crime Blog:

Defendant representing himself in Dallas County case acts oddly before jury
Today, March 24, 2009, 4 hours ago | Jennifer Emily
Miles Fleming is representing himself in a Dallas County aggravated assault case.

That's odd enough.

But Fleming must wear a shock belt under his shirt. Yesterday, during jury selection, he lifted up his shirt to show jurors the shock belt amidst talking about how he is an outlaw.

A shock belt is a device meant to deter someone from acting out violently. Should a defendant try to hit someone or doing something else he shouldn't, a bailiff can remotely shock them with electricity.

Fleming, 38, apparently also thinks the free masons are out to get him.

This case is the talk of the Frank Crowley courthouse. Defense attorneys and prosecutors are stopping by to watch when they can spare a few minutes.

The jury will likely get the case this afternoon to decide guilt or innocence.

Fleming is accused of assaulting a coworker on a roofing job in July 2003. The assault happened not long after Fleming's girlfriend called to say she was cheating on him.

Monday, March 23, 2009

Input is requested on Understanding the Impact of Mental Illnesses on Parole and Probation Outcomes

Understanding the Impact of Mental Illnesses on Parole and Probation Outcomes
The Council of State Governments Justice Center is interested in understanding the impact of mental illnesses on parole and probation outcomes and specialized community correction responses for offenders with mental illnesses. A frequent barrier to understanding these issues is the lack of valid data on the prevalence and severity of mental illnesses on parole and probation caseloads. The Justice Center would like to identify probation or parole agencies with a high level of data analysis capacity and the ability to address the following questions:

1. Do you use a mental health screening process, and if so, does this process rely on a validated screening instrument (meaning research in has been conducted in the jurisdiction or in other localities showing that the screening accurately identifies mentally ill persons)? Is there an assessment process that follows screening? How is this information recorded (e.g. electronically or via paper records), who records it, and does it inform caseload assignments?
2. Is the mental health screening process or instrument standardized across counties and/or across jails and prisons?
3. What type of risk instrument is being used and has it been validated? How is this information recorded, who records it, and how does it inform caseload assignments?
4. Does the probation/parole agency have access to mental health information about referred individuals from jails/prisons? If so, how is this information transferred to the probation/parole agency?
5. Does the probation/parole agency have access to risk information about referred individuals from jails/prisons? If so, how is this information transferred to the probation/parole agency?

If you can shed light on these issues and would be willing to participate in a 45-60 minute phone interview, please email Hope Glassberg at the Council of State Governments (hglassberg@csg.org) or call 646-383-5737.

Court Innovations talks about Problem-Solving Courts

Court Innovations talks about Problem-Solving Courts. One discussion is the lack of best practices model courts or standardization.

Saturday, March 21, 2009

Changing Insanity Law in Texas

HB 1150 Thompson

Relating to the insanity defense in a criminal case.

Changes "know" to "appreciate," and allows that the jury is aware that the defendant will be committed to treatment if found NGRI.

More committee assignments

More committee assignments:

SB 1296 Hegar

Relating to the certification of a county jailer as a special officer for offenders with mental impairments.

Criminal Justice

SB 1323 Whitmire

Relating to the amount of a surcharge assessed on conviction of certain intoxicated driver offenses on the driver's license of certain persons who complete a drug court program.

Criminal Justice

This one reduces the surcharge on the driver's license of those that complete a drug court program. The large surcharge has been criticized by the drug court programs in being prohibitive in obtaining and maintaining employment extremely difficult, especially those requiring driving.

SB 1395 Zaffirini

Relating to the use of person first respectful language in reference to individuals with disabilities.

Health & Human Services

SB 1455 West

Relating to the operation of prison diversion progressive sanctions programs.

Criminal Justice

SB 1477 Uresti

Relating to certain judicial findings required before a court may order a person to receive extended outpatient mental health services.


SB 1505 Whitmire

Relating to the arrest and release on bail or other form of bond of certain criminal defendants with a mental illness or with mental retardation.

Criminal Justice

SB 1557 Duncan

Relating to the early identification of criminal defendants who are or may be persons with mental illness or mental retardation.

Criminal Justice

SB 1139 Hinojosa

Relating to the applicability of the death penalty to a capital offense committed by a person with mental retardation.

Criminal Justice

SB 1198 Van de Putte

Relating to the court-ordered administration of psychoactive medication to certain criminal defendants.

Criminal Justice

Actions referred to committees

Here are some relevant bills that were referred to committees yesterday, 3/20/09:

SB 1626 Wentworth

Relating to the reporting of certain confidential statements made to a mental health professional.

Health & Human Services

If passed, this bill compels mental health professionals to warn law enforcement if their client threatens a third party. At present, there is no duty to warn in Texas.

SB 1627 Wentworth

Relating to the collection of biometric identifiers of certain persons receiving inpatient mental health services.

Health & Human Services

Not sure of the utility or reasoning why we need the fingerprints and DNA of those committed to Vernon State Hospital. Any thoughts?

SB 1648 Van de Putte

Relating to providing outreach and behavioral health services to certain military service veterans and their families and providing for the creation of clinical practice guidelines.

Veteran Affairs & Military Installations

It would appear that this bill will allow DSHS funded community MHMR centers to provide behavioral healthcare to veterans. Also, these services would be reimbursed by the VA.

SB 1665 Wentworth

Relating to post-commitment treatment and supervision of persons with mental illness who are manifestly dangerous.

Health & Human Services

It would appear that the intent of this bill is to allow the conditional release of mental health patients who were once considered manifestly dangerous into outpatient treatment. It would appear that there is a great deal of conditions with a significant financial burden for community centers. Will the lege transfer the inpatient funding resources to the outpatient community centers? I seriously doubt it. This has always been the problem with outpatient commitment options. I would like to see the research and cost analysis on this proposal before I agree with it.

SB 1786 Whitmire

Relating to requiring the Texas Department of Criminal Justice to establish a comprehensive reentry and reintegration plan for offenders released or discharged from a correctional facility.

Criminal Justice

Looking at the text, this bill looks good, no, great! It even includes continuity with the family with special attention for the child(ren) of the offender. Again, funding is the key. There are some federal reentry grants out there, but these will only go so far.

SB 1847 Hegar

Relating to the provision of services to a wrongfully imprisoned person who is discharged from a correctional facility.

Criminal Justice

SB 1848 West

Relating to the provision of reentry, reintegration, and other services to a wrongfully imprisoned person who is discharged from a correctional facility.

Criminal Justice

I will look at committee assignments earlier in the week to see if there are anything of interest.

Friday, March 20, 2009

Texas Scores a "D" for Mental Health

Texas can brag that the impact of the economic crisis is mild, but try and tell that to the hundreds of thousands of people on waiting lists for mental health services. The National Alliance for the Mentally Ill (NAMI) gave Texas a D for Mental Health Services, down from a C in the 2006 report. Click here for the Texas Score Card and for the full report of the United States, click here. Innovations include Bexar County Jail Diversion, and urgent needs include funding for treatment in the community and improved access to services. Let's face it, if state hospitals are losing funding, and the advocacy groups want to close the state schools, where will these folks end up if not able to receive treatment locally? IN JAIL! This is a crisis driven system and all research supports that this is ultimately the most expensive system for the taxpayers. The best jail diversion and hospital diversion programs include plans to fund preventative and maintenance mental health programs. Pay a little now or a whole lot later! Would you rather spend $350 for one day of treatment at a state hospital because you are in crisis or $350 for one month in your community where you live? How much would you be willing to spend if it prevents a gruesome tragedy such as that in the case of Andre Thomas? Now we Texans will be spending $5 million to execute him (probably more in his case). How many people would $5 million treat and for how long? Texas taxpayers are saying to the Texas legislature that they are willing to risk tragedies such as that in Thomas' family AND the risk of having to pay the millions to execute him because it means we don't have to adequately pay for indigent mental health care. Would Texans rather live under this belief that the death penalty deters even the most psychotic, substance induced individual that we need to continue to funnel millions of dollars into supporting the death penalty when the cure can come in to the form of involuntary outpatient commitments and a $5.00 pill? Albeit, we cannot tell which person is the next Andre Thomas, but I guess for now, Texans are willing to risk it to save (or at least have the false belief they are saving) money. Email your legislator, tell them to fund mental health services. In this area, the waiting list is one year long!

Tuesday, March 17, 2009

My favorite bill so far

SB 1557 authored by Senator Duncan has to be my favorite bill so far.