Thursday, January 28, 2016

Jailing the mentally ill

From the Hogg Foundation, see a Houston Chronicle column (Jan. 18) titled, "Texas, stop treating mental illness like it's a crime."
Without question, some people with mental illness need to be incarcerated. But for low-level nonviolent offenders, we should look to measures that can divert people from jails and into community-based mental health treatment programs.

The sequential-intercept model is a good example and highlights how this process of diversion can happen at every point along the criminal justice continuum - from the moment the 911 call is placed all the way to re-entry into the community after incarceration.

What's required are common-sense reforms such as targeted training for police and 911 dispatchers, screening for behavioral health conditions at the early stages of the process, and improved coordination between the justice system and social service agencies. For example, re-entry peer support, in which a recently released person is paired with a trained mentor who's been through the same experience, has been tested in Pennsylvania with promising results. The Texas Legislature approved up to $1 million in funding last session for two pilot sites. Scaling of such a program, if the pilots prove successful, could make an enormous difference.

Another good example is the improved protocol for 911 dispatchers in Houston, which requires that all callers be asked if their call involves a mental-health issue. Callers who say yes are routed to special crisis counselors who work out of the police department and can often deal appropriately with a situation without even bringing law enforcement into it.

We should take these kinds of steps because it's not only the right thing to do, the time is right. The evidence base for diversion programs has matured to the point where we can have confidence that the money will be well-spent. Law enforcement officials across the country support such measures. And advocates, experts and policymakers are recognizing that systemic change is needed to address systemic problems. It's time for more Texas lawmakers to get on board. 
Meanwhile, the SA Express News published a column (Jan. 22) by Sheriff Susan Parmerleau touting Bexar County's much-admired mental health diversion program, which has garnered national praise and generated impressive results:
The results have been remarkable. In 2009, the 15 deputies assigned to our mental health unit received crisis intervention training, which teaches them how to recognize someone in a mental health crisis and how to de-escalate the situation. Prior to 2009, our mental health deputies had to use physical force, on average, 50 times a year taking those with mental health issues into custody. Since that time, in more than six years, force has only had to be used three times. The difference between 300 times and three times is dramatic.

Since this program was started, more than 20,000 people with serious mental illness have been identified and diverted from jail into treatment. And the program has contributed significantly to resolving the problem of overcrowding in the jail.

Bexar County’s improvements in responding to people in crisis have also led to significant savings by reducing incarceration and emergency room use. In the past five years, the jail diversion program has saved Bexar County more than $50 million. This has been achieved through wise investments in community mental health services, and hiring more professionals to provide treatment. It has also succeeded by focusing resources on rehabilitation, housing and employment assistance. ...
Jails have become de facto mental institutions, and that has to change. As we work together as a community, we can provide those with mental illness the help they need. Those suffering with mental illness need treatment programs, not jail cells.
Finally, UT-Austin academic William Kelly offered up an interesting critique of the mens rea debate going on at the federal level, arguing that the real mens rea issues in the criminal justice system relate to mental illness:
Today, 40 percent of individuals in the U.S. criminal justice system (federal and state) have a diagnosable mental illness. Sixty percent of inmates in the nation’s prisons have experienced at least one traumatic brain injury. Nearly 80 percent of justice-involved individuals have a substance abuse problem.  The prevalence in the justice system of individuals with intellectual disabilities is three to five times what it is in the general population. There are substantial numbers of individuals in the justice system with neurodevelopmental and neurocognitive deficits and impairments.

Moreover, there’s overwhelming evidence that many individuals with mental illness, addiction, neurodevelopmental deficiencies, and intellectual deficits lack the ability to form intent as it is defined in the law.  How many lack this ability we don’t really know, because we rarely inquire about intent. But the statistics cited above should raise serious questions about how we go about the business of criminal justice in the U.S.

In the vast majority of state and federal criminal convictions, the government rarely is required to prove intent. That’s because the vast majority of criminal indictments (roughly 95 percent) are resolved through a plea agreement.  If the offender agrees to the terms of the agreement, it’s essentially a done deal. That puts prosecutors in charge of sorting out who is criminally responsible and who is not. At the end of the day, the vast majority are held responsible.

Mens rea is supposed to serve as a gatekeeper at the front door of the justice system, separating innocent from criminal behavior. The reality is that criminal intent is just not much of an issue under current criminal procedure. That in turn has significantly contributed to our incarceration problem by facilitating the punishment of more and more individuals.
It has also contributed to our recidivism problem.

When we punish mentally ill, addicted, intellectually disadvantaged and/or neurocognitively impaired individuals, we tend to return them to the free world in worse shape than when they came in. This is simply more grease for the revolving door.


Anonymous said...

"When we punish mentally ill, addicted, intellectually disadvantaged and/or neurocognitively impaired individuals, we tend to return them to the free world in worse shape than when they came in. This is simply more grease for the revolving door."..
---- yes, GFB unless they die a miserable death in prison, after having lived in the prison's squalor, pain, humiliation and after they have been subject to the worst kind of abuse one can suffer as they are placed in ad seg more than others.
---- in which case no, they do not come back in worse shape, they just don't come back at all.

Many rot there and die too young.

This happens more often than one may think, because of suicides, neglect, lack of meds or wrong meds, abrupt discontinuation of meds, lack of medical care for comorbid conditions.

Add: continuous punishment and harassment by guards and wardens whose incredible ignorance, sadism, self-righteousness, lack of compassion and understanding causes an inmate to receive case after case for minor and insignificant infractions. It's a form of psychological torture.

I have witnessed this at the Michael's unit also the Monford unit where many mentally ill perople are housed. The wardens there do not have a iota of understanding. Their refrains: "they are responsible for their behavior even if they are mentally ill", "they are faking mental illness", "I don't believe in mental illness", "they can get better if they want to", "It's their fault if they are here", "if they find God, they'll get better", "it's their parents' fault".... --- these are the ignorant remarks I have heard over and over when I worked there.

Do you want to see Texas ignorance at work? Talk to a few wardens, have coffee with a few guards, and enjoy a conversation with TDCJ "nurses". Then you will truly understand what happens when you place a mentally ill person in prison.

Anonymous said...

In the past this was true. The good ol' boy culture is on the way out in a few months. TDCJ is in the process of evolving into a new agency and leads the nation in many reforms. New correctional officers in the agency are now required to complete an additional 32 hours of mental health training. There are many funding needs in the agency that need to be addressed. Capital expenses such as building new facilities to replace old mold infested non-climate control buildngs are needed. Newer, but smaller prisons are needed to replace the out of date infrastructure. Secure cells that are non-solitary cells are needed to house the more dangerous offenders so that they may have some social structure without endangering the population.

Anonymous said...

In Harris County, significant progress has been made to reconsider criminalization aspects of persons in a mental health crisis with alleged low-level criminal involvement. Typical Class B misdemeanor offenses such as criminal trespass, theft and simple assaults are more appropriately handled with stabilization and treatment - rather than jailing the person. The integration of law enforcement and mental health professionals has multiple proven benefits including, but beyond, the reduction in the jail population via diversion, to a treatment facility. There are the fiscal benefits gained from out of detention treatment and medication costs and perhaps most importantly, the reduction in use of police first-responders to a mental health call - if a specialized and trained mental health unit is available.

Anonymous said...

Training in the recognition, diagnosis and treatment of major mental health disorders, especially in the context of competency to stand trial, insanity pleas and mitigation of sentence should be compulsory for any attorney permitted to take court appointments in criminal cases. There is already an organization, Capacity for Justice, providing training for mental health professionals with regard to the relevant legal concepts. The courts should work with Capacity to set up training sessions in every region for attorneys regarding the relevant mental health issues. THAT would help improve these problems.

Anonymous said...

08:55:00 AM
"In the past this was true" - NO SIR! This is true as we speak. A family member died recently because of your f@#&*g neglect. In October a warden at the Skyview unit said: "He ain't that sick!" - a guard (with rank) echoed: "Nah, he don't look sick to me!" - A few weeks later the inmate was dead because of gross medical neglect that went on until the last minute. So, no sir, this is true NOW!

Lies, denials. minimizazions: TDCJ modus operandi. You are TDCJ. Your words unmask you.

32 hours of mental health training? We need an attitude change. 32 hours of training a bunch of uneducated imbecilles and mean psychopaths doesn't even begin addressing the problem.


The bad language? A reflection of how mad I am. Just came back from the cemetery. For you it is a statistic to be debated. For me it is a forever loss for which you don't give a damn!
SO NO! Things are the same as they have always been.

As to "TDCJ is in the process of evolving into a new agency and leads the nation in many reforms", keep on being delusional and on spreading LIES. Go to the "hospice" at the Michael's unit. Look at the rusted beds, the inmates left to die with no care (2 low-level nurses to take care of up to 20 dying inmates is NOT enough!), the roaches, rats and lack of morphine while the patients' hauls and screams are felt throughout - Look at Polunsky and Estelle: are you trying to bamboozle the public here? Are you trying to be self-delusional so that you can look at yourself in the mirror? Look at the empty beds at the Galveston Hospital, which could host twice the amount of inmates that's hosting now, but can't for lack of funding (so they say.) - Look at your "retrofitted vans which serve as "ambulances" and which have bad shock absorbers, making the transportations of seriously ill inmates a living hell. Look at everything around you (are you around or do you sit in an office?) and tell me that things are not the same.

My most fervent prayer: that you either do an honest assessment of what's really STILL going on or that you rot in hell! With no apologies for my bad language. You killed one of mine in a horrible way. I will never forget nor forgive you or the likes of you.

George said...

@ Anonymous 03:49

The pain that you're feeling exudes off the page. What you are saying is the absolute truth. There are certain units within TDCJ that have a long, long history of extreme abuse and extreme neglect. We must not allow people who don't want the truth to come to muzzle us from speaking the truth.

As to the anonymous commenter who says change is just around the corner, I say bullshit, if you'll pardon my French. It's gonna take a hell of a lot more than 32 hours of training to change the atmosphere of the Texas prison system's mentality and how they deal with prisoners who have mental issues and challenges. The whole system needs an overhaul, from the top down rather than the other way around. The chum floating at the top is what's stagnating the rest of the system.

Senator Whitmire and all the rest of the legislators that deal directly with criminal justice matters in the Texas Leg need to pull their heads out of the mole holes and genuinely deal with this as a whole and not piecemeal as has happened for much too long. You might as well rename TDCJ and leave out Justice because there's very little, if any, of that within the system.