Treatment instead of jail
Courts try new approach to mental illness
There is a court reporter in the courtroom of Sangamon County Circuit Court Judge John Madonia on this Friday afternoon. That’s a bad sign.
If everyone here in Sangamon County’s fledgling mental health recovery court was going to therapy sessions, testing clean for drugs, not getting arrested and otherwise behaving themselves, there would be no need for a court reporter, who is called in to create an official record when someone screws up and is sent to jail as punishment. And more than half of the five defendants here today have screwed up.
First comes the defendant who lugs a backpack around to stores where clerks have learned to keep a close eye. Shoplifting landed him in this program aimed at keeping the mentally ill out of jail, and he was caught yesterday removing price tags from goods in a hardware store. He has also presented the court with a phony letter from a purported expert in psychology on letterhead that includes an office address that doesn’t exist, a phone number that doesn’t work and a web address that comes up “Server Not Found.”
According to the letter, the defendant suffers from a rare type of post-traumatic stress disorder, and treatment can’t begin until he is free from distractions inherent in legal proceedings. Translation: Get this guy out of mental health recovery court and he can be cured.
Madonia reminds the defendant that this court that got started in February is designed to get treatment for the mentally ill so that they can get their lives together and stop committing crimes. With the help of a team that includes prosecutors, probation officers and mental health professionals, the judge has done his homework. The disorder cited in the letter isn’t recognized by the American Psychiatric Association, Madonia notes, and it is associated with survivors of concentration camps. Have you been in a concentration camp, Madonia asks the defendant. No, he answers.
“You are dangerously on the verge of going to prison, and that’s what this program is designed to prevent,” Madonia says before ordering the man jailed for five days and telling him that he must attend weekly therapy sessions when he gets out.
Next is a woman dressed in jailhouse stripes whom Madonia had jailed for breaking a rule. She has a history of shoplifting household cleaners and huffing them to the point of passing out. The mental health court recovery team that advises the judge wants to put her in an inpatient substance abuse program, but hasn’t found a spot. It’s time for her to get out of jail, but there’s no good place for her to live.
“I wish we had better news for you,” Madonia says. “We’re going to get you the help you need, and we’ve got to save you from yourself.”
The judge says that she can be released but will be on house arrest. She is not to leave her home for any reason other than court dates and medical appointments. What about grocery shopping, asks the woman, who has been arrested 14 times since 2008, usually for unlawful use of an intoxicating compound, the legal term for huffing.
“The grocery store is exactly where we can’t have you going,” Madonia intones.
The next defendant is also dressed in stripes. He was jailed and tested for drugs four days after skipping court a week ago. He’s being held on a $100,000 bond, quite an achievement for a shoplifter.
“The level of disappointment I have, you should be able to feel from where you are,” Madonia tells the man who stands at least 10 feet away from the bench. “You had a smorgasbord of narcotics in you. It’s like you went to Golden Corral and sampled from every station.”
Don’t send me back to jail, the man pleads.
“I promise, if you give me this one chance, I can show you,” the defendant begs. “I think, really, I can do better.”
“You’re going to get that opportunity,” responds Madonia before sending him to jail for 14 days. He can get out early, the judge says, but only if he lands a spot in an inpatient treatment program. That doesn’t happen, and so he ends up spending two weeks in jail.
Reduced recidivism, higher costs
Sangamon County’s mental health recovery court, which started up on Feb. 20, is both an experiment and a leap of faith aimed at keeping the mentally ill out of jail, reducing recidivism and saving money. Defendants who might otherwise go to jail or prison are placed on probation for two years and closely monitored to ensure that they attend therapy sessions, stay off drugs and otherwise obey court instructions aimed at keeping them out of trouble. If they don’t follow directions, they can be jailed for short periods of time as punishment.
In chambers, Madonia says that the program is going better than he expected. But he has no illusions about the future of the half-dozen defendants.
“Honestly, I don’t know what I’m hoping for,” Madonia says. “If we can get one success out of this, it will be worth it.”
Most defendants were arrested for shoplifting. None are considered violent, and their records tend to be long, with three or more arrests, often for the same crimes over and over again. They all suffer from mental disorders but there are, so far, no schizophrenics. Madonia says that the court has been cautious in accepting schizophrenic defendants because their behavior can be unpredictable and difficult to manage.
The county launched the program with no money set aside for the purpose although the probation department is applying for a $250,000 federal grant. The federal government provided $50,000 for planning last year. Madonia says that mental health recovery court is too important to put on hold.
“If we waited for the funding, we weren’t sure we would ever get off the ground,” the judge says. “This is bigger than shoplifters. This is about the system in general.”
Given the lack of money, finding drug treatment and other services for the half-dozen defendants has proven a challenge, Madonia says. But agencies both public and private are doing what they can.
A specialist from Memorial Medical Center is assessing candidates for the court and has so far evaluated 18 inmates in the county jail. Memorial is also connecting defendants with appropriate therapy and even stands ready to help defendants find jobs.
Figuring out who might benefit from the program is a matter of determining balance: Is an inmate more mentally ill than criminal, or more criminal than sick? The former go to the front of the line.
“We’re losing money all over the place, but it’s good for the community,” says Janice Gambach, president of Mental Health Centers of Central Illinois, an affiliate of Memorial Health System that also includes Memorial Medical Center. “There’s a lot of people in jail with mental health issues – we know there’s a real critical need out there. This is kind of a labor of love, if you will. We’re trying to take it slowly. What’s great about this is, we’re not the new kids on the block. There’s a lot of research out there.”
Recent studies by Policy Research Associates, a New York behavioral health research firm, show that mental health courts in other states reduce recidivism.
“Absolutely, they (defendants) do better, even if they don’t finish,” says Lisa Callahan, a researcher at Policy Research Associates, which conducted studies with funding from the John D. and Catherine T. MacArthur Foundation. “All of the evaluations and studies of mental health courts come to the same conclusion: They work.”
They are not, however, necessarily less expensive than the traditional approaches of jailing the mentally ill or putting them on probation and crossing fingers that they will be able to fend for themselves.
In 2009, researchers in San Francisco found that it takes three years after someone enters mental health court before savings in jail, probation and other traditional criminal justice costs outstrip the amount spent on therapy and other services aimed at keeping the mentally ill out of jail. In the first year, the San Francisco mental health court spent $2.32 for every $1 saved in traditional criminal justice costs; in the second year, the court spent $2.64 cents for every $1 saved in traditional costs. In the third year after enrollment, the court spent 90 cents to save $1 in traditional costs.
In a 2014 study, Policy Research Associates examined three courts in California, Minnesota and Indiana and determined that mental health courts cost $4,000 per year more for each enrollee than the traditional approach of jailing defendants.
“The findings presented here call into question some of the assumptions of MHC advocates who argue that participation in these courts will result in more cost-effective and efficient interventions for jail detainees who have a serious mental illness,” researchers wrote in their 2014 report. “Our findings suggest that broad claims of cost savings over time for MHCs as they currently operate are not supportable.”
Still, mental health courts have become enormously popular in the United States. Fewer than five existed in 1997. Today, there are an estimated 350 mental health courts. Callahan says that the Affordable Care Act, which has expanded insurance for the mentally ill, can help with costs.
“Frankly, with an increase in services and an increase in people who have access to health insurance now, it’s likely that more people will have treatment because they have insurance to pay for it,” Callahan says.
Starting from scratch
The first mental health courts in Illinois were set up in 2004, with Cook and DuPage counties leading the way. The courts are still a relatively new and rare phenomenon in the Land of Lincoln, with just 17 of the state’s 102 counties having mental health courts and nine of those having been established since 2010.
“Honestly, I think the state of Illinois lags behind in social awareness funding,” Madonia says.
Nonetheless, the Sangamon County court is growing. Last week, it accepted its sixth defendant, but the number of probation officers, lawyers and mental health professionals who attend court each week still outnumber defendants. Madonia figures the court can handle a maximum of 24 defendants, far short of the need.
“There’s no additional cost to the state’s attorney’s office or the courts,” says state’s attorney John Milhiser, who attends court each week and has ultimate say over who will be enrolled. “I think there is an issue with bed space – I think there are issues with bed space in the jail and issues with bed space in treatment facilities. … With the mental health court, we need individuals who want to get help, number one. No one has to be there, they have to want to get help.”
Housing is critical, Madonia says.
“At one of our first meetings, we realized that they (defendants) have to have a place to go,” the judge says.
Enter Helping Hands of Springfield, a social service agency that specializes in finding housing for the homeless.
So far, two enrollees have found housing at Helping Hands’ homeless shelter, but living in a dormitory setting with 40 other people isn’t necessarily the best option for someone who suffers from certain conditions such as post-traumatic stress disorder, says Rod Lane, Helping Hands executive director.
“I think we’re seeing success, and I think it’s giving some individuals motivation to get things done that they know they need to do,” Lane says. “Eventually, I think we’ll need more players at the table. … Currently, we’re running into walls a lot of times when we need to get someone placed. Group homes, community living is an urgent need for a lot of these individuals. I’m seeing some folks in shelters who really shouldn’t be there.”
The challenge was obvious during a recent court session when a defendant who has been living at Helping Hands resisted Madonia’s call to move back in with her mother. The mother-daughter relationship has been strained, and still is. The defendant’s mother was also in court. She and her daughter, who has been coming home to shower and do laundry, sat on opposite ends of a spectator’s bench in the courtroom. The defendant says that she doesn’t want to live with her mother, and her mother says amen.
“I can honestly say: We don’t get along,” the mother told the judge. “She’s been more motivated than I’ve ever seen her. But she fights with me. The only reason I’m here today is that, whether she realizes it or not, she needs somebody.”
Madonia looks frustrated and pained as the courtroom falls into silence. Finally, he decrees, the defendant can continue living at Helping Hands, even though he says that it can’t be a long-term solution.
Michael Torchia, director of probation and court services, is hoping to land a $250,000 federal grant that could pay for such things as a full-time mental health professional in the jail, which now provides 28 hours of mental health services per week, to assess incoming prisoners to determine whether they belong in mental health recovery court. The money could also be used for therapy, psychotropic medications and a coordinator to administer the court, he said.
“Right now, all of the agencies involved in this are trying to provide as many resources as we can,” Torchia says. “A lot of people are volunteering their time and effort.”
So far, so good
While Torchia, Lane, Milhiser and others on the court team charged with keeping track of defendants and making recommendations to the judge meet in private prior to the start of the weekly court session, Christine Overton quietly scolds another defendant sitting behind her in the courtroom who tells her that Madonia “slammed” him by sending him to jail for a positive drug test.
“He didn’t slam you, you slammed yourself,” Overton says. “This judge ain’t playing.”
It’s too early to proclaim anyone a success, court officials say, and no one is a poster child. But so far, Overton is doing as well as anyone can expect.
She usually shows up early for court each Friday afternoon and stays longer than required, watching as other defendants appear before the judge to be praised, scolded or sent to jail.
“Court might start early,” Overton explains during a recent interview at Helping Hands. “I stay late because I want to see what everyone else is going through.”
So far as Overton is concerned, the chance to dodge prison by getting her life in order is a godsend.
“I was on drugs really bad,” Overton says. “I’ve done the dating thing, the prostitution thing. After awhile, I refused to lie on my back, so I started stealing. … I’ve been to prison. I’ve been to jail. There’s just something about the last time I was in jail. I’m 46 years old. You get tired of going back and forth to jail.”
Overton’s criminal record stretches back to 1990 and includes more than a dozen arrests, including 11 for shoplifting. She does not look or sound crazy. Overton says that she did well in high school and has an associate’s degree in behavioral health. Staying off illegal drugs, she says, hasn’t been difficult.
“It’s hard if I don’t take my medication – then I self-medicate,” she says. “When I’m not on my medication, no one deals with me.”
Overton faces two years in prison if she doesn’t succeed. She was on probation for a 2012 felony shoplifting case when she was again arrested for shoplifting in January. She says that she knows she’s on the brink.
“These folks aren’t playing with you about going to prison,” she says.
This time, Overton vows, will be different. And, so far at least, it is. Last week, she had demonstrated sufficient progress that she was allowed to move into an apartment subsidized by the U.S. Department of Housing and Urban Development, the same sort of relatively independent living arrangement she had before her most recent arrest.
“What’s different this time is, I’ve never had anyone fight for me,” says Overton, who has been clean for more than a month and has drug tests to prove it. “They’re seeing something in me I’m not seeing in myself. You never thought you were something – anything – because that’s what you were told by your friends and your family. It was just an awesome thing that I got a chance to do this. I was always told I was a crackhead.”
Lane, of Helping Hands, says it’s up to Overton to stay out of trouble and follow court directions. Among other things, that means staying away from her family, which has contributed to her downward spirals.
“Christine is showing the most success at this point,” Lane says. “I think that she saw, ‘Oh, no – if I don’t do this, I’m going to see a life I don’t want to see, and I want to get my life back.’ I’m very proud of her.”
The court, Lane says, isn’t a panacea. It can only help defendants help themselves, he says.
“I think the judge and the team want to remove barriers, if possible,” Lane said. “If they can’t, then the system’s going to have to take them. We want to reduce that if we can.”
Contact Bruce Rushton at firstname.lastname@example.org.