Guilford County Mental Health Court

A front page article in the News and Record today pronounces the virtues of the new Mental Health Court in Guilford County.  Count me among those that have concerns regarding this development.

The program provides for alternative sentencing.  Instead of jail or prison, the criminal is ordered to undergo treatment and is monitored for a period of time.  The article gives a case example of a bipolar gentleman who shot at his wife.

This type of program was pushed by folks who wanted to obviate the need for a new county jail; and by others who ideologically (or for racial reasons) do not like the idea of incarcerating people.

I see a number of problems that could loom on the horizon:

1. As a physician, I have a basic understanding of the nature of mental illness.   In addition, I have had the opportunity to tour jails and prisons on several occasions, and am aware of the prevalence of mental illness in the incarcerated population.  I am concerned about what will happen when some of these folks are not incarcerated for significant periods.

While I do not quite reach the same conclusions as Thomas Szasz regarding his view that mental illness is a myth, and do not oppose the "medicalization" of differences among people with respect to the way they think and behave-- as he does-- I wonder about the wisdom of shielding those with mental illness from the consequences of their behavior.  One of the chief objectives of the criminal justice system, after all, should be protecting the public-- not assuaging the sensibilities of political progressives and/or minority leaders.

2. Mental illness, to the extent that we agree it exists, is often chronic.  It can exist over a period of many years, or even be life-long.  Providing a limited period of treatment and supervision does not deal with the reality that the illness will outlast any efforts by the criminal justice system to assure the criminal is treated and monitored. 

In addition, we have learned in a graphic way recently about the shortcomings of supervision and monitoring of criminals in the state of North Carolina.  We have other programs, such as probation, that allow criminals to remain out of prison.  And we learned about how well that program works in the Eve Carson case.  We learned that insufficient resources in North Carolina are dedicated to the task of monitoring criminals in the community.  And we also know that we have a revolving door criminal justice system, with weaknesses at virtually every link; so when monitoring fails, repeat criminals are less likely to be caught and brought to justice.

3. We need to consider that many folks with chronic mental illnesses do not take their medicine reliably.  If we accept the premise that the mental illness caused the crime in the first place, then it is nearly inevitable that non-compliance with medical regimens will leave the public at risk.  Indeed, this was one of the major impacts of deinstitutionalizing the mentally ill years ago.  Some folks prone to criminal behavior could no longer be supervised continuously, and treatment could no longer be assured.  

4. In spite of treatment for drug abuse and alcoholism, these problems are notoriously subject to relapses.  Indeed, they oft must be regarded as chronic mental illnesses also.

5. The ability to use mental illness as a vehicle for avoiding time in jail or prison virtually assures that artful defense attorneys will seek to establish diagnoses among their accused clients, and thereby manipulate the system.  Consider the high prevalence of depression in the general population.  Agitation and anger can be symptoms of depression; and these "symptoms" of depression are oft associated with violent criminal acts.

6. This mental health court approach seems to conflict with the "broken windows" theory of law enforcement, which emphasizes maximal apprehension and prosecution of even petty criminals to drive crime rates downward.

7. Consider the high-profile murders we have seen recently, as in the cases of Eve Carson or Regan Bailey.   Suppose we learned that their killers suffered mental illness, and were going to be treated medically instead of being sent to prison.  Would we be satisfied with that outcome?  After all, that is the natural conclusion of the approach being touted.  If it is considered to be valid and safe for the perpetrators of lesser crimes, it should also be valid and safe for murderers.  Are we comfortable with this approach being extended to murderers, and if not, why not?

Comments

[cara michele]

Joe, I agree that our behavior must (and does) have consequences, but incarceration is not the only or the most appropriate consequence in every circumstance when a mentally ill (or addicted) person commits a crime. Research shows that mental health courts (and drug courts) reduce recidivism and violence by people with mental health disorders -- and the diversion programs cost less than incarceration.

I'm not a "political progressive." I'm a conservative -- social and fiscal. And when I hear (and see, in the case of drug court, which I've observed) that we can do programs that reduce recidivism and violence and cost less taxpayer dollars AND at the same time treat people with compassion and respect and help restore lives and families, I say, why in the world would we NOT do that?

I strongly encourage you to spend a day observing drug court and/or mental health court. I was impressed with the system and proud of the men and women who came before the court, committed to changing their lives. I support drug and mental health courts, and I'm very thankful that we have them in Guilford County.

[Fred Gregory]

Cara,

As Joe said the system is ripe for gaming. It has been and will continue to be conned repeatedly .
I appreciate yor pride in the repentent criminal class but one day you may wake up and read about a horrible and unspeakable act of violence committed by someone who promised to change their life. It is not unprecedented by any means at all. Granted petty acts of law breaking don't warrant
incareceration but numerous studies for decades have shown that jails prevent crime make the public safer. As George Will wrote on June 22:

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/20/AR2008062002276.html

Then there is the notorious case of the Old Salisury Road murderer found not guilty of by reason of insanity. Every year a bunch of shrinks say he is now cured. Want him as a neighbor?

http://en.wikipedia.org/wiki/Michael_Hayes_(spree_killer)

Let's not forget about John W. Hinckley Jr. who attempted to assassinate President Reagan in 1981. He is still confined to a mental institution but is able to visit his mother and has ( not making this up ) " fondling " privileges with at least one woman; and is dating several others. Where did he find these companions ? Geez.

Cara, I have some of the the same concerns as Joe and urge you to carefully consider the downside of this " court " before giving it your full throated endorsement. That's all.

[Joe Guarino]

It would almost be tempting to consider this type of approach if our state did a good job of supervising those on probation. But unfortunately it does not. Law enforcement is not prioritized in our state or in our city, so we cannot rely on the usual processes to make this thing work.

And there is a component of incarceration that a drug/mental health court cannot fulfill. That is, the act of repaying one's debt to society, of being punished for one's crimes.

There is nothing that precludes our criminal justice system from doing treatment in addition to incarceration-- except, perhaps, the will to do so, and the resources needed. Why not do both? Perhaps this is the approach that should be taken.

[cara michele]

>> “...you may wake up and read about a horrible and unspeakable act of violence committed by someone who promised to change their life...”, “Want [Michael Hayes] as a neighbor?”, “Let's not forget about John W. Hinckley Jr.“

If you're worried about recidivism, I'd think you'd support drug and mental health courts, because they reduce recidivism and violence. (And cost less than incarceration.) And neither Hayes nor Hinckley were adjudicated in mental health court, nor would they have qualified for diversion.

>> “I have some of the the same concerns as Joe and urge you to carefully consider the downside of this 'court' before giving it your full throated endorsement.“

Fred, I think I have considered the pros and the cons. I've done the reading. I've talked with people in the field. And I visited Judge Sue Burch's drug court during our GASARA training:
http://chosenfast.com/2007/10/16/local-substance-abuse-training-academy-graduates-first-class/
And I was so glad to hear that we were getting a mental health court, too.

I support diversion programs that reduce crime and violence, save tax dollars, and help restore lives. That just makes sense. (I also support incarceration. Not everyone is a candidate for diversion, obviously.)

If you want to do a field trip, you, Joe and I can go to drug and/or mental health court and then discuss it over lunch. Email me.

[Joe Guarino]

Michele, I am not sure that sitting and watching the court in action would provide the data needed to determine whether the public is being kept safe over a prolonged period of time from those served by the court, and whether the system is being abused. And I am not sure it would provide reassurance that justice is being served.

Think back to the example the N&R provides of the bipolar man who shot at his wife. The only thing that prevented him from attaining the status of a murderer was the fact that he missed his target. And yet, he apparently gets treatment instead of incarceration.

[cara michele]

Joe, as far as "processes," I know that there was concern when mental health court started here about how the state's mental health "reform" (haha) would affect things:

http://www.redorbit.com/news/health/1157634/mental_health_court_up_and_running/index.html

I'd like to know more about how they're handling those challenges. Some of my friends who are moving from homelessness to housing have encountered (ahem) obstacles while navigating our local mental health system. Granted, that is a concern.

Re: "repaying a debt to society" and "being punished." Justice should be tempered with mercy. (Model: Jesus.)

>> "There is nothing that precludes our criminal justice from doing treatment in addition to incarceration-- except, perhaps, the will to do so, and the resources needed..."

I agree that it should be done, and I agree with your reasoning on why it's not happening.

[cara michele]

>> "Think back to the example the N&R provides of the bipolar man who shot at his wife. The only thing that prevented him from attaining the status of a murderer was the fact that he missed his target. And yet, he apparently gets treatment instead of incarceration."

And forgiveness from his wife, too -- who says that he didn't deserve to go to jail. Because, I presume, she (and the judge and the mental health providers) believed that his actions stemmed from his illness, which is now apparently being controlled through treatment. So he got more mercy than judgment. God bless him. And yes, we'll see what happens next. (But hey, even if he'd gone to jail for shooting at her, he'd have gotten out eventually. Wonder what his mental state would have been like by then? There are no guarantees, people...)

I get that this is controversial stuff for a whole lot of people -- the whole treatment v. punishment thing for mentally ill and/or addicted people. My perspective is shaped by both science and faith. Your mileage may vary. ;)

[bubba]

"And forgiveness from his wife, too -- who says that he didn't deserve to go to jail."

Because of poor "gun control" on his part?

I wonder if her family would have expressed this sentiment if his aim had been true, and his intent fulfilled?

[Joe Guarino]

Bubba, you raise a good point about gun control. The Supreme Court seemed to have settled the issue, at least for now, as to whether it is permissible for folks to possess guns. But if we are going to be serious about gun-related crime, we have to prosecute when it occurs, and have people pay the consequences.

And Michele, you raise a good point about whether these folks will slip through the cracks with their treatment because of the turmoil in our public mental health system. (And, as I pointed out, because of the intrinsic nature of many mentally ill individuals to stop taking their medicine.)