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Wednesday, May 14,2014

Crime and treatment

Ingham Countyīs Mental Health Court aims to keep sick offenders out of jail

by Lawrence Cosentino

Thomas Boyd has seen a lot of defendants, but the chief judge of 55th District Court in Ingham County can still picture one young man he sentenced a few years ago.

"He was only 17, hadnīt even grown into his full adult male body, and he was already a big, gangly kid," Boyd said.

The man heard voices others didnīt hear. He had already been in and out of mental hospitals, including Kalamazoo Psychiatric.

When Meridian Township police arrested him on a misdemeanor charge and put him in the back of the police car, the voices told him the cops were going to kill Boyd him. He lay on his back, legs up, kicked out the window of the car and ran away, his hands still cuffed behind his back.

"He wasnīt going to get far, but the voices told him to get out of there," Boyd said.

Boyd had already seen too many defendants with mental illness end up in jail instead of getting the medication, therapy and community support that might help them avoid the criminal justice system.

"I knew full well he didnīt need to be in jail, but I had no other place for him," Boyd said. "My probation officers were trying every day to get the mental health system to give us the information we needed. That young man spent two and a half weeks in jail he didnīt need to, had he been stabilized at the hospital."

No wonder Boyd is so enthusiastic about heading up Ingham Countyīs first Mental Health Court program.

"Iīve been frustrated for years," Boyd said. "I have felt the need to do something different with people that have mental illness since the moment I got here, which is eight and a half years."

Since Dec. 13, about 20 defendants with serious mental illness, all of whom would probably have ended up in jail, have gotten a different kind of attention at Inghamīs Mental Health Court: judicially supervised treatment.

"The traditional approaches to behavior modification donīt work well with people that have mental illness," Boyd said, meaning jail and probation.

"And thatīs what we do. Weīre in the behavioral modification business."

Funded by a $261,000 grant from the State Court Administrative Office, Inghamīs Mental Health Court is a partnership between the district court and the Community Mental Health Authority for Clinton, Ingham and Eaton counties. The projectīs partners stretch all over the community, from MSUīs Psychiatry Department to CATA to the Lionīs Club to whoever sold Sgt. Amy Ottke of the Sheriff’s Department the cupcakes she served at this monthīs first Mental Health Court hearing.

Ottke brings cupcakes to mark the birthdays that pop up each month among the courtīs participants — the courtīs preferred term to "defendants" or "offenders."

"Thatīs not what people normally expect from the sheriff at the jail," Boyd said. "Itīs definitely a different approach to avoiding recidivism."

Alan Platt leads the courtīs four-person contingent from Community Mental Health, where Platt is supervisor of adult mental health services. (Platt co-wrote the grant for the Mental Health Court with the district court.)

"Itīs a labor-intensive program," Platt said. "We spend a lot of time with each individual, coordinating services for them."

Those services arenīt limited to diagnoses, medication and therapy. When an older Mental Health Court participant got seriously behind on his utility bills, the court arranged a payment plan with the Board of Water and Light.

To get a young participant on track toward employment, Boydīs team set him up with practice GEDs. "We sat him in the court and took four practice tests on a laptop right here," Boyd said. "He passed all four and now we know heīs ready to take the GED."

When another participant needed eyeglasses, probation officer Al Spencer hooked him up with a pair, courtesy of a Lionīs Club volunteer who met them in the court parking lot.

Another young man needed a blood test after taking his medications. Boyd and the team made sure he knew how long to fast before the test, and made arrangements to get him to the test if his mother couldnīt take him.

Another man had money saved to move from a group home to independent living. Support service specialists from Community Mental Health have been going to apartment interviews with him, helping him apply for housing. Participants who need counseling on budget planning are referred to experts from Capital Area Community Service.

Mental health therapist Jill Platte, Plattīs colleague from Community Mental Health (and no relation), is a key member of the Mental Health Court team. She assesses participants to make sure they are clinically eligible and handles some of the treatment once they are in the program.

The grant establishing the Ingham County Mental Health Court requires that participants have a "serious" condition such as schizophrenia or any other psychotic disorder; bipolar disorder, longterm depression, or disabling, long-term post traumatic stress syndrome.

Christian McDaniel, director of adult mental health services for Community Mental Health, said "serious" is neither a clinical nor legal term, but a "descriptor."At the Ingham Mental Health Court, itīs Platteīs call whether the participantīs condition is serious.

Anyone can recommend that an offender participate in the Mental Health Court, from the police officer making the arrest to a family member to a caseworker or an attorney. Participation is voluntary.

Some health court participants transferred from regular probation. "They were doing very poorly, risking failure and going to jail, and we transferred them to our much more supportive, treatment oriented program," Platte said.

Robert Sheehan, director of the Community Mental Health Authority, said the Mental Health Court grant permits Platte, or another staffer, to focus on a caseload of 20 clients, compared to 40 to 80 otherwise.

"Itīs a fantastic package," Sheehan said. "They can dedicate themselves to the program and not be distracted by other things."

Platte still has her hands full. All of the participants at Inghamīs Mental Heath Court have two or more co-occurring diagnoses, either a serious mental illness or substance abuse disorder. Most participants are repeat offenders.

"Weīve got people who have pretty long rap sheets for little crimes, in and out of jail," Platte said. "They might commit a crime when theyīre completely psychotic and not really able to make good decisions. Our mental health system has had difficulty stabilizing them so theyīve fallen through the cracks. Theyīve had commitment hearings. They havenīt been able to succeed on a probationary schedule."

"These are very high functioning people, very capable," Boyd said. "They just have a serious mental illness that has pushed them into criminality."

Inghamīs Mental Health Court participants were convicted of a wide range of offenses, including assault, retail fraud, stalking, disorderly charges, auto theft, domestic violence and larceny.

It doesnīt take a new offense to land a mentally ill person back in serious trouble. Probation bristles with hurdles for the mentally ill. "They might have trouble getting to the required appointments, especially regular drug testing," Platte said. The mental health court might furnish transportation to testing site, make phone calls for them if they donīt have a phone, or even pay for the tests.

"When they come out of jail, they donīt want to go back, but they find themselves violating probation and getting into more trouble, because their mental illness has gotten in the way of their follow-through," Platt said.

Sometimes, Boyd said, probation is the worst thing for a troubled defendant. "There isnīt a more anti-social environment in the world than our lobby," Boyd said.

No participants have "graduated" from the 5-month-old Ingham County program yet, but Platte reported "good progress." Some participants, she said, have been free of substance abuse or stuck with their medications for the first time in their lives. "They have improved relationships in their lives, engaged in therapy, and just become more positive," Platte said. One participant has found and kept a part-time job with the health court teamīs help.

Boyd had is own way of measuring success. He said that without the Mental Health Court, "each of these people would have spent more time in jail than would have been appropriate."

Boyd is convinced that if the mental health court had existed when he sentenced the gangly young man who heard voices and fled the police, the outcome would have been different.

"We would have talked about his medications and steps we could take to increase the likelihood that he would continue taking them" Boyd said. "We would research possible housing options. We would start the process of stabilizing him in the community, using all the resources available to each team member. "

To Boyd, the programīs success depends on close and frequent huddles between his court, representatives of Ingham County Sheriff Gene Wriggelsworthīs staff and community-based mental health professionals. Each week, the Mental Health Court team assembles to discuss the weekīs caseload for an hour and holds about two and a half hours of hearings. The contingent from the Community Mental Health Authority consists of Platt, Platte, services specialist Mary Liska and peer support specialist Marietta Shelton. From the 55th District Court, thereīs Judge Boyd, who runs the program, along with chief probation officer Denise Wells, probation officer Al Spencer, and Sgt. Ottke. A defense attorney is also present.

The team is about to grow bigger. Beginning this week, hearings will be held on Wednesdays to accommodate the schedule of new members from the MSU Psychiatry Department, where a new forensic rotation for senior-level psychiatry residents is starting up. MSU residents will do a two-month stint at the Mental Health Court, where they will attend meetings, participate in decisions and help with hands-on treatment, including therapy and medications.

MSU Professor José Herrera will spend four hours a week supervising and helping with treatment.

With the Mental Health Court team in place, the stage is set for growth. At last weekīs hearings, Boyd saw 15 participants. There are about 20 in all. The grant establishing the court was written with the expectation of serving about 50 to 60 people a year.

This fall, Plattīs team at the Community Mental Health Authority will help the 55th District Court apply for a grant renewal that will take effect Oct. 1. "We will ask for more resources to expand the program," he said.

Platt estimated that about 15 percent to 20 percent of people that come in and out of Ingham County Jail have a serious mental illness.

"Youīll see studies that go up to 80 percent, but it depends on which diagnoses youīre including," he said.

A 2012 study by the Michigan Supreme Courtīs State Court Administrative Office found that mental health courts donīt stop the revolving door of incarceration and mental illness, but they put a stick in the works.

The study compared recidivism rates of participants in mental health courts with a comparison group of offenders who went through regular probation.

Checking in at 12, 18, 24 and 30 months after admission into the program, researchers found a "significant difference" between the groups every step of the way. At 12 months, about 5 percent of mental health court participants had been reconvicted, compared to over 19 percent of the comparison group. By the 30-month mark, more than 40 percent of the comparison group had been convicted of a new offense, compared to under 20 percent of those who went through mental health court.

The study also found that 97 percent of mental health court participants improved their mental health, as assessed by professionals, and about a quarter of the participants gained improvements in education and employment.

(By 2012, more than 300 offenders have "graduated" from a mental health court and hundreds more have successfully completed such programs since then.)

Findings like these have made mental health courts popular on both sides of the stateīs legislative aisle. Inghamīs Mental Health Court came into being quickly after Public Act 274 was passed by the state Legislature and signed into law last December. Lt. Gov. Brian Calley chairs the Mental Health Diversion Council, part of the stateīs Department of Community Health charged with helping mentally ill offenders get treatment instead of doing jail time.

The law expanded the mental health court system by authorizing the stateīs circuit and district courts to set up mental health courts and set guidelines for eligibility. Depending on how many courts decide to write grant proposals, the law promises to add significantly to the 16 that were already in place around the state last fall.

Boyd is encouraged that the Mental Health Court bill passed the stateīs contentious Legislature easily.

He cited two compelling reasons for the overwhelming bipartisan support.

"Some people were motivated by the fact that they didnīt believe what we were doing was effective," he said. "Other people were motivated by the fact that it was way too costly. So thereīs hardly anybody left to think we should keep doing what weīre doing."

As the program grows, Boyd is spreading the word about the new court to law enforcement and mental health communities. He held two forums with public health and law enforcement agencies this year and plans to hold several more, including a June 6 forum at Lansingīs Alane & Chartier law firm (see info box.)

With the new law on the books, mental health courts are likely to proliferate. According to Platt, the 30th Circuit Court in downtown Lansing is working on a grant from the State Court Administrative Office to develop a mental health court for people who have been convicted of felonies.

Nobody is pretending that 20, or even 200, mental health courts will compensate for the drastic plunge in adequate mental health care and systematic closing of public mental health facilities in Michigan and across the nation since the 1980s.

Boyd and others attended an eye-opening presentation at a National Alliance for the Mentally Ill conference at East Lansingīs Hannah Center last fall. The keynote sparker was Pete Earley, former Washington Post reporter and author of "Crazy: A Fatherīs Search Through Americaīs Mental Health Madness."

Earleyīs account of grappling with his sonīs mental illness and incarceration struck a familiar note. "He was fascinating," Boyd said. "Mental illness is being re-institutionalized, only now itīs through the criminal justice system."

However, in "Crazy," Earley declared the trend toward mental health courts and jail diversion programs "encouraging," but cautioned that they are only reactive steps.

"The mentally ill should not be arrested and go to jail to get mental health services and treatment," he wrote.

Boyd is hoping the Mental Health Court will be part of a solution for those who do run afoul of the law.

"So many times, parents that have been working with their kidsī mental illness, something bad happens or they give up and dial 911 asking for help," Boyd said. "They find out itīs the last thing they get. They just get victimized again.

"One of our goals is to make sure that when families reach out to dial 911, they actually get help."


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