street roots
14
O ct 14, 2011
Mental health and criminal justice: Penny wise and definitely foolish
BY CHRIS O'CONNOR
CONTRBUTING WRITER
A s an attorney working solely in
Z % indigent defense, I often see the
X JLterrible collision of mental health and
the criminal justice system. Some of those
in government and policy positions need to
come down to the courthouse and see the
unfortunate mess that results when the
criminal justice system tries to deal with
what ultimately is a medical problem.
I think a closer and more personal look at
individual cases as examples would help us
refocus our efforts on what works and
improve results while saving money. The
current approach is failing all of the, people
involved, from victims of real crime to
people lost in their mental disorder and
disease.
This is not to say that there are not many
hardworking, compassionate and smart
people working in the various treatment
agencies and government offices. It’s just
that they don’t get the seemingly limitless
budgets and lack of financial accountability
given to the police, the district attorney and
the jails and prisons or the forensic wards of
the state hospital. Spend a few more
pennies on the front line workers,
counselors, doctors and nurses and you can
save many pounds on the criminal justice
end.
Imagine a person with schizophrenia. r
Unfortunately, it’s not hard to do. Around
the world anywhere from 0.5 percent to 1
percent of the population suffers from this
condition. This mental disorder often shows
up as longterm disorganized speech, ;
delusional thinking and bizarre beliefs.
People suffering from schizophrenia often
have severe barriers to social interaction
and functioning in day-today life.
Take this example of a young man who is
d e a lin g w ith th e o n s e t o f sc h iz o p h r e n ia and
hd^Ti5' “
can get the help he needs. Imagine that he
has a family active in his life that wants to
support him and seek help for him. A
number of barriers exist If they walk into
the county or city office here in Portland,
there is no direct help available. If the
family is lucky, it may be referred to some
programs that deal with mental health
crisis; but these are not necessarily easy to
access, immediately available, and too many
are not on a walk-in basis. Simply put,
people sliding into or dealing with mental
health crisis cannot find or access services.
Time after time I hear about families that
want to help, but the person who needs the
help is not sick enough for a civil
commitment (forced hospitalization for
those who present an immediate danger to ‘
themselves or others, or v ho are unable to
care for their own basic needs to the point
of imminent death), but neither are they
well enough to function in the community
independently. The saddest cases are where
the illness is apparent to all who encounter
the person, but, as is the case in many
situations, part of the illness is the person’s
lack of awareness of the fact that they are
sick. In the worst cases the family or
treatment agency’s support is incorporated
into the delusional beliefs of the person, and
costs to you, while the punishment will
never “fix” the defendant’s underlying
medical issue and bizarre thought process.
He will not necessarily learn, or reform or
be less likely to engage in the same conduct
because of the court process and
punishment. Medication and a new stability
may help, but changes in his behavior will
not occur because of the criminal
conviction.
Imagine an elementary school in which a
child sick and feverish w iththe flu who
vomited in the hallway was sent to detention
for making, a mess. That’s what you have in
many cases. Probation, jail,, prison, picking
up trash in the park or an occasional check
in, with a probation officer with hundreds of
other supervisees is not going to help a
mentally ill person. It is not going to reform
them. It is not going to reveal the error of
their ways and it certainly isn’t going to
prevent the next unfortunate encounter or
incident that draws the attention of the
authorities.
There are alternatives. The first
alternative starts before the incident Had
the man had easy access to and been taking
medication before the event (even at
hundred of dollars a month), the city, county
and state would have saved tens of
thousands of dollars. A second alternative is
• for the district
attorney to treat
the matter as a
mental health case
Probation, ja il, prison, picking up trash In the from the beginning
and instead
park or an occasional check-in w ith a
explore civil
probation officer with hundreds of other
commitment or to
supervisees Is not going to help a m entally 111
consider simply
person. It Is not going to reform them. It Is not not charging the
case. (It is
going to reveal the error of their ways and it
justice system. Imagine he is in a coffee
shop downtown. He isn’t on his medication
because he can’t afford it or hasn’t been
able to access câre, Maybe he didn’t make it
into the lottery for the Oregon Health Plan,
or maybe he was one of the lottery
applicants that was not chosen. He is having
what the rest of the world would describe as
unusual thoughts and is acting strangely.
Im a g in e h e k n o c k s o v e r a n o t h e r p a tr o n ’s
co ïIeëiü p T rw S an aî
criminal laws in Oregon call disorderly
conduct, or he harasses the manager by
shoving her away when she steps in to deal
with the outburst. The police are called.
Maybe the man insults the officers, fitting
them into his current paranoid beliefs or
struggles when the officers take him into
custody. Suddenly the resources are
forthcoming, and the “system” starts
spending money like it never has before in
this young man’s case!
The money flows. First the policé: tired
after getting their long hours on a three-day
weekend, perhaps they can’t spend the rest
of their shift getting this man checked into
the hospital so they take him to the jail. The
Sheriff has a bed for the man in one of the
most expensive jails in the nation. At a cost
to you, the jail medical staff will of course
want to check on him and see if medication
is appropriate in his case and then they will
begin attempting to treat him.
Meanwhile the PA reads the police I
reports and decides to charge him .with a
misdemeanor charge of harassment and
resisting arrest. After the court staff spends
some money arraigning him, the’judge
makes sure that the man gets a public
defender such as myself and the case gets
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finding will result in probation and more
up to speed. A review of the police report
and a brief interview with the new client will
reveal that the person suffers from a mental
health disorder. The lawyer isn’t a doctor, so
he asks the Public Defense Services
Commission for money to hire an expert.
$1,500 to $2,500 and a few weeks later, a
psychologist generated a report for the
lawyer. The conclusion in many cases in this
posture is that the defendant cannot aid and
assist in his own defense. If the psychosis is
severe or the defendant is uncooperative,
the judge may then send the person to the
Oregon State Hospital, where you, the
they perceive their family, friends and
advocates as acting against their interests.
People dealing with a mental health crisis
are not able to advocate for themselves.
These people and families will not get the
treatment or attention they need to manage
a severe illness. The city, county and state
are dealing with budget and resource
shortfalls. In many cases there is not a place
to refer people in this situation. Yet the
resources become basically unlimited once
you involve the criminal justice system.
Stop and consider the same young man
when his life intersects with the criminal
|
unfortunate encounter or incident that draws
the attention of the authorities.
taxpayer, will pay thousands of dollars a
month to house and treat the person until
they are lit enough to proceed. The total bill
runs into the tens of thousands of dollars
and, of course, the case hasn’t even been
resolved yet.
If the man regains the capacity to
proceed to trial it’s possible that there will
still be a trial. The defense attorney will
need another $1,000 to bring in the expert
to talk about mental health and the
defendant’s illness. Maybe the state will
need to hire its own expert. The officers, if
¿idled to court on their day off, are earning
time and a half pay and will spend more
than half the day sitting in the hallway of the
courthouse awaiting their time to testify.
And of course the jurors, the court staff, the
deputies guarding the man in the courtroom
all have other things they could be doing,
along with the variety of direct and indirect
costs for them to be there.
The verdict doesn’t even matter. A guilty
im portant to note
th a t th e cost of
the public
defender, the
police court time,
the experts, the
hospitals, the
doctors and the
jail does not come from the DA’s budget.)
A third option and almost free solution
might be to simply to keep an accounting of
the real cost of the decisions made in the
.criminal justice system. Surely in the
imaginary example above someone — a
judge, the DA, a newspaper reporter, a
cyncial public defender — would notice if
every time money was spent on a case the
big number on the front of the court file
went up by thousands of dollars. As it stands
now, your money is being spent by one
agency or branch of government because of
-decisions made by another branch or
agency. They are spending other agencies’
money, but ultimately it all comes from the
same taxpayer’s funds. A public accounting
of tiie penny wise, pound foolish and buck
passing would force reform.
Chris O ’Connor is an attorney with the
Metropolitan Public Defenders office in
Portland
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