Mental illness and the courts

Our view: Ordering defendants with serious mental illnesses to undergo treatment could reduce the number of chronic offenders and save the criminal justice system money on behalf of their clients

April 18, 2011

Mental health professionals have known for years that people who suffer from serious mental illnesses are often more likely to end up in jail than in some form of treatment. That's why a new program in the Baltimore City Circuit Court to divert some seriously ill defendants to mental health programs instead of jail is a worthy effort. But to succeed, the initiative will require not only an adequate supply of mental health treatment slots in Baltimore, but also increased access to stable, safe and affordable housing for the mentally ill defendants it serves — something that has been lacking in the past.

The initiative, known as the Mental Health Case Management Docket, is aimed at the repeat offenders who commit crimes as a result of having a serious mental illness rather than from criminal intent. People who suffer from lifelong psychiatric conditions such as schizophrenia, bipolar disorder or clinical depression are often incapable of taking responsibility for their actions. Unless they get treatment that addresses their underlying disorder, their behavior is unlikely to change and they may remain a danger to themselves and others, regardless of the sentence they receive.

In such cases, simply putting people behind bars or on unsupervised probation back in their communities does nothing to ensure either their safety or the public's — especially in cases that come before the circuit courts, which deal with more serious crimes that often involve violence. Lower courts in the city and in Prince George's and Harford counties have had mental health programs for several years, but the new mental health docket in Baltimore will be the only circuit court initiative in the state devoted to dealing with defendants with serious psychiatric illnesses.

That's a big step forward for the criminal justice system, because the illnesses in question can be devastating to people who suffer from them. Schizophrenia is a psychotic disorder that makes its victims prey to terrifying visual and auditory hallucinations, jumbled thoughts and persistent delusions that distort their perception of reality. People who suffer from bipolar disorder are subject to wild emotional swings, from elevated moods of grandiosity and invincibility to feelings of unbearable sadness, hopelessness and despair. Major depression isn't just feeling "blue" but a life-threatening, chronic condition that can drive people to neglect themselves and their responsibilities to others or even push them to suicide. In all three cases, even if people are capable of distinguishing right from wrong, they may be unable to act on that knowledge.

The circuit court's mental health docket will be overseen by Judge Gale Rasin, who helped develop the program with Baltimore Mental Health Systems, the quasi-public, nonprofit agency that fills the role of the city's mental health authority, although it is not a part of city government. The three-year pilot project is expected to serve about 30 people a year at an annual cost of about $120,000. That is not cheap, but officials hope it will pay off over the long run by reducing the cost of trials and incarceration in the criminal justice system and lower arrest rates among the program's participants.

Given the experience of other states where similar programs have had success, there's good reason to believe the city's diversion program can meet its goals. Officials say there are enough available slots to accommodate the mentally ill defendants referred by the courts, most of whom will be treated on an out-patient basis in their communities. There is also an adequate but more limited number of residential treatment programs for patients who require hospitalization.

The big obstacle, officials say, is finding stable housing for the people they treat. There's been a lack of affordable, safe housing in the city for years, making it extremely difficult for people with low incomes to find suitable shelter. The average Social Security payment in the city (about $600 a month) isn't enough to pay market-rate rents without subsidies, and there are never enough subsidized units to meet the demand.

Strictly speaking, that's a housing problem, not a mental health issue. Yet access to housing has a huge impact on the ability of mental health patients to make progress in treatment. People who don't have a regular place to sleep or stow their belongings invariably have a harder time staying on their medications or keeping appointments with their psychiatrist. The challenge for the program's case managers will be to help negotiate the maze of city, state and federal agencies that provide housing services so their clients can stabilize their situations and benefit from therapy — rather than continuing to turn up in the criminal justice system.

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