Tuesday, July 28, 2009

Mother Decapitates 3 1/2 Week Old Newborn

This is such a preventable tragedy. Mental illness has many victims and this is probably the most blatant example. We can't bring baby Scott back, but we can prevent it from happening again. These issues break my heart and I'm sure I will write more about this as I have more time.

from My SA:

It was Sanchez's mother who called police Sunday. She told them she was awakened by Sanchez around 4:30 a.m. She said she saw her daughter sitting with the boy. He had been decapitated, a police report said. Sanchez's mother took the baby, put him on a bed and called police, according to the report.

When police arrived, Sanchez was sitting on a couch, yelling, “I killed my baby. I want to die,” the report said.

An officer found the child's body lying in blood on a bed next to the knife, believed to be the weapon used in the killing, and two swords, which Rios said were not involved in the death. Authorities were seen carrying two bags out of the home, and officials on the scene confirmed that they contained the baby's remains.

The baby was missing body parts, and police were investigating claims the mother made to them about ingesting those parts, sources said.

Colchin was surprised to hear that Sanchez, who brought her baby across the street for a visit last week, is a suspect in the infant's death, though she admits Sanchez sometimes appeared a bit odd.

“She was never aggressive; always sweet,” Colchin said. “She did seem to be living in a world of her own, but she must have been deranged. I feel so sorry for that baby, the little angel.”

Rios said Sanchez did not have a criminal history related to mental illness, but police will investigate that further, and the district attorney's office will handle how Sanchez's mental state affected her actions.

Here's an update:

Sanchez told detectives that she was “hearing voices” and the devil made her kill her baby boy, who was born June 30.

The Bexar County district attorney's office will review the detectives' recommended capital murder charge, which is punishable by the death penalty.

“You can still be prosecuted if you have some form of mental illness,” said First Assistant District Attorney Cliff Herberg. “The test is if you understand the difference between right and wrong. The question is whether or not you know your act is wrong.”

Dr. Lucy Puryear, a Houston psychiatrist and author, said mothers who experience postpartum psychosis often have a history of other mental disorders, but in some cases childbirth triggers the psychosis.

“It's usually really severe,” Puryear said.

Puryear testified as an expert witness in the case of Andrea Yates, who drowned her five children in Houston in 2001.

While postpartum depression affects one in 10 mothers, Puryear said, the more severe postpartum psychosis — which includes hallucinations — affects one in 1,000.

“In all of the (high-profile) cases, the thinking involves the babies: The mother had to kill the baby to protect it, or God has spoken to the mother and there is a mission to kill the baby, or sometimes the baby is the devil, who needs to be gotten rid of to save the world,” she said.

Relatives said Sanchez's mental health severely deteriorated in the week before Scotty's death. On July 20, she moved out of the home she shared with the baby and his father near Windcrest.

The same day, she checked herself into a hospital after hearing voices, but she soon checked herself out, according to a source familiar with the investigation but unauthorized to speak to the media. She then took the baby to stay at her mother's home.

Buchholz said he called her every day to convince her to return, to no avail.

She finally reappeared about 2 p.m. Saturday at Buchholz's parents' home on the Northeast Side.

“We were so happy to see Scotty again,” Buchholz said.

She was at the home for about 15 minutes when Buchholz told Sanchez that he needed a copy of Scotty's birth certificate and Social Security card. The request seemed to “set her off,” Buchholz said.

“She grabbed the baby and just said, ‘I gotta go. I gotta go. I'm out of here.'”

His mother called 911, and a sheriff's deputy arrived to investigate the incident as a disturbance, court records show.

That night, while Buchholz was attending the Judas Priest concert, he received a cell phone call from Sanchez.

“She told me she had found someone else and she never wanted to see me again,” he said.

Police think she killed the baby six hours later.

The couple's volatile relationship was on and off for the past six years, ever since they met while enrolled in the San Antonio College of Medical and Dental Assistants, but they became dedicated to making it work after learning Sanchez was pregnant last year, relatives said.

“She took really good care of herself during the pregnancy,” said Buchholz, who also has been diagnosed with schizophrenia. “We were excited about having a baby.”

Monday, July 27, 2009

Mentally Ill Immigrants Have Little Hope For Care When Detained

Mentally ill immigrants have little hope for care when detained
11:20 PM CDT on Sunday, July 12, 2009
By EMILY RAMSHAW / The Dallas Morning News
AUSTIN – Jose Fernandez Sanchez was delusional when he broke a window to enter his neighbor's apartment. The schizophrenic and epileptic 45-year-old, who had gone to an Austin hospital the day before, complaining of hearing voices, told police he was trying to light a candle for his dead mother. But instead of taking Sanchez to get medical attention, authorities started deportation proceedings against him, leaving the legal permanent resident in a detention-center cell for eight months. By the time a judge saw Sanchez, he was so catatonic that he couldn't answer a simple question.
Sanchez was one of the lucky few: His siblings pooled their money to hire an attorney, who made a compelling case to an immigration judge. Sanchez went from the detention center to a San Antonio psychiatric hospital, where he should have been all along.
But most mentally ill immigrants aren't so fortunate. They get limited mental-health care while in detention, advocates say – and that's only if they're diagnosed. They aren't entitled to competency hearings before standing trial. And the majority of them face judges without legal counsel, and with little recourse to defend themselves from deportation.
"I felt like I didn't have the power to get help. They didn't care how they were taking care of me," said Sanchez, who emigrated from Mexico in 1988 and received amnesty in the United States. "I was very scared, because I knew if I was sent back to my country, they wouldn't be able to help me like the U.S."

National guidelines

Immigration detention officials say they have strict guidelines for mental-health care in detention centers. All inmates receive a mental-health screening as part of their intake exam, they say. Those with suspected mental illness are referred for more tests and treatment. In fiscal 2008, detention-center personnel performed nearly 30,000 mental-health interventions – including providing emergency care to detainees seen as suicide risks.
"We are continuing to work ... to improve the services and the availability of health care to those in our custody," said Tim Counts, spokesman for U.S. Immigration and Customs Enforcement.
But immigration court officials acknowledge there's little guidance for how to handle mental health once these detainees come before a judge. Although judges can't accept an admission of guilt from an "unrepresented incompetent," there are no immigration-court proceedings to determine a person's competency. Judges have to go with their gut – which can be tough to gauge with language barriers and the frequent use of long-distance video conferencing.
"There are no rules or any guidelines or any laws related to determining mental competency," said Elaine Komis, spokeswoman for the Executive Office for Immigration Review, which oversees deportation hearings for the U.S. Department of Justice. "When judges encounter someone who seems to be mentally incompetent, they do try as much as possible to arrange for some kind of pro bono counsel."
Social-justice advocates say that's not good enough. Researchers from the nonprofit advocacy group Texas Appleseed have teamed up with pro bono attorneys from the Akin Gump law firm to study mental-health procedures in detention and deportation proceedings. Their focus is on Texas, which houses a third of the country's immigrant detainees and is home to eight of the nation's 55 immigration courts.
These advocates say detention facilities don't consistently follow mental-health standards, and often don't have enough mental-health workers to handle the estimated 15 percent of detainees suffering from mental illness.
Until early this year, they say, two Texas detention centers housing a combined 2,700 people shared a single psychiatrist. As a result, they say, detainees who receive mental-health treatment in the community rarely get it once they're incarcerated. They miss medicine doses, get misdiagnosed or are prescribed drugs with which they aren't familiar.
"There are no real standards for diagnosing or dealing with mental-health issues while in the system," said Steve Schulman, a partner with Akin Gump who heads the firm's pro bono practice.

Lack of hearings

Advocates say that even if someone is diagnosed with mental illness in the detention setting, it's rare for that to get passed along to a judge.
Unlike in the criminal- justice system, there are no mental-competency hearings. Fewer than half of detainees have legal representation. Immigrants represented by attorneys are 50 percent more likely to avoid deportation, but the government has no obligation to appoint counsel for those who can't afford it.
"The end result is that people are being deported without regard for their mental health," said Ann Baddour, senior policy analyst at Texas Appleseed.
In one case, advocates say, a severely mentally ill woman was nearly deported to Russia because she told authorities she was a Russian immigrant. She was actually a U.S. citizen from Indiana. In another, a Haitian immigrant whom a criminal court had declared incompetent to stand trial was taken into custody by immigration officials at a psychiatric hospital.
Sanchez's siblings are sure their brother would have wound up back in Mexico – or worse, dead – if they hadn't been able to hire an attorney.
"He was never evaluated properly, never given proper treatment," said Sanchez's brother, who asked not to be identified because of his immigration status. "He was all alone in there. We feared the worst, that he would be deported or even take his own life."

Saturday, July 25, 2009

The Bradley Report: Lord Bradley's Review of People with Mental Health Problems or Learning Disabilities in the Criminal Justice System (UK)

Results are presented from a "six-month independent review to determine to what extent offenders with mental health problems or learning disabilities could be diverted from prison to other services and what were the barriers to such diversion" (p. 4). This report is divided into the following six chapters: setting the scene; early intervention, arrest, and prosecution; the court process; prison community sentences, and resettlement; delivering change through partnership; and annexes. The "Government's Response" is also attached.

Spotlight on Chief Justice Mental Health Task Force

According to the Website:
The Council of State Governments Justice Center announced February 19, 2007 (link to Press Release) that Texas’s Court of Criminal Appeals has been selected to participate in the Chief Justices’ Criminal Justice / Mental Health Leadership Initiative. This is a national project designed to assist state supreme court chief justices in guiding efforts in their state to improve the response to people with mental illnesses in the criminal justice system. The Honorable Sharon Keller, Presiding Judge of the Court of Criminal Appeals, and Chair of the Task Force on Indigent Defense, has created a Mental Health Task Force to address problems involving people with mental illness who are in the criminal justice system. She applied to the Council of State Governments for outside funding and technical assistance for the committee.

Does this Task Force still exist? The website indicates that they had 5 meetings in 2007, but that is it.

Here's a copy of their work plan.

Thursday, July 23, 2009

Act Now to Prevent the Incarceration of People with Mental Illness

Take Action!
The criminalization of people with mental illness is a growing problem that devastates many members of our community. A study released this month in the journal Psychiatric Services shows that the prevalence of people with serious mental illness in jails is increasing. The study, which was presented June 1st at a Senate briefing featuring NAMI National board member Fred Frese, found that overall, 16% of jail inmates have a serious mental illness. Even more alarming, 31% of female jail inmates have a serious mental illness. These numbers suggest that up to 2 million jail bookings every year involve an individual with serious mental illness. From NAMI.org

Tuesday, July 21, 2009

Re-Entry Assistance from the National Institute of Corrections

Now Available: Technical Assistance for States through the National Institute of Corrections’ Transition from Prison to the Community (TPC) Initiative

The National Institute of Corrections (NIC), part of the US Department of Justice, launched its Transition from Prison to the Community (TPC) Initiative in order to articulate a comprehensive and strategic approach to transition from prison. The result has been the creation of the TPC Model, which in part reflects the accomplishments of eight states who have made significant progress in enhancing their reentry practices to bring about increased community safety through successful offender reentry. See The TPC Reentry Handbook: Implementing the NIC Transition from Prison to the Community Model, which can be found at http://www.nicic.gov/Library/022669 for an overview of their accomplishments and a full description of the Model. A web-based version of the Handbook will be available soon at http://www.prisontransition.com.

NIC is now pleased to announce the beginning of a new phase of its TPC Initiative that will support technical assistance in up to six additional states. Competitive applications to participate in this phase of the TPC Initiative are due August 17, 2009. This assistance is intended as a resource for state jurisdictions willing and able to work with NIC technical assistance providers to put into place the principles, approaches, and strategies that make up the TPC Model. Assistance will be provided in the form of a “site coordinator” who will provide advice, facilitation, and access to other project resources such as cross-site exchanges, and access to a network of practitioners from the original eight TPC sites. The project will also include the support of an evaluation specialist from the technical assistance team to guide each participating jurisdiction’s efforts to design and implement a measurement and evaluation strategy.

To hear and see a recording of a webinar, held on July 16, 2009, for potential applicants to have their questions answered about the initiative and the application process, click here. To download and view a PDF of the presentation from the webinar, click here.

Collaborative partnerships involving a state’s key correctional agencies—agencies responsible for prisons, for discretionary release/setting of conditions/responses to violations of post-release supervision, and post release supervision—are welcome to apply. For more detailed information about this exciting initiative, and to access the solicitation and proposal requirements, please visit the National Institute of Corrections Web site at http://www.nicic.gov/TPCModel. For a copy of the application kit click here. The application can be filled out electronically, however, applications must be printed and mailed in hard copy to the address noted in the kit.


Sex Offender Registry Laws: Based on Science or Fallacy?

Sex Offender Registry has been under much scrutiny here lately as discussed on Grits for Breakfast. Are sex offender laws based on scientific evidence or the appeal to fear fallacy? This literature review will help to answer this question.

Monday, July 20, 2009

Mentally Ill Woman Admits to Setting Fires

Woman arrested for setting Far East Dallas apartment fire admits to setting other blazes
Yesterday, July 19, 2009, 9:40:33 PM | Scott Goldstein/Reporter
Ebonia Collins suffers from mental illness and had not taken her medication for one month, according to police documents.

Perhaps that is part of the explanation for why she admittedly set a fire that destroyed an entire building in a Far East Dallas apartment complex Thursday evening. She also told Dallas Fire-Rescue investigators that she set two other fires in the Millennium Pointe Apartments in the 2900 block of Dilido Road. One was a mattress fire and the other was a dumpster fire.

Luckily, only one person was hospitalized following the Thursday fire that caused more than $600,000 in damages. A teenage boy hurt himself jumping from his third-floor balcony.

In a rather dramatic scene, Collins was spotted by shouting residents as the fire was still burning Thursday night. Cops, fire officials, residents and news reporters ran after her and she was taken into custody near the scene.

She's in the Dallas County Jail tonight on an arson charge. Her bail was set at $10,000.

Army Documents Link Between Murder and Mental Illness

Army Documents Link Between Murder and Mental Illness
July 20, 2009

News Summary

Combat stress and behavioral-health problems were underlying causes in most cases where soldiers at a key Army base committed murder after returning from war zones, the Colorado Springs Gazette reported July 15.

The report came after a half-dozen Fort Carson, Colo., soldiers were charged with murder over a six-month period last year. "Soldiers allegedly involved in crimes related to homicide at Fort Carson from 2005-2008 were, in retrospect, at risk for engaging in violent behavior based on a clustering of known risk factors for violence, namely prior criminal behavior and psychopathology," the report said.

Army officials said that a mix of addiction problems, mental illness and leadership failures -- including inadequate attention to identifying and treating soldiers' underlying problems -- contributed to the killings. "Those three in combination are a really toxic mix," said Army surgeon general Lt. Gen. Eric Schoomaker.

The report also noted a possible correlation between the degree of combat exposure and the likelihood of engaging in violent crime when soldiers return home, although Army officials refuted that connection, noting a broader study showing that 65 percent of crimes committed by Army personnel were attributed to soldiers who had not been to war.

Fort Carson officials said the findings have led to more intense efforts to train personnel to recognize signs of mental illness and ensure that soldiers who test positive for drugs or are identified as problem drinkers get addiction treatment. Most of the soldiers who committed murder in and around the Colorado base had a history of addiction problems, but fewer than half had received treatment, the Army study found.

Thursday, July 16, 2009

Prevalence of Serious Mental Illness Among Jail Inmates

Download pdf.

The current rates of mental illness among inmates in five jails (two in Maryland and three in New York) are investigated. There are 13.5% male and 31.0% female inmates with serious mental illness. While "[t]here is broad consensus that jails are not the optimal settings to provide acute psychiatric treatment . . . the substantial presence of individuals with serious mental illnesses in our country's jails . . . calls for a clearer explication of the contributing factors and discussion of appropriate responses"

Wednesday, July 15, 2009

Making the case for treatment: Details on the interface between a local care system and the criminal justice system

Making the case for treatment
Details on the interface between a local care system and the criminal justice system
by Kate K.V. Lawson, MPA; Michael R. Berren, PhD; and Neal Cash, MS

The situation is not uncommon: A family member of an individual with a mental illness calls local law enforcement as a “last resort.” A situation has escalated to the point of being a crisis and, for everyone involved, it appears as though all other options have been exhausted. While the call is generally a last-ditch effort to ensure safety for the individual and/or others, law enforcement’s presence often results in the individual with a mental illness being arrested or detained.

In addition to this scenario, it is not unusual for individuals with a mental illness to become involved in the criminal justice system for crimes that often are a consequence of their illness and/or social situation (such as vagrancy because the individual often has nowhere else to go). They then must manage the difficult task of negotiating a complicated criminal justice system while attempting to reengage in treatment.

The criminalization of mental illness is hardly a new topic. It has been written about for decades, with an article by Abramson (1972) being one of the earliest.1 Following Abramson’s article have been hundreds of others addressing the issue of jails and prisons becoming primary housing facilities for individuals with mental illness. Not only is it a topic of concern for professional publications, the criminalization of people with mental illness regularly is addressed in the popular press. For example, a March 3 blog post on the Dallas Morning News Web site talked about a bill that would prevent local authorities from using “time and convenience” as reasons for incarcerating mental health patients.2

There are a myriad of reasons, however, why using the criminal justice system as a de facto mental health system is inappropriate, including the following.

• Jails and prisons are ill-equipped to serve as mental health facilities. Where statistics are available, inmates with mental illness have higher than average disciplinary rates. A study in Washington State found that while inmates with mental illness constituted nearly 19% of the state's prison population, they accounted for 41% of infractions.3 This leads to the additional issue of inmates with mental illness who have problems with controlling their behavior being disproportionately placed in solitary confinement. Furthermore, solitary confinement is particularly difficult for inmates with mental illness because of limited medical care and the psychologically harmful consequences of isolation and idleness.
• While in detention medications may be discontinued or changed, and the variety of case management, skill building, and clinical services will be limited or eliminated completely.
• Incarceration is an expensive alternative to treatment. While prison can cost quite a bit more, even incarceration at the Pima County (Arizona) jail can cost nearly $100 per day.
• Once an individual’s treatment has been interrupted by incarceration it can be difficult to reengage him/her in services, thereby adding to the long-term costs.
• In addition to the costs to taxpayers and adverse impact on the individual, it is unethical to use incarceration and prison as an alternative to treatment.

Our response
Given all of the reasons for not wanting to inappropriately incarcerate individuals with mental illness, the Community Partnership of Southern Arizona (CPSA) collaborated with its provider network and the criminal justice system to form the Behavioral Health/Criminal Justice System Workgroup. The workgroup’s first task was to identify systemic issues that led to inappropriate incarceration and/or inappropriate length of stay. Following the identification of issues the workgroup began to focus on the strategies and interventions that could be implemented to reduce the time that an individual with a mental illness is inappropriately incarcerated. That is not to say that incarceration is always inappropriate. There are a variety of circumstances in which incarceration might be appropriate to protect an individual from being a danger to him/herself or others, or serve as an intervention before more serious destabilization occurs. Furthermore, incarceration may become a “wake-up call” for the individual as to the consequences of not properly managing his/her illness.

One of the workgroup’s primary outcomes was creating the CPSA Criminal Justice Team, established to be a resource and link between the justice and treatment systems. The team works with behavioral healthcare provider agencies (each of which was mandated to employ a criminal justice specialist) and other stakeholders, such as courts, probation officers, pre-trial services, the jail, police departments, and attorneys, to facilitate resolutions of both system-wide and member-specific issues.

To have a positive impact on inappropriate incarceration, the collaborative relationship between the various behavioral healthcare and justice entities must allow for information to pass quickly and efficiently, while at the same time observing applicable HIPAA rules and regulations. Contrary to popular belief, HIPAA rules do not necessarily have to be a barrier for communication between criminal justice and behavioral healthcare agencies. Rather, it can provide tools to aid in cross-system information sharing.

For example, when an individual is detained in the jail, time is of the essence in transmitting critical behavioral healthcare information from the treatment provider in the community to the treatment provider in the jail. Failure to do so can result in further destabilization and crisis for the individual, thereby increasing risk of injury to the individual (including suicide), other inmates, and jail staff.

Collaborative strategies
The three most commonly used tools to share CPSA member-specific information within the Criminal Justice Team includes the following.

Provider-to-provider information sharing. To identify in real time clients who have just been arrested, twice a day the “booking list” of the county is filtered against the CPSA member roster. When a match is identified the Criminal Justice Team sends a notification to the criminal justice specialist at the behavioral healthcare agency, notifying him/her that a client in his/her network has been arrested. This real-time notification includes the charges, the client’s enrollment status within the behavioral healthcare system (SMI, substance abuse, etc.), the assigned court or jurisdiction, and the next court date. The Criminal Justice Team also notifies the contracted healthcare provider at the jail that an inmate in its custody is enrolled in the community behavioral healthcare system.

A recent enhancement to the Criminal Justice Team initiative is to have a CPSA criminal justice team member attend the initial appearance court hearings (at which a judge determines conditions of release, if any, and informs the individual of the charges). The team member’s participation allows for:

• A universal consent form (discussed below) to be signed
• An assessment to determine the individual’s ability to transport him/herself home and to treatment
• Information sharing with pre-trial services and the presiding judge

For individuals not enrolled in the treatment system, the criminal justice team member facilitates the enrollment process and timeliness of having the person seen by a treatment provider. This recently implemented process has significantly increased the likelihood that the individual may avoid being taken into custody.

If a CPSA-enrolled member is taken into custody, CPSA provider agencies are contractually required to submit to the jail healthcare provider clinical information, including medications the individual is taking, case management notes, and any other information deemed relevant. CPSA’s pharmacy staff also send the most recent pharmacy information to the jail’s healthcare provider. The jail healthcare provider, in turn, places individuals with mental illness on a specialized caseload, which allows them to be housed in acute or subacute mental health “pods” within the jail, if needed.

On a weekly basis the CPSA Criminal Justice Team members, the behavioral healthcare agencies’ criminal justice specialists from, and the mental healthcare provider meet to discuss general issues and conduct staffing and discharge planning for inmates enrolled in the behavioral healthcare system. Individuals who have been identified as having a mental illness but not enrolled in CPSA may be referred/evaluated for enrollment while in custody. The team may coordinate transportation for individuals too unstable to leave the jail unassisted or assessment for court-ordered treatment for those who meet the legal criteria of danger to self, danger to others, persistently or acute disabled, or gravely disabled.

Universal consent form. The Criminal Justice Team developed and implemented use of an information-sharing universal consent form accepted by all providers in the CPSA system and readily used by all criminal justice entities, including court officials, attorneys, probation officers, and law enforcement. While a consent form is not required for all information-sharing activities (e.g., as ordered by a judge or to the healthcare provider at the jail), using the form not only establishes a recognition for the individual’s privacy, but also lets the individual know of every agency with whom his/her information will be shared and for what purpose. The form permits the Criminal Justice Team and providers to share real-time information, which may change daily depending on the person’s stability and criminal case processing. It also permits communication with multiple justice entities when cases are pending in more than one court or jurisdiction.

Mental health courts and judicial orders. A standardized judicial order for sharing healthcare information typically is used in the specialty mental health courts by judges who have received behavioral health training and understand these orders’ legal and medical implications. Standardized orders permit a level of sharing and collaboration that is even greater than allowed through the universal consent form. CPSA co-sponsored mental health courts are examples for how collaboration between various social service and criminal justice entities benefits the stakeholders, community and, most importantly, the CSPA members. CPSA has active mental health courts in five jurisdictions, as well as a consolidated justice court and felony superior court. Members enrolled in a mental health court have been found to be more compliant with treatment, resolve criminal charges more efficiently and effectively, and commit fewer new offenses. These outcomes result in improved public safety, cost savings to taxpayers, and better outcomes for our members.

Systemic strategies
HIPAA-compliant mechanisms for sharing member-specific information is only part of the process used by the community to make the most appropriate use of the criminal justice system as it concerns mental health patients. There are also a number of strategies to impact system-wide issues. Other collaborations that CPSA coordinates, or is an active participant in, include:

• Pima County Forensic Task Force
• Mental health court steering committee
• Crisis intervention training with law enforcement
• Court-specific collaborative committees

As a result of these collaborations, Southern Arizona has developed standards and ethics that value progressive programs that positively impact individuals with mental illness involved in the criminal justice system.

Kate K.V. Lawson, MPA, is the Criminal Justice Manager at the Community Partnership of Southern Arizona (CPSA), the regional behavioral health authority coordinating and managing publicly funded behavioral health services in Cochise, Graham, Greenlee, Pima, and Santa Cruz Counties. Michael R. Berren, PhD, is CPSA’s Director of System Development and a clinical lecturer in the Department of Psychiatry at the University of Arizona. Neal Cash, MS, is President/CEO of CPSA. For more information, e-mail michael.berren@cpsa-rbha.org.

1. Abramson MF. The criminalization of mentally disordered behavior: possible side-effect of a new mental health law. Hosp Community Psychiatry 1972;23(4):101-5.
2. Ramshaw E. Keeping mental health patients out of jail [blog post]. Dallas Morning News. March 3, 2009. http://trailblazersblog.dallasnews.com/archives/2009/03/keeping-mental-health-patients.html.
3. Fellner J. A corrections quandary: mental illness and prison rules. Harvard Civil Rights-Civil Liberties Law Review 2006;41(2):391-412. http://www.law.harvard.edu/students/orgs/crcl/vol41_2/fellner.pdf.

Denial Of Care

Denial of care
From the Houston Chronicle

If you are a mentally ill Houston adult without financial resources, getting arrested and locked up at the Harris County jail may be your quickest route to government-funded treatment.

Ever fewer hospital beds and services are available for such patients, and the closing of state institutions has forced thousands of them onto the streets, swelling the ranks of the homeless. For those in need, the jail has become the biggest single provider of mental health care in the area. Unfortunately, it comes with an arrest record.

And the situation is getting worse. A dwindling number of Texas psychiatrists provides compassionate help to mentally ill adults. Because of an archaic Medicaid regulation, those doctors are now being discouraged from dispensing it.

At the root of the problem is the original Medicaid legislation passed in 1965, at a time when many patients with serious mental illnesses were committed to state institutions, making short-term stays in private facilities an expensive, and little used, option. Those between the ages of 21 and 65 could not qualify for Medicaid coverage of mental health treatment delivered by physicians in private hospitals.

Since then the discovery and use of a new generation of pharmaceuticals has made hospitalization to establish a drug regimen for use in a home setting far more common. Unfortunately, the law has not kept up with the times and such care is beyond the reach of those without insurance. As a result of that restriction, Texas Health and Human Services Commission officials have sent demand letters to nearly 200 psychiatrists and institutions demanding return of Medicaid payments made in error. The totals range from $1,000 to $130,000.

The state is billing Texas physicians for the money because a federal audit found $1.67 million in improper payments made from 2001-2007.

Dr. George Santos, president of the Texas Society of Psychiatric Physicians, told the Chronicle's Todd Ackerman that the penalties will discourage mental health care professionals from treating indigent patients. Currently, there are only about 40 psychiatrists in Texas who do so.

“It is already difficult finding psychiatrists to treat patients in a hospital setting,” explained Dr. Santos. “Now, the few remaining are being punished for taking these patients.”

As Congress debates health care reform this year, lawmakers need to amend the outdated Medicaid regulations to reopen the doors of private hospitals and doctors' offices to a large segment of the mentally ill population who need better treatment options than simply going to jail.

Tuesday, July 14, 2009

DC Public Defender's Office Provides Their Process for Competency Procedures

Click here for the powerpoint presentation.

Law, Procedure, and Advocacy Concerning Pretrial Evaluation of Criminal Defendants for Competence to Stand Trial - PDS Summer Series, July 24, 2007
Presenters: Dave Norman and Janet Mitchell

Restoration of Competency to Stand Trial: A Training Program for Persons With Mental Retardation

This article describes the development and use of a formal training tool for restoration of competency in clients with mental retardation who are incompetent to stand trial. The program was developed at Eleanor Slater Hospital within the Rhode Island Department of Mental Health, Retardation and Hospitals. This article describes the development of The Slater Method, the training tool format, the procedure for use of the Slater Method, and the duration of treatment to restore competency to stand trial in clients with mental retardation. Although the developmentally disabled population is not limited to persons with mental retardation, we have used the phrase
mental retardation instead of developmentally disabled because the judicial system more commonly uses mental retardation.
The effect of Texas' implementation of a "justice reinvestment strategy to increase public safety and reduce spending on corrections" is explained (p. 1). Sections of this bulletin include: highlights of findings; Texas's growing prison population in 2007; description of the Justice Reinvestment Initiative enacted in 2007; implementation of the Initiative; implementation status; prison population trends 2007-2009; 2009 prison population projections; actual population at calendar year end compared to projected population of January 2007 before the Initiative; and challenges faced by the Texas Legislature to maintain an effective correctional system.

Download the report.

Download the presentation.

Read Representative Jerry Madden's statement to the Commerce, Justice, Science, and Related Agencies, Appropriations Subcommittee, U.S. House of Representatives.

Jail Diversion for the Mentally Ill: Breaking Through the Barriers

Click here for the pdf.
A conference was held on April 2, 1990 that brought together mental health, correctional, and law enforcement professionals to address issues surrounding the mentally ill person who comes in contact with the local jail. Research and program reviews from which the conference deliberations developed are provided. Four categories identified and examined are: screening and evaluation; crisis intervention; treatment; and transfer/discharge planning.

One Year Out: Tracking the Experiences of Male Prisoners Returning to Houston, Texas

Click here for the report from The Urban Institute.
The experiences of prisoners during the year following their release are recounted. Topics discussed include: overview of the reentry experience; characteristics of returning prisoners; family status; preprison histories; in-prison experiences; moment of release; housing and community; family relationships and support; substance use; employment, income, and debt; health; postrelease program participation; parole mandatory supervision; reoffending and reincarnation; understanding reentry success and failure; and implications.

Interview with NAMI's Sam Cochran Criminal Justice Award Recipient, Judge Manley

The Criminal Justice Symposium at last week’s NAMI Convention in San Francisco featured excellent presentations by Judge Stephen V. Manley of Santa Clara County’s Mental Health Court and Kathleen Connolly-Lacey who co-founded San Francisco’s Behavioral Health Court. Santa Clara’s Mental Health Court is the largest such court in the nation, serving 1,600 individuals with mental illness and substance abuse disorders, most of whom have been charged with felonies. San Francisco’s Behavioral Court is a collaboration in the best sense of the word between the court system and the mental health system. Individuals served by the Court (also primarily charged with felonies) have access to an array of services, including Assertive Community Treatment, supportive housing, and supported employment.

A particularly moving moment occurred when Judge Manley introduced a young woman who was a graduate of his Court five years ago. Since her arrest and diversion, she has made great progress in recovery, has moved to Albuquerque, NM and was attending the NAMI Convention as a representative of NAMI-New Mexico. She later told me that she believes that Judge Manley’s compassion and support “saved my life.”

Prior to speaking at the Convention, Judge Manley, this year’s recipient of NAMI’s Sam Cochran Criminal Justice Award, stopped by the studio’s of KQED, Northern California’s public radio station, and gave an interview about the Santa Clara Court. Here is a link to that interview.


Thanks to Judge Manley and Ms. Connolly-Lacey for their excellent presentations and for compassion and strong commitment to recovery for people with mental illnesses.

Thursday, July 9, 2009

Dallas police keeping closer tabs on downtown's repeat offenders

12:00 AM CDT on Thursday, July 9, 2009

By TANYA EISERER / The Dallas Morning News

The Dallas Police Department is tracking repeat offenders who commit most of the petty crime in the downtown area.

Currently, 157 men and women are on the list, police officials said. About 50 are behind bars or are in some kind of alternative treatment program such as a mental institution.

"These are our biggest recidivists who go through the revolving door of the criminal justice system," said Deputy Chief Vince Golbeck, commander of the central patrol division, which includes the central business district.

Several months ago, the city and county kicked off a pilot program to deal with downtown's repeat offenders, many of whom are homeless and mentally ill.

"Many of these individuals are getting picked up on lesser charges such as public intoxication, sleeping in public or urinating in public," said Officer Eric Tabbert, who compiles the list. "But they are also the same individuals doing the more serious stuff."

Tabbert said he reviews police reports and arrests from the downtown area every morning, in part, to look for repeat offenders who need to be added to the list. That information is given to patrol officers as well as downtown security directors.

Each week, he also sends an updated list to the county mental health department for them to determine who might benefit from mental health services. He also works with the Dallas County district attorney's office to ensure that repeat offenders who need it are recommended for higher bail amounts and longer sentences.

Occupying the top spot on the list is Keith Brooks, a 43-year-homeless man repeatedly convicted of criminal trespass and drug possession. Brooks is in the Dallas County Jail being held on a charge of felony harassment of a public servant.

"We've been dealing with him for years," Tabbert said.

"I am personally seeing that some of these folks who may have been in jail for only 10 or 15 days are getting six months because of their impact offender status," Tabbert said. "That's a whole lot longer time that they won't be out plying their trade."

He said the program is needed because downtown police officers believe The Bridge, Dallas' homeless assistance center opened May 2008, has added to the downtown homeless problem.

"We're seeing new faces," Tabbert said. "They're hearing about this, and they're making their way to Texas."

Dallas County to settle two jail inmate lawsuits

Dallas County to settle two jail inmate lawsuits

07:53 AM CDT on Wednesday, July 8, 2009

By KEVIN KRAUSE / The Dallas Morning News

Dallas County commissioners voted Tuesday to settle two federal jail neglect lawsuits for close to a half-million dollars.

County officials say the lawsuits are the last major legal claims related to prior conditions in the jail system, which were described a few years ago by federal investigators as being dangerous to inmates' well-being.

As a result of the settlements, the family of former inmate Rosie Sims will receive $250,000, and former inmate Bruce A. McDonald will receive $190,000, minus legal expenses.

Sims, 60, who was mentally ill, died in the Dallas County jail in 2005.

Her family filed a wrongful death lawsuit, claiming she died of pneumonia after guards and a nurse refused to take her to the infirmary.

Sims, who suffered from paranoid schizophrenia, spent more than a year and a half in the jail awaiting trial before her death.

She didn't receive medical treatment or "even a routine physical examination" during that time, according to the lawsuit. The guards found Ms. Sims lying on the floor in her own waste after she collapsed in her cell but didn't take her to be examined, the suit said.

The story of Sims' lifelong struggle with schizophrenia and her treatment while in custody were told in a series of articles in The Dallas Morning News in 2006.

McDonald contended in his suit that the county violated his constitutional rights by denying him treatment in the jail after he was punched in the eye by another inmate in 2005.

He said he lost vision in the eye after the injury went untreated for seven weeks despite the fact that doctors said on three different occasions that he needed surgery.

Both lawsuits were headed for trial after the county tried unsuccessfully to have them dismissed.

"They're definitely acknowledging that there was a problem. They'll settle when they think they'd get a worse outcome when they go to court," said Scott Henson, a criminal justice expert.

County Judge Jim Foster said he voted for the settlements because it was "the right thing to do" and because it's expensive to defend lengthy lawsuits.

Commissioner John Wiley Price called it a "fair resolution to the case" and added that there shouldn't be any more such settlements down the road.

"The faucet turns off," he said.

Tuesday's approved payouts follow several other settlements and judgments against the county related to allegations of mistreatment in the jails:

•In April, a federal jury in Dallas awarded more than $300,000 to former inmate Mark Duvall, who alleged that a staph infection he caught while in jail in 2003 left him blind.

•In 2008, a federal jury ordered the county to pay $900,000 to former inmate Stanley Shepherd for denying him proper medical care while he was in custody in 2003.

In recent years, county commissioners have spent more than $100 million improving jail conditions and jail health.

Monday, July 6, 2009

Doc puts inmates' mental health first

From my SA news:
By Melissa Fletcher Stoeltje - Express-News

It's become a given among mental health professionals that jails are now the largest psychiatric hospitals in the country. In Bexar County, as in others around the nation, roughly one out of four inmates suffers from some kind of mental illness.

That translates into some 800 inmates at the county jail being treated for a psychiatric disorder — hundreds more than patients being cared for at the San Antonio State Hospital.

Dr. Sally Taylor, administrator of psychiatric services at Bexar County Jail, has been on the front lines of the struggle to treat and rehabilitate mentally ill prisoners.

Before that, she was the medical director of the psychiatric emergency room at University Hospital for 17 years, dealing with some of the most disturbed and violent patients and training scores of medical students and other health professionals.

But she's done more than that. By all accounts, Taylor has been a tireless advocate for the mentally ill in San Antonio, working with local advocacy groups to reduce stigma about mental illness, encourage churches to address mental disorders and promote education and community awareness about mental disease.

Recently, she worked with other mental health groups on legislation to compel mentally ill prisoners to take their medication.

This is important for those who have been found incompetent to stand trail and are in jail awaiting transfer to an inpatient competency restoration program.

This will allow treatment for those with severe mental illness who are a danger to self or others or who lack the capacity to understand the risk of refusing treatment, and who have been excluded from court ordered treatment simply because they are located in jail.

It might even help some inmates enough that they could enter outpatient competency restoration.

The bill was signed into law by Gov. Rick Perry.

Because of her work, Taylor was recently one of 41 psychiatrists around the country to be given the prestigious 2009 Exemplary Psychiatrist award by the National Alliance on Mental Illness, for which she was nominated by the local NAMI chapter.

“Psychiatrists who are honored have really gone the extra mile,” said Michael Fitzpatrick, executive director for NAMI. “We awarded Dr. Taylor not only for her work in (University Hospital's psychiatric ER) but for her engagement with us on policy, corrections and faith-based initiatives. She's just outstanding.”

Yolanda Alvarado, chairwoman of the Bexar County Mental Health Task Force, said Taylor was the driving force behind the compelled medication legislation.

“I know that it came from her brain,” Alvarado said. “She got the judges involved, too. She actually went to testify. Because she's a doctor, she carries such credibility.”

Speaking from her office inside the jail, Taylor, who earned her medical degree from the University of Texas Health Science Center, said mentally ill people off their medication often commit petty crimes — criminal mischief and the like — then wind up in jail.

Before the legislation she worked on became law, they couldn't be compelled to take medication in jail, unlike in mental health facilities. They would be judged incompetent to stand trial.

“And then what happens is they end up languishing in jail for two or three months because there are no open beds at the state hospitals,” she said.

“And for all that time they're deteriorating and getting worse. I worry that some of these people might never be restored because the brain stays sick for so long.”

Sometimes an inmate goes into the state hospital for competency restoration, then comes back to the jail and again refuses medication — which sends him or her back to the hospital. It's becomes a cycle.

Taylor, to appease advocacy groups that resist the idea of compelled medication, helped craft the legislation to apply only to those inmates who are deemed a danger to themselves or others.

But her goal is not just to help restore sick inmates to competency. In 2008 she advocated for more than 100 inmates who had committed misdemeanor crimes to have their charges dropped so they could then enter treatment programs, rather than incarceration.

“In coordination with the district attorney's office, the probate court, the jail staff and the Center for Health Care Services, we were able to get civil commitments sending them to the state hospital,” she said. “That may not sound like a lot of people, but for us it was a brand new process, and it became a well-oiled process.”

Taylor applauds the city's award-winning jail diversion program, which trains police officers to recognize mentally ill law-breakers and take them to ERs and other treatment facilities instead of jail.

But she said much more needs to be done with regard to the long-term needs of mentally ill lawbreakers.

“We do a great job recognizing the (mentally ill) at the front door, but the problem is the back door,” she said. “Bexar County is one of the lowest counties in per capita funding for mental health in Texas, and Texas is 48th or 49th out of the 50 states in terms of funding for mental health.

“You can do all the screening and all the jail diversion that is possible, and I'm completely in favor of that, but you've got to have services for people when you send them out in the world.”

Too often, she said, released mentally ill inmates confront a host of obstacles on the outside that hobble them in being compliant with their medical care. And then they re-offend.

“If somebody comes to the jail because it's a place to sleep and eat, you want to be able to provide that on the outside,” she said. “We don't have enough residential units, we don't have enough housing, we don't have enough supported employment, we don't have support services, we don't have intensive case management. So we drop the ball.”

Taylor, who swims and makes jewelry to de-compress from her high-pressure job, said she is drawn to working with the prison population because she is able to help give voice to the voiceless.

“I like helping people that the rest of society shuns,” she said.

Friday, July 3, 2009

The Mentally Ill in Jail: Whose Problem Is It Anyway

On July 15, 2009, the National Institute of Corrections will host a live 3-hour (11-2) satellite/Internet broadcast to provide an overview of opportunities that can help your organization prepare to work with persons suffering from mental illness in jails. “The Mentally Ill in Jail: Whose Problem Is It Anyway?

County planning to build forensic mental hospital

By Howard Roden

Updated: 06.29.09

A 120-bed forensic mental hospital could be operating in Montgomery County by early 2011, county commissioners announced Monday. To be built adjacent to the Joe Corley Detention Facility in north Conroe, the hospital will ease a statewide demand for forensic psychiatric care, Precinct Commissioner Ed Chance said. It also will ease a financial burden for the county as it increases manpower and money to transport psychiatric cases to the Rusk facility in East Texas, he said.

In 2006, a round trip to Rusk with two deputies and a patient cost about $250. The county expended around $50,000 on those trips that same year. “Saving those lost hours is a big issue,” Chance said. “It will allow our law enforcement to stay closer to our courts and, in the process, generate a substantial increase in jobs and the local economy.”

The project became reality during the 81st session of the state Legislature when Sen. Tommy Williams, R-The Woodlands, succeeded in getting an appropriation included in the Texas Health and Human Services budget. “It’s a great opportunity for us to have this state-of-the-art facility close to home,” Williams said. “I think it solves a number of problems for the (Houston) region. With the remote location of the Rusk facility, Montgomery and Harris counties send more forensic cases than the other 25 counties of the region combined.”

Williams said that when the Rusk forensic mental hospital is at capacity, some of its patients are transferred to the facility in Vernon, which is West Texas.
Montgomery County Judge Alan B. Sadler said the forensic mental hospital, which will be on a four- to five-acre site at an estimated cost of $30 million to $35 million, should have an immediate impact on the local needs. “On any given day, one-third of our county inmates are in need of mental health assistance,” he said. “In my opinion, (the hospital) will be full in six months or less of Montgomery County patients.”

Like the Joe Corley facility, which houses U.S. Marshals and federal immigration inmates, the forensic mental hospital will be financed through revenue bonds, Chance said. Although a company has not been chosen to design and build the facility, the county already has hired GEO Group to operate the facility, Chance said. Florida-based GEO operates the Corley facility.

The Probation Experiment: Travis County Department Utilizes Evidence-Based Best Practices to Reduce Recidivism, Revocations

From the Texas Association of Counties Magazine:
The use of evidence-based practices to reduce recidivism and probation revocation is reviewed. Following an overview, this article discusses: developing the framework -- assessment, re-engineering, and offender supervision; and new tools for success -- diagnostic report that rates an individual in 11 different areas related to re-offending incorporating a "color-coded risk-needs supervision matrix" and motivational interviewing training.
The experiment achieved positive results: because of its four-year effort, the county’s overall one-year recidivism rates dropped from 29 to 24 percent.

More recidivism-related outcomes:

Pre-experiment, 26 percent of low-risk offenders were re-arrested within one year; post-experiment, only 6 percent were re-arrested after one year. That is a 77 percent drop in low-risk offender recidivism.
Pre-experiment, 26 percent of those offenders were re-arrested within one year; post-experiment, only 13 percent were re-arrested within one year of their original offense. That is a 50 percent drop in medium-risk offender recidivism.
Pre-experiment, 34 percent of those offenders were re-arrested within one year; post-experiment, only 31 percent were re-arrested within one year. That is a 9 percent drop in high-risk offender recidivism.