In "Mentally Ill Don't Belong in Jailhouse" (July 27, 2008), the Temple Daily Telegram presents a compelling and comprehensive picture of the issues facing people with severe mental illness in Central Texas. It also explores the limitations imposed on government agencies, given funding cuts, a decrease in facilities, and other constraints.
The following article is a lengthy but worthwhile read.
"Before Carolyn Law was sent to prison in March 2006 for killing her mother, she was a college educated woman who had worked in real estate and tried to control her schizophrenia through medication.
At one point, she was so successful at controlling her illness, the state used her in a video that promoted the services that helped her cope.
'She was a poster child for services offered through the (Central Counties Center for Mental Health Mental Retardation),' said Eldon Tietje, executive director for MHMR.
Tietje said Ms. Law could still be considered a symbol for the mentally ill, only now she would be a symbol for what is wrong with the state’s treatment of the issue.
'She is someone who did pretty good for a long time,' Tietje said. 'She could and did take advantage of services when they were available, but she deteriorated over time and didn’t comply with treatment.'
Much like Ms. Law’s condition, the state’s funding for mental health programs has eroded over time, Tietje said.
And Tietje is not the only local official voicing concern over the treatment options for mentally ill in the state.
Judge Martha Trudo, 264th State District Court, sentenced Ms. Law to 45 years in prison for murder. Judge Trudo thinks it’s time for the state to do a better job addressing mental health issues.
'It isn’t a problem to be hidden,' she said. 'We really need to be doing something about (the mentally ill). They end up being warehoused in the pen.
'We do not do a good job of taking care of the mentally ill in Texas. There are tremendous waiting lists, doctors won’t see them unless they get picked up and put in jail. Then we are obligated to do it.
'A lot of people can function and work if they have support.'
In March 2006, Ms. Law addressed the court before her sentencing and said that mentally ill people such as her are misunderstood. She also said she hoped to see advancement in the treatment of mental patients.
'You have heard from many people here who have been hurt. I’ve been hurt for the last 20 years,' she said. 'I’m the biggest victim of all, as I see it.'
The local mental health picture
In his 16 years at the top post at Central Counties MHMR, Tietje said referrals have doubled as the population in the area has increased.
'The prevalence of mental illness may not be greater but we have more people and the resources are less, also during that time most of the private hospitals have closed, so there are fewer in-patient services,' he said.
A 2003 state budget crunch took more than $100 million out of the community MHMR system. But rather than this being an anomaly, it looks more like a pattern. In 1994, Tietje said his budget was $16.5 million. It was slashed to $12 million in 1995, a 25-percent cut.
'A result of that budget cut, we lost a Fort Hood work program that served 200 people,' Tietje said.
Closely supervised program participants cleaned buildings and restocked the commissary on base.
Budget constraints have also contributed to the closing of a three-quarter-way house in Gatesville that helped get people back on their feet. It had 30 beds and was a place where people could stay and look for work while they stabilized on their medications.
'It was a structured environment that made sure they got meds and food,' Tietje said.
And the Gatesville center has not been the only facility that has been shuttered.
Clinics in Bell, Coryell, Hamilton, Lampasas, and Milam counties have all been closed.
Patricia Roy-Jolly, MHMR supervisor who works with community support services, said she has witnessed a general pattern with many of the mentally ill she attempts to help.
She said mentally ill people often commit a crime and are incarcerated in Bell County Jail, which, in turn, ships them to Austin State Hospital. In Austin, the person gets stabilized on medication and usually within about a month is sent back to the area with three weeks of medication and the charge to regularly visit a doctor.
Ms. Roy-Jolly said usually the patient makes one or two appointments before he or she stops taking their medication and disappears for a while until he or she is rearrested and the process starts all over again.
'We’re just in a terrible predicament. A lot of these people do not have family members or they have family members who can’t help them anymore,' Judge Trudo said.
'It’s probably time for Texas to look at having group homes or do something.'
One funding cut came at the hands of the Texas Commission on Alcohol and Drug Abuse when the agency overextended funds by not regulating properly.
'Our funding from substance abuse services went from $80,000 to $15,000. We gave up our patient substance abuse services,' Tietje said. 'We got rid of it because we couldn’t afford it.'
Right now the best option for temporary inpatient care for mentally ill patients is the Austin State Hospital, but up until about eight years ago Temple was able to provide inpatient crisis stabilization.
'We had to give it up because it became too expensive for us to run,' Tietje said.
And the Austin State Hospital is often near capacity. For at least two weeks this month the hospital was so full it was on diversion and recommending people go to San Antonio for services. The other option for jails was to warehouse the prisoners until a slot opened at the hospital.
Other programs or services impacted by budget constraints include: two-day treatment services in Temple and Killeen that served 30 to 40 people, access to counseling services, transportation and noon meals.
'There’s a whole lot less mental health services in these five counties than there was 13 years ago,' Tietje said. 'When there are no support services, people are less likely to seek or stay up on treatment.'
This year’s budget for Central Counties MHMR is $14.5 million.
'We have fewer resources today and inflation has eroded our spending ability. We have had no inflationary increases from any funding groups, county or state,' Tietje said. 'As a result, our services have eroded and more and more people with mental illness show up in jails or emergency rooms.'
The impact on the community
The struggles of the state in answering the question on how to deal with people who struggle with mental illness is often shared by the families and church communities of these individuals.
In Ms. Law’s case her former minister Joe Baisden, Belton Church of Christ, said he spent a tremendous amount of time ministering to her in the years preceding the killing of her mother.
'Carolyn used to be a member of my Bible class. I was called in many times when her mother and her had problems,' he said. 'She freely talked about mental illness and gave us a great deal of insight. When she was on her meds she came to support group and was smooth as silk - other times she was erratic.'
Baisden said he will never forget when his church community was having a fellowship day in Yettie Polk Park in Belton and he was called to help Law’s family.
She had dropped her boys off at a mall in the Austin area and was later arrested at the State Capitol building when she pulled a fire extinguisher off a wall and sprayed paintings on display in the building.
'It grieved me that she had this kind of destiny in this life,' Baisden said about Ms. Law. 'It’s sad.'"
Monday, July 28, 2008
Possible New Mental Health Court in Smith County
The Tyler Morning Telegraph reports that Smith County commissioners have been asked to establish a “mental health court,” with the aim of providing better care for offenders with mental illness and reducing jail overcrowding ("Commissioners To Consider Creating ‘ Mental Health Court ’", July 27, 2008).
Here's an excerpt:
"It’s something like the county’s drug court, which diverts misdemeanor offenders with addiction problems.
A presentation will be made on Monday by Dr. David Self, chief forensic psychiatrist for the Rusk State Hospital, and Valerie Holcomb, with the Texas Corrections Office on Medically and Mentally Ill at the Andrews Center.
The Andrews Center estimates that about 20 percent of Smith County jail inmates have been treated for mental illness in the past. A mental health court would focus on intensively supervised probation for the mentally ill, who would receive outpatient treatment."
***
Numerous counties in Texas, including Bexar, El Paso, Tarrant, and Dallas, have established mental health courts, which addresses the needs of those with mental illness who come into contact with the criminal justice system. There are more than 150 mental health courts in operation throughout the United States.
Here's an excerpt:
"It’s something like the county’s drug court, which diverts misdemeanor offenders with addiction problems.
A presentation will be made on Monday by Dr. David Self, chief forensic psychiatrist for the Rusk State Hospital, and Valerie Holcomb, with the Texas Corrections Office on Medically and Mentally Ill at the Andrews Center.
The Andrews Center estimates that about 20 percent of Smith County jail inmates have been treated for mental illness in the past. A mental health court would focus on intensively supervised probation for the mentally ill, who would receive outpatient treatment."
***
Numerous counties in Texas, including Bexar, El Paso, Tarrant, and Dallas, have established mental health courts, which addresses the needs of those with mental illness who come into contact with the criminal justice system. There are more than 150 mental health courts in operation throughout the United States.
PA Death Row Inmates Can Be Forcibly Medicated
The Pennsylvania Supreme Court has ruled that two death row inmates with mental illness can be forcibly medicated in order to render them competent to continue their appeals and face execution.
Texas courts have addressed this issue in the case of death row inmate Steven Staley, who has been diagnosed with severe paranoid schizophrenia and believes that he is being poisoned by medication. A state district judge ordered the state to forcibly give Staley anti-psychotic drugs. Last fall, the Texas Court of Criminal Appeals ruled that it did not have jurisdiction to rule on whether this constituted cruel and unusual punishment and and took no action on the case. As far as I am aware, Staley remains in prison and on medication.
Here's the story from the Philadelphia Inquirer ("PA high court OKs forced drugging of mentally ill death-row inmates," July 23, 2008):
"Ruling in the case of Thavirak Sam, a Cambodian immigrant who killed three family members in 1989 and has been mentally incompetent for years, the court said that if Sam were left untreated, his appeal would remain in limbo indefinitely.
'Not to litigate the claims delays both justice and finality,' wrote Chief Justice Ronald Castille, who was Philadelphia district attorney when the killings occurred.
Sam's defense attorney, Jules Epstein, said he believed the rulings marked the first time in the United States that an appellate court had approved forcible medication for a death-row inmate who is not a danger to himself or others.
'The decision raises a profound question of what to do with mentally ill death-row inmates . . . who have no family or other dedicated person to speak for them,' said Epstein, a law professor at Widener University.
Deputy District Attorney Ronald E. Eisenberg said the rulings would allow appeals to proceed.
'This way, at least there will be a decision one way or another about the validity of the conviction and sentence,' he said.
The issue is important because the U.S. Supreme Court ruled in 1986 that convicted murderers cannot be executed if they are so mentally ill that they cannot understand why they face a death sentence and what that sentence means.
Sam, now 51, has been on death row since 1991, and prosecutors have been trying for several years to get him medicated so he can be competent enough to decide whether he wants to continue his appeal or be put to death.
At varying points over the years, Sam has imagined that the U.S. Supreme Court had ordered him freed and that a Cambodian prince had interceded on his behalf.
In another Philadelphia case, the high court also ruled that Herbert Watson, convicted in 1983 of shooting to death his estranged girlfriend, must be medicated to determine whether he wants to proceed with his appeal.
Castille wrote in that case that prosecutors were 'attempting to vindicate society's compelling interest in bringing an end to the litigation of this case, which is now well into its third decade.'
In both cases, Castille was joined by Justices Thomas Saylor, J. Michael Eakin and Seamus McCaffery. Justices Max Baer and Debra Todd dissented. ..."
***
Earlier posts on Steven Staley are available here and here.
Texas courts have addressed this issue in the case of death row inmate Steven Staley, who has been diagnosed with severe paranoid schizophrenia and believes that he is being poisoned by medication. A state district judge ordered the state to forcibly give Staley anti-psychotic drugs. Last fall, the Texas Court of Criminal Appeals ruled that it did not have jurisdiction to rule on whether this constituted cruel and unusual punishment and and took no action on the case. As far as I am aware, Staley remains in prison and on medication.
Here's the story from the Philadelphia Inquirer ("PA high court OKs forced drugging of mentally ill death-row inmates," July 23, 2008):
"Ruling in the case of Thavirak Sam, a Cambodian immigrant who killed three family members in 1989 and has been mentally incompetent for years, the court said that if Sam were left untreated, his appeal would remain in limbo indefinitely.
'Not to litigate the claims delays both justice and finality,' wrote Chief Justice Ronald Castille, who was Philadelphia district attorney when the killings occurred.
Sam's defense attorney, Jules Epstein, said he believed the rulings marked the first time in the United States that an appellate court had approved forcible medication for a death-row inmate who is not a danger to himself or others.
'The decision raises a profound question of what to do with mentally ill death-row inmates . . . who have no family or other dedicated person to speak for them,' said Epstein, a law professor at Widener University.
Deputy District Attorney Ronald E. Eisenberg said the rulings would allow appeals to proceed.
'This way, at least there will be a decision one way or another about the validity of the conviction and sentence,' he said.
The issue is important because the U.S. Supreme Court ruled in 1986 that convicted murderers cannot be executed if they are so mentally ill that they cannot understand why they face a death sentence and what that sentence means.
Sam, now 51, has been on death row since 1991, and prosecutors have been trying for several years to get him medicated so he can be competent enough to decide whether he wants to continue his appeal or be put to death.
At varying points over the years, Sam has imagined that the U.S. Supreme Court had ordered him freed and that a Cambodian prince had interceded on his behalf.
In another Philadelphia case, the high court also ruled that Herbert Watson, convicted in 1983 of shooting to death his estranged girlfriend, must be medicated to determine whether he wants to proceed with his appeal.
Castille wrote in that case that prosecutors were 'attempting to vindicate society's compelling interest in bringing an end to the litigation of this case, which is now well into its third decade.'
In both cases, Castille was joined by Justices Thomas Saylor, J. Michael Eakin and Seamus McCaffery. Justices Max Baer and Debra Todd dissented. ..."
***
Earlier posts on Steven Staley are available here and here.
Monday, July 21, 2008
Costs of Mental Health Care Overwhelm Harris County Jail
Today's Houston Chronicle features the following article about the revolving door of severely mentally ill homeless offenders in the Harris County Jail ("Finding escape behind bars," July 21, 2008). Many of these inmates have been arrested on dozens of occasions; many have substance abuse disorders in addition to mental disorders.
As the number of these chronic inmates continues to increase, the cost of both incarceration and treatment has soared to $87 million annually. While some organizations have launched new programs aimed at providing support for severely mentally ill homeless people immediately upon their release from jail, the demand for services still far outpaces the limited resources available.
Here's the article in full:
"At the Harris County Jail, deputies and health care workers have a name for them — frequent fliers.
They are mentally ill homeless people who return to jail so often, sometimes on minor charges, that they become familiar to the psychiatric staff.
During a recent survey, county officials found that more than 400 of the jail's 11,000 inmates were homeless and suffered from a major mental illness: schizophrenia, bipolar disorder or a chronic depressive-psychotic disorder. They were among 1,900 inmates on psychotropic medications.
When the mentally ill homeless leave jail — and leave behind its mental health care staff — many stop taking medication and end up on the street again. Treatment resumes only when they commit a crime and return to jail or their dementia overwhelms them and they are brought to an emergency psychiatric center.
Treating the mentally ill as they cycle through jail and emergency psychiatric wards is expensive. A county budget analyst estimates that it costs $80,000 a year, per person.
At the jail, spending on mental health care has risen to $24 million annually, and the combined cost of incarcerating and treating the mentally ill is $87 million annually.
'The jails have become the psychiatric hospitals of the United States,' said Clarissa Stephens, an assistant director of the county's budget and management services office who has been studying the jail's mental health costs.
The Commissioners Court is so concerned about the rising costs that it has retained a consultant — psychiatrist Avrim Fishkind — to study whether providing outpatient services and supervised housing would reduce the numbers of mentally ill revolving through the jail.
'The costs of reincarcerating and court costs far outweigh what the costs would be if you housed, clothed and supervised the mentally ill,' Fishkind said.
A June survey of more than 11,000 inmates revealed:
•About one-quarter suffer from mental illness or once suffered from it.
•Of those on medication, 978 suffered from schizophrenia, bipolar disorder or a severe depressive-psychotic disorder.
•Of the 978 with a major mental health disorder, 423 likely were homeless.
•Of the 423 homeless with a major mental health disorder, 97 percent had been arrested at least once before during their lifetimes; 43 percent had a prior arrest during the last 10 years.
On the day of the survey, the jail's mentally ill homeless inmates included:
•A 39-year-old woman booked 45 times since 2001.
•A man, 26, booked 30 times since 1999.
•A man, 52, booked 33 times since 1992.
•A man, 25, booked 20 times since 2001.
Some of the mentally ill — many of whom also are substance abusers — keep committing crimes and getting rearrested, in part, because few are properly supervised when they are released, said David Buck, a Baylor College of Medicine associate professor and president of Healthcare for the Homeless-Houston.
Houston isn't alone in facing this issue. After many mental hospitals were closed in the 1970s and 1980s, countless patients were released in cities that were ill-equipped to house those who needed such care.
'What happens here happens in many communities. We are criminalizing mental illness,' said Betsy Schwartz, president of Mental Health of America of Greater Houston, a nonprofit that promotes effective treatment for the mentally ill.
Left to find her own way
Patricia George, 34, said her thinking always becomes clearer when she returns to jail and gets back on medication.
In the past 20 years, George, who says she is bipolar and schizophrenic, has been charged with 12 felonies and 31 misdemeanors, with most of the bookings in Harris County. In all, she has spent nine years in jail.
Like other mentally ill inmates, George has been expected to find her way — with no car and little money — to mental health providers, to line up counseling and to fill prescriptions for her medication in the weeks after her release.
In the meantime, medications she was taking in jail wear off, she said during an interview three days after her July 5 release from jail.
'Just walking down here (for the interview), I'm starting to hear voices,' said George, who finished a six-month sentence for prostitution.
Not filling prescriptions
Many of the mentally ill never fill their prescriptions or return to counseling, said Steven Schnee, director of Mental Health and Mental Retardation Authority of Harris County, a government agency that provides mental health care locally. They just return to their former lives, usually on the streets.
George, who often is homeless between jail stints, hopes she can avoid a return to jail this time. She has been working with Healthcare for the Homeless-Houston, which started a program that helps released mentally ill inmates find housing and reach appointments with mental health providers and counselors.
Michael Seale, director of the county jail's health services, said the mental health staff becomes frustrated because inmates stabilized in jail drift into psychosis when they get out.
'Whatever good work we've done may not have any value two or three weeks after they get out,' Seale said.
The jail — which has come under scrutiny recently for inmate deaths and was inspected by federal investigators earlier this month — spent about $10 million on mental health care in 2004. Two years ago, only 600 inmates were on psychotropic medications.
But staffing and funding then wasn't nearly adequate for the increasing numbers of mentally ill inmates.
Since mental health wards have been expanded, the jail now has beds for 244 mentally ill inmates, including 70 who are acutely ill.
The jail contracts with Harris County Psychiatric Center for 24 more beds.
The jail's mental health team delivers medications to an additional 1,650 inmates through outpatient treatment.
The team is big, employing 82 health care workers. That includes eight psychiatrists, 18 psychiatric registered nurses, 34 psychiatric technicians, seven licensed vocational nurses and 12 employees who screen incoming inmates.
Chief Deputy Mike Smith of the Sheriff's Office said the jail's mental health operation is comparable to the biggest non-jail mental health hospitals in the state.
Smith, as head of the jail, is among those credited with upgrading its mental health services. 'I've had people say I better watch what I say or I'll come across as a liberal,' he said. 'We shouldn't be treating our mentally ill in the jails. We should be treating them in the free world.'
Advocates say the number of mentally ill cycling through jails and psychiatric wards can be greatly reduced.
Many need to be placed in permanent supervised housing, Schwartz said.
Those who are less ill could be placed in apartments and monitored at least weekly by case managers.
But in Harris County, there are fewer than 1,500 rooms or apartments where the mentally ill can receive supervision or services, Schwartz said.
About 10,000 such units are needed.
'If these kind of housing opportunities existed, there would be far fewer mentally ill in jail,' she said."
***
An earlier post on the mental health care system (and its impact on criminal justice issues) in Harris County is available here.
More on Healthcare for the Homeless-Houston is available here.
As the number of these chronic inmates continues to increase, the cost of both incarceration and treatment has soared to $87 million annually. While some organizations have launched new programs aimed at providing support for severely mentally ill homeless people immediately upon their release from jail, the demand for services still far outpaces the limited resources available.
Here's the article in full:
"At the Harris County Jail, deputies and health care workers have a name for them — frequent fliers.
They are mentally ill homeless people who return to jail so often, sometimes on minor charges, that they become familiar to the psychiatric staff.
During a recent survey, county officials found that more than 400 of the jail's 11,000 inmates were homeless and suffered from a major mental illness: schizophrenia, bipolar disorder or a chronic depressive-psychotic disorder. They were among 1,900 inmates on psychotropic medications.
When the mentally ill homeless leave jail — and leave behind its mental health care staff — many stop taking medication and end up on the street again. Treatment resumes only when they commit a crime and return to jail or their dementia overwhelms them and they are brought to an emergency psychiatric center.
Treating the mentally ill as they cycle through jail and emergency psychiatric wards is expensive. A county budget analyst estimates that it costs $80,000 a year, per person.
At the jail, spending on mental health care has risen to $24 million annually, and the combined cost of incarcerating and treating the mentally ill is $87 million annually.
'The jails have become the psychiatric hospitals of the United States,' said Clarissa Stephens, an assistant director of the county's budget and management services office who has been studying the jail's mental health costs.
The Commissioners Court is so concerned about the rising costs that it has retained a consultant — psychiatrist Avrim Fishkind — to study whether providing outpatient services and supervised housing would reduce the numbers of mentally ill revolving through the jail.
'The costs of reincarcerating and court costs far outweigh what the costs would be if you housed, clothed and supervised the mentally ill,' Fishkind said.
A June survey of more than 11,000 inmates revealed:
•About one-quarter suffer from mental illness or once suffered from it.
•Of those on medication, 978 suffered from schizophrenia, bipolar disorder or a severe depressive-psychotic disorder.
•Of the 978 with a major mental health disorder, 423 likely were homeless.
•Of the 423 homeless with a major mental health disorder, 97 percent had been arrested at least once before during their lifetimes; 43 percent had a prior arrest during the last 10 years.
On the day of the survey, the jail's mentally ill homeless inmates included:
•A 39-year-old woman booked 45 times since 2001.
•A man, 26, booked 30 times since 1999.
•A man, 52, booked 33 times since 1992.
•A man, 25, booked 20 times since 2001.
Some of the mentally ill — many of whom also are substance abusers — keep committing crimes and getting rearrested, in part, because few are properly supervised when they are released, said David Buck, a Baylor College of Medicine associate professor and president of Healthcare for the Homeless-Houston.
Houston isn't alone in facing this issue. After many mental hospitals were closed in the 1970s and 1980s, countless patients were released in cities that were ill-equipped to house those who needed such care.
'What happens here happens in many communities. We are criminalizing mental illness,' said Betsy Schwartz, president of Mental Health of America of Greater Houston, a nonprofit that promotes effective treatment for the mentally ill.
Left to find her own way
Patricia George, 34, said her thinking always becomes clearer when she returns to jail and gets back on medication.
In the past 20 years, George, who says she is bipolar and schizophrenic, has been charged with 12 felonies and 31 misdemeanors, with most of the bookings in Harris County. In all, she has spent nine years in jail.
Like other mentally ill inmates, George has been expected to find her way — with no car and little money — to mental health providers, to line up counseling and to fill prescriptions for her medication in the weeks after her release.
In the meantime, medications she was taking in jail wear off, she said during an interview three days after her July 5 release from jail.
'Just walking down here (for the interview), I'm starting to hear voices,' said George, who finished a six-month sentence for prostitution.
Not filling prescriptions
Many of the mentally ill never fill their prescriptions or return to counseling, said Steven Schnee, director of Mental Health and Mental Retardation Authority of Harris County, a government agency that provides mental health care locally. They just return to their former lives, usually on the streets.
George, who often is homeless between jail stints, hopes she can avoid a return to jail this time. She has been working with Healthcare for the Homeless-Houston, which started a program that helps released mentally ill inmates find housing and reach appointments with mental health providers and counselors.
Michael Seale, director of the county jail's health services, said the mental health staff becomes frustrated because inmates stabilized in jail drift into psychosis when they get out.
'Whatever good work we've done may not have any value two or three weeks after they get out,' Seale said.
The jail — which has come under scrutiny recently for inmate deaths and was inspected by federal investigators earlier this month — spent about $10 million on mental health care in 2004. Two years ago, only 600 inmates were on psychotropic medications.
But staffing and funding then wasn't nearly adequate for the increasing numbers of mentally ill inmates.
Since mental health wards have been expanded, the jail now has beds for 244 mentally ill inmates, including 70 who are acutely ill.
The jail contracts with Harris County Psychiatric Center for 24 more beds.
The jail's mental health team delivers medications to an additional 1,650 inmates through outpatient treatment.
The team is big, employing 82 health care workers. That includes eight psychiatrists, 18 psychiatric registered nurses, 34 psychiatric technicians, seven licensed vocational nurses and 12 employees who screen incoming inmates.
Chief Deputy Mike Smith of the Sheriff's Office said the jail's mental health operation is comparable to the biggest non-jail mental health hospitals in the state.
Smith, as head of the jail, is among those credited with upgrading its mental health services. 'I've had people say I better watch what I say or I'll come across as a liberal,' he said. 'We shouldn't be treating our mentally ill in the jails. We should be treating them in the free world.'
Advocates say the number of mentally ill cycling through jails and psychiatric wards can be greatly reduced.
Many need to be placed in permanent supervised housing, Schwartz said.
Those who are less ill could be placed in apartments and monitored at least weekly by case managers.
But in Harris County, there are fewer than 1,500 rooms or apartments where the mentally ill can receive supervision or services, Schwartz said.
About 10,000 such units are needed.
'If these kind of housing opportunities existed, there would be far fewer mentally ill in jail,' she said."
***
An earlier post on the mental health care system (and its impact on criminal justice issues) in Harris County is available here.
More on Healthcare for the Homeless-Houston is available here.
Friday, July 18, 2008
Texas Mother to Remain in State Mental Hospital
Below is an update on the case of Deanna Laney, from the Tyler Morning Telegraph ("Woman Who Stoned Children to Death Will Remain in Mental Facility," July 8, 2008). Ms. Laney was found not guilty by reason of insanity for the murder of her children. She has spent the last four years in state mental hospitals.
The Texas Code of Criminal Procedure "prohibits the court and attorneys from informing a juror or prospective juror of the consequences to the defendant if a verdict of not guilty by reason of insanity is returned. The purpose of this provision is to prevent the jurors, if possible, from being influenced by the consequences of their decision to the defendant. It has been held that this provision does not deny fundamental fairnessto the defendant." (Texas Criminal Procedure and the Offender with Mental Illness: An Analysis and Guide, pp. 156-157).
Here's the article in full:
"Deanna Laney — who was found not guilty by reason of insanity after she stoned her young sons to death in 2003 — will remain in a mental facility for another year, a state district judge decided Monday.
A closed-door civil commitment hearing was held in 114th District Judge Cynthia Stevens Kent’s court, as it has been each year since Ms. Laney’s April 2004 capital murder trial.
After the hearing, defense attorney F.R. “Buck” Files Jr. said Judge Kent maintained the same order as she did last year.
When Ms. Laney was acquitted by a Smith County jury in April 2004, Judge Kent ordered Ms. Laney be placed in a maximum-security inpatient treatment facility. Since then, Judge Kent has presided over private hearings each year and determined that Ms. Laney should remain at an inpatient facility.
Last year, after attorneys discovered that Ms. Laney had been transferred from Vernon State Hospital to the Kerrville State Hospital and was being allowed unsupervised furloughs by doctors, Judge Kent put a stop to it at the request of prosecutors. Ms. Laney’s defense attorneys appealed her decision, but the 12th Court of Appeals ruled in April 2007 that the Texas Department of Mental Health and Mental Retardation could not grant Ms. Laney passes to leave the facility with her parents to go shopping and dining in the Hill Country.
In June 2004, Vernon State Hospital transferred Ms. Laney from its maximum-security facility to Kerrville State Hospital, a non-secure impatient facility, court documents state.
Between August and December 2005, Ms. Laney’s treatment team granted her brief passes off the hospital campus in Kerrville.
THE MURDERS
A jury found Ms. Laney, a 43-year-old housewife who home-schooled her children, not guilty by reason of insanity for stoning her sons to death on Mother’s Day weekend in 2003.
Joshua, 8, and Luke, 6, were found dead in the front yard of the family’s New Chapel Hill home, and then-14-month-old Aaron was found seriously injured in his crib.
Ms. Laney’s attorneys admitted during the trial that she had stoned her children, but contended that she was insane and did not know that what she was doing was wrong. Ms. Laney told authorities God told her to kill her children.
Under Texas law, people are found legally insane if, at the time of an offense, they did not know their conduct was wrong because of some mental illness or defect.
Ms. Laney was defended in trial by attorneys Files, Tonda Curry and LaJuanda Lacy, while Smith County District Attorney Matt Bingham, former First Assistant DA Brett Harrison and current First Assistant DA April Sikes prosecuted the case.
Judge Kent issued a restrictive and protective order, limiting what attorneys can say about the case."
The Texas Code of Criminal Procedure "prohibits the court and attorneys from informing a juror or prospective juror of the consequences to the defendant if a verdict of not guilty by reason of insanity is returned. The purpose of this provision is to prevent the jurors, if possible, from being influenced by the consequences of their decision to the defendant. It has been held that this provision does not deny fundamental fairnessto the defendant." (Texas Criminal Procedure and the Offender with Mental Illness: An Analysis and Guide, pp. 156-157).
Here's the article in full:
"Deanna Laney — who was found not guilty by reason of insanity after she stoned her young sons to death in 2003 — will remain in a mental facility for another year, a state district judge decided Monday.
A closed-door civil commitment hearing was held in 114th District Judge Cynthia Stevens Kent’s court, as it has been each year since Ms. Laney’s April 2004 capital murder trial.
After the hearing, defense attorney F.R. “Buck” Files Jr. said Judge Kent maintained the same order as she did last year.
When Ms. Laney was acquitted by a Smith County jury in April 2004, Judge Kent ordered Ms. Laney be placed in a maximum-security inpatient treatment facility. Since then, Judge Kent has presided over private hearings each year and determined that Ms. Laney should remain at an inpatient facility.
Last year, after attorneys discovered that Ms. Laney had been transferred from Vernon State Hospital to the Kerrville State Hospital and was being allowed unsupervised furloughs by doctors, Judge Kent put a stop to it at the request of prosecutors. Ms. Laney’s defense attorneys appealed her decision, but the 12th Court of Appeals ruled in April 2007 that the Texas Department of Mental Health and Mental Retardation could not grant Ms. Laney passes to leave the facility with her parents to go shopping and dining in the Hill Country.
In June 2004, Vernon State Hospital transferred Ms. Laney from its maximum-security facility to Kerrville State Hospital, a non-secure impatient facility, court documents state.
Between August and December 2005, Ms. Laney’s treatment team granted her brief passes off the hospital campus in Kerrville.
THE MURDERS
A jury found Ms. Laney, a 43-year-old housewife who home-schooled her children, not guilty by reason of insanity for stoning her sons to death on Mother’s Day weekend in 2003.
Joshua, 8, and Luke, 6, were found dead in the front yard of the family’s New Chapel Hill home, and then-14-month-old Aaron was found seriously injured in his crib.
Ms. Laney’s attorneys admitted during the trial that she had stoned her children, but contended that she was insane and did not know that what she was doing was wrong. Ms. Laney told authorities God told her to kill her children.
Under Texas law, people are found legally insane if, at the time of an offense, they did not know their conduct was wrong because of some mental illness or defect.
Ms. Laney was defended in trial by attorneys Files, Tonda Curry and LaJuanda Lacy, while Smith County District Attorney Matt Bingham, former First Assistant DA Brett Harrison and current First Assistant DA April Sikes prosecuted the case.
Judge Kent issued a restrictive and protective order, limiting what attorneys can say about the case."
Tuesday, July 15, 2008
New Private Mental Health Defenders Office in Lubbock
KCBD, NewsChannel 11 in Lubbock reports that officials in Lubbock County have received funding for a new program aimed at diverting offenders with mental illness from jail and providing them with quality legal representation ("New Program Addresses Lubbock County Inmate Mental Health," July 10, 2008). While both Travis and Bexar Counties provide public mental health defenders to those who have committed misdemeanor offenses, Lubbock's Private Mental Health Defenders office will be the first of its kind in Texas. The program will use county funds to pay a nonprofit organization to oversee cases defended by private attorneys
Here's the full story:
"Efforts are underway in Lubbock County to save taxpayers money and increase public safety. A $400,000 state grant will help Lubbock County open a Private Mental Health Defenders office. The goal is to address the mental health of Lubbock County inmates could save the county thousands of dollars at the same time.
If you commit a crime in the Hub City, you will most likely end up in the Lubbock County Jail. But Lubbock County Director of Court Administration David Slayton says, for some, crime is a by-product of mental health illness. 'These individuals need help, we understand that but we don't want there to be a public safety risk by releasing them back out on the street. To figure out how to best deal within the justice system has been really tricky,' Slayton said.
Slayton says, come this fall, the county will try something new - a Private Mental Health Defenders office. The office initially will be funded mostly by the state, but by the fifth year Lubbock County will pick up the entire bill. '[What] We anticipate is the savings in the jail cost will be enough to pay for this over, probably multiple times over,' Slayton added.
The state grant will put experts in the jail to help identify inmates with mental health issues. Something Sheriff David Gutierrez says will help the problem. 'We as sheriffs have had problems throughout the decades with mental health issues in the jail. The reality is that now we are trying to bring this across through the judicial system to identify them prior to intake,' Sheriff Gutierrez said.
Slayton says as part of the program the court will have the option to appoint specially trained attorneys to defend those identified with mental health problems.
Defense Attorney Ted Hogan says it will help move people more efficiently through the court system. 'It's a way of dealing with folks that aren't your traditional criminals. Helping folks get back on their feet who hopefully don't come back and enable us to do it much more efficiently than what the old system has allowed us to do,' Hogan added.
The idea, and its potential savings, has some Lubbock County commissioner's support. 'Take the grant money and do what needs to be done. Take care of these folks and give them [sic] learned council and keep those folks from possibly going to jail which will save us tax dollars,' Commissioner Bill McCay said.
But not all are in support. District Attorney Matt Powell tells NewsChannel 11 his office is already taking steps to make sure those with mental issues have good representation.
Still Slayton says many could benefit from the new office. 'It's good from the perspective of the tax payer, it's good for the defendant and they can get the mental help they need with their mental illness,' Slayton added.
This will be the first program of its kind in the state and one of the few in the country. It's expected to be up and running by the beginning of October."
***
An earlier post about this program is available here.
Tuesday, July 8, 2008
Government Agencies and Foundations Invest in Mental Healthcare
Here's an update from the Austin American-Statesman on efforts aimed at increasing funding for mental health services in Austin/Travis County ("Spending on mental illness sees a sudden boost," July 5, 2008):
"... Across Austin and in other parts of Texas, foundations and government organizations are giving more money to programs that help people with mental illnesses — an area that advocates say has long been underfunded in Texas.
The Travis County Healthcare District recently budgeted $3.2 million to pay for more in-patient care at local psychiatric hospitals, up from $1.9 million in 2007. St. David's Community Health Foundation last month awarded $2.3 million in grants to local nonprofit groups working on mental health issues, up from $1.3 million the year before.
In May, the Department of State Health Services handed out $25 million in new money to 17 local mental health centers, including more than $4.6 million for crisis care in Austin. The funding is part of $82 million the Legislature approved in 2007 to stem the tide of people with mental illness flooding emergency rooms, psychiatric hospitals and jails.
That state-sanctioned financial support was widely seen as a victory in Texas, which is ranked 47th in the country for its per capita spending on people with mental illnesses. It's unclear whether the extra spending will continue, though.
'It's hard to tell whether or not it's a turning point, but a lot of eyes are on this,' said Mike Maples, director of mental health and substance abuse programs for the Department of State Health Services.
Mental health advocates have long tried to push psychiatric issues into the spotlight. Those efforts have received a boost from media coverage of mental health problems facing Iraq war veterans. State and national lawmakers are debating ways to improve mental health care for veterans. And this week, the U.S. House passed a bill requiring group health plans to provide the same level of coverage for mental illnesses that is given to other health problems.
On the state and local level, crisis appears to be a driving force in the new spending.
Last fall, in an effort to stay within its state-allocated budget, the Austin-Travis County Mental Health Mental Retardation Center cut the number of patients it sent to Austin State Hospital. At that time, the center usually housed 100 to 110 patients at the hospital at any given time. Since then, the number has fluctuated: at one point in January, 56 Travis County patients were in the state hospital; this week there were 75.
With private mental health hospitals often full and unable to fill the void, dozens of suicidal, manic or violent people — insured and uninsured — have been diverted to area emergency rooms, where they might wait hours or even days to be sent to a local psychiatric hospital.
Local hospitals have responded by devoting more resources on the crisis patients.
The Seton Family of Hospitals, for example, added 16 beds at Seton Shoal Creek psychiatric hospital. It also set aside six beds at the University Medical Center at Brackenridge emergency room for people with mental and physical health problems — a move that cost about $460,000 during the fiscal year that ended July 1. Seton also said it would double its $3 million a year psychiatric residency program, adding four more residents to the program.
'You can't deal with community health problems if you're not also taking care of mental health issues,' said Greg Hartman, senior vice president of University Medical Center at Brackenridge. 'There's too much of a connection.'
The hospital bed shortage also spurred officials with the Travis County Healthcare District to increase mental health funding.
'I think (the bed shortage) was the catalyst for saying to ourselves, We've got to do something,' said Patricia Young Brown, president of the healthcare district. 'There has to be a better way.'
The district increased its contribution to the local mental health effort by agreeing to finance inpatient care over the next year that could help 368 to 728 additional indigent patients, depending on their length of stay in the hospital. Officials said they plan to continue that level of financing indefinitely.
Although the St. David's foundation also provided funding for in-patient psychiatric beds, most of its recent grants support local nonprofits. Waterloo Counseling, for example, will receive $112,000 for mental health employees, including counselors. Any Baby Can was given $149,00 to provide in-home counseling to 85 additional clients each year.
'It was really clear there was a lot of need, a big gap in mental health services," he foundation's president Dick Moeller said. ...'"
Read the full article.
**
More information about the $25 million in grants awarded by the TX Department of State Health Services is available here.
"... Across Austin and in other parts of Texas, foundations and government organizations are giving more money to programs that help people with mental illnesses — an area that advocates say has long been underfunded in Texas.
The Travis County Healthcare District recently budgeted $3.2 million to pay for more in-patient care at local psychiatric hospitals, up from $1.9 million in 2007. St. David's Community Health Foundation last month awarded $2.3 million in grants to local nonprofit groups working on mental health issues, up from $1.3 million the year before.
In May, the Department of State Health Services handed out $25 million in new money to 17 local mental health centers, including more than $4.6 million for crisis care in Austin. The funding is part of $82 million the Legislature approved in 2007 to stem the tide of people with mental illness flooding emergency rooms, psychiatric hospitals and jails.
That state-sanctioned financial support was widely seen as a victory in Texas, which is ranked 47th in the country for its per capita spending on people with mental illnesses. It's unclear whether the extra spending will continue, though.
'It's hard to tell whether or not it's a turning point, but a lot of eyes are on this,' said Mike Maples, director of mental health and substance abuse programs for the Department of State Health Services.
Mental health advocates have long tried to push psychiatric issues into the spotlight. Those efforts have received a boost from media coverage of mental health problems facing Iraq war veterans. State and national lawmakers are debating ways to improve mental health care for veterans. And this week, the U.S. House passed a bill requiring group health plans to provide the same level of coverage for mental illnesses that is given to other health problems.
On the state and local level, crisis appears to be a driving force in the new spending.
Last fall, in an effort to stay within its state-allocated budget, the Austin-Travis County Mental Health Mental Retardation Center cut the number of patients it sent to Austin State Hospital. At that time, the center usually housed 100 to 110 patients at the hospital at any given time. Since then, the number has fluctuated: at one point in January, 56 Travis County patients were in the state hospital; this week there were 75.
With private mental health hospitals often full and unable to fill the void, dozens of suicidal, manic or violent people — insured and uninsured — have been diverted to area emergency rooms, where they might wait hours or even days to be sent to a local psychiatric hospital.
Local hospitals have responded by devoting more resources on the crisis patients.
The Seton Family of Hospitals, for example, added 16 beds at Seton Shoal Creek psychiatric hospital. It also set aside six beds at the University Medical Center at Brackenridge emergency room for people with mental and physical health problems — a move that cost about $460,000 during the fiscal year that ended July 1. Seton also said it would double its $3 million a year psychiatric residency program, adding four more residents to the program.
'You can't deal with community health problems if you're not also taking care of mental health issues,' said Greg Hartman, senior vice president of University Medical Center at Brackenridge. 'There's too much of a connection.'
The hospital bed shortage also spurred officials with the Travis County Healthcare District to increase mental health funding.
'I think (the bed shortage) was the catalyst for saying to ourselves, We've got to do something,' said Patricia Young Brown, president of the healthcare district. 'There has to be a better way.'
The district increased its contribution to the local mental health effort by agreeing to finance inpatient care over the next year that could help 368 to 728 additional indigent patients, depending on their length of stay in the hospital. Officials said they plan to continue that level of financing indefinitely.
Although the St. David's foundation also provided funding for in-patient psychiatric beds, most of its recent grants support local nonprofits. Waterloo Counseling, for example, will receive $112,000 for mental health employees, including counselors. Any Baby Can was given $149,00 to provide in-home counseling to 85 additional clients each year.
'It was really clear there was a lot of need, a big gap in mental health services," he foundation's president Dick Moeller said. ...'"
Read the full article.
**
More information about the $25 million in grants awarded by the TX Department of State Health Services is available here.
Wednesday, July 2, 2008
North Carolina Inmate Found Incompetent for Execution
According to the Associated Press (and reported in the Times-News Online), a Superior Court judge has found Guy LeGrande incompetent for execution ("Judge: NC inmate too ill for execution," July 1, 2008). LeGrande has been on death row in North Carolina since 1996.
It is interesting to note that LeGrande was allowed to represent himself at trial, despite compelling evidence of his severe mental illness. The U.S. Supreme Court recently considered this issue in the case of Indiana v. Edwards and ruled that someone who is deemed competent to stand trial may not necessarily be granted the right to self representation. As with the case of Texas death row inmate Scott Panetti, who also was allowed to represent himself despite his extensive history of schizophrenia, Guy LeGrande's trial has been called "farcical."
Here's the article from the AP in full:
"A death row inmate who wore a Superman shirt and represented himself at trial is too mentally ill to be executed, a judge has ruled.
Stanly County Superior Court Judge Robert Bell ruled that Guy LeGrande, 49, was 'not competent to be executed' because he is psychotic and delusional, according to a ruling signed Friday but released Tuesday.
LeGrande was convicted and sentenced to death in 1996 for the 1993 shooting death of Ellen Munford in a murder-for-hire plot.
'The court has finally stepped in and halted a colossal miscarriage of justice, the execution of a seriously mentally ill man,' defense attorney Jay Ferguson said.
District Attorney Michael Parker, who didn't try the original case, said he hadn't received a copy of the ruling and couldn't comment. The state attorney general's office said it was reviewing the decision.
The ruling came nearly a year after the last hearing was held in LeGrande's case. LeGrande's execution is stayed until the state decides whether to appeal, and the murder conviction is not affected by the judge's decision.
The judge said LeGrande refuses to cooperate with his [current] defense attorneys, Ferguson and James Monroe, even to the point of sitting apart from them in court.
'The gross delusions stemming from Mr. LeGrande's severe mental disorder puts an awareness of a link between his crime and its punishment in a context so far removed from reality that the punishment can serve no purpose,' the judge wrote in his 10-page order.
LeGrande's defense lawyers said their client also claimed to communicate with television star Oprah Winfrey through the television. LeGrande also believed that he was getting a pardon and a financial settlement from the state.
Transcripts of the trial showed that LeGrande cursed the jury and said he would meet them in hell. At one point he told them to 'pull the damn switch and shake that groove thing.'
LeGrande had been scheduled to be executed Dec. 1, 2006, but the execution was halted to review LeGrande's mental state."
***
LeGrande will most likely remain on death row, unless the state agrees for his sentence to be commuted. In its Recommendation on the Death Penalty and Persons with Mental Disabilities, the American Bar Association states that
"If, after challenges to the validity of the conviction and death sentence have been exhausted and execution has been scheduled, a court finds that prisoner has a mental disorder or disability that significantly impairs his or her capacity to understand the nature and purpose of the punishment, or to appreciate the reason for its imposition in the prisoner's own case, the sentence of death should be reduced to the sentence imposed in capital cases when execution is not option." [Italics added]
***
Read more about Guy LeGrande on The Progressive Pulse, a blog sponsored by NC Policy Watch.
Additional coverage is available from the News & Observer.
It is interesting to note that LeGrande was allowed to represent himself at trial, despite compelling evidence of his severe mental illness. The U.S. Supreme Court recently considered this issue in the case of Indiana v. Edwards and ruled that someone who is deemed competent to stand trial may not necessarily be granted the right to self representation. As with the case of Texas death row inmate Scott Panetti, who also was allowed to represent himself despite his extensive history of schizophrenia, Guy LeGrande's trial has been called "farcical."
Here's the article from the AP in full:
"A death row inmate who wore a Superman shirt and represented himself at trial is too mentally ill to be executed, a judge has ruled.
Stanly County Superior Court Judge Robert Bell ruled that Guy LeGrande, 49, was 'not competent to be executed' because he is psychotic and delusional, according to a ruling signed Friday but released Tuesday.
LeGrande was convicted and sentenced to death in 1996 for the 1993 shooting death of Ellen Munford in a murder-for-hire plot.
'The court has finally stepped in and halted a colossal miscarriage of justice, the execution of a seriously mentally ill man,' defense attorney Jay Ferguson said.
District Attorney Michael Parker, who didn't try the original case, said he hadn't received a copy of the ruling and couldn't comment. The state attorney general's office said it was reviewing the decision.
The ruling came nearly a year after the last hearing was held in LeGrande's case. LeGrande's execution is stayed until the state decides whether to appeal, and the murder conviction is not affected by the judge's decision.
The judge said LeGrande refuses to cooperate with his [current] defense attorneys, Ferguson and James Monroe, even to the point of sitting apart from them in court.
'The gross delusions stemming from Mr. LeGrande's severe mental disorder puts an awareness of a link between his crime and its punishment in a context so far removed from reality that the punishment can serve no purpose,' the judge wrote in his 10-page order.
LeGrande's defense lawyers said their client also claimed to communicate with television star Oprah Winfrey through the television. LeGrande also believed that he was getting a pardon and a financial settlement from the state.
Transcripts of the trial showed that LeGrande cursed the jury and said he would meet them in hell. At one point he told them to 'pull the damn switch and shake that groove thing.'
LeGrande had been scheduled to be executed Dec. 1, 2006, but the execution was halted to review LeGrande's mental state."
***
LeGrande will most likely remain on death row, unless the state agrees for his sentence to be commuted. In its Recommendation on the Death Penalty and Persons with Mental Disabilities, the American Bar Association states that
"If, after challenges to the validity of the conviction and death sentence have been exhausted and execution has been scheduled, a court finds that prisoner has a mental disorder or disability that significantly impairs his or her capacity to understand the nature and purpose of the punishment, or to appreciate the reason for its imposition in the prisoner's own case, the sentence of death should be reduced to the sentence imposed in capital cases when execution is not option." [Italics added]
***
Read more about Guy LeGrande on The Progressive Pulse, a blog sponsored by NC Policy Watch.
Additional coverage is available from the News & Observer.
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