[House Hearing, 108 Congress]
[From the U.S. Government Publishing Office]
MENTALLY ILL OFFENDER TREATMENT AND CRIME REDUCTION ACT OF 2003
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CRIME, TERRORISM,
AND HOMELAND SECURITY
OF THE
COMMITTEE ON THE JUDICIARY
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
ON
S. 1194
__________
JUNE 22, 2004
__________
Serial No. 98
__________
Printed for the use of the Committee on the Judiciary
Available via the World Wide Web: http://www.house.gov/judiciary
______
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COMMITTEE ON THE JUDICIARY
F. JAMES SENSENBRENNER, Jr., Wisconsin, Chairman
HENRY J. HYDE, Illinois JOHN CONYERS, Jr., Michigan
HOWARD COBLE, North Carolina HOWARD L. BERMAN, California
LAMAR SMITH, Texas RICK BOUCHER, Virginia
ELTON GALLEGLY, California JERROLD NADLER, New York
BOB GOODLATTE, Virginia ROBERT C. SCOTT, Virginia
STEVE CHABOT, Ohio MELVIN L. WATT, North Carolina
WILLIAM L. JENKINS, Tennessee ZOE LOFGREN, California
CHRIS CANNON, Utah SHEILA JACKSON LEE, Texas
SPENCER BACHUS, Alabama MAXINE WATERS, California
JOHN N. HOSTETTLER, Indiana MARTIN T. MEEHAN, Massachusetts
MARK GREEN, Wisconsin WILLIAM D. DELAHUNT, Massachusetts
RIC KELLER, Florida ROBERT WEXLER, Florida
MELISSA A. HART, Pennsylvania TAMMY BALDWIN, Wisconsin
JEFF FLAKE, Arizona ANTHONY D. WEINER, New York
MIKE PENCE, Indiana ADAM B. SCHIFF, California
J. RANDY FORBES, Virginia LINDA T. SANCHEZ, California
STEVE KING, Iowa
JOHN R. CARTER, Texas
TOM FEENEY, Florida
MARSHA BLACKBURN, Tennessee
Philip G. Kiko, Chief of Staff-General Counsel
Perry H. Apelbaum, Minority Chief Counsel
------
Subcommittee on Crime, Terrorism, and Homeland Security
HOWARD COBLE, North Carolina, Chairman
TOM FEENEY, Florida ROBERT C. SCOTT, Virginia
BOB GOODLATTE, Virginia ADAM B. SCHIFF, California
STEVE CHABOT, Ohio SHEILA JACKSON LEE, Texas
MARK GREEN, Wisconsin MAXINE WATERS, California
RIC KELLER, Florida MARTIN T. MEEHAN, Massachusetts
MIKE PENCE, Indiana
J. RANDY FORBES, Virginia
Jay Apperson, Chief Counsel
Elizabeth Sokul, Counsel
Katy Crooks, Counsel
Jason Cervenak, Full Committee Counsel
Bobby Vassar, Minority Counsel
C O N T E N T S
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JUNE 22, 2004
OPENING STATEMENT
Page
The Honorable Howard Coble, a Representative in Congress From the
State of North Carolina, and Chairman, Subcommittee on Crime,
Terrorism, and Homeland Security............................... 1
The Honorable Robert C. Scott, a Representative in Congress From
the State of Virginia, and Ranking Member, Subcommittee on
Crime, Terrorism, and Homeland Security........................ 2
WITNESSES
Ms. Cheri Nolan, Deputy Assistant Attorney General, Office of
Justice Programs, U.S. Department of Justice
Oral Testimony................................................. 4
Prepared Statement............................................. 6
Mr. Ted Sexton, Sheriff, Tuscaloosa County Sheriff's Office,
Tuscaloosa, Alabama
Oral Testimony................................................. 9
Prepared Statement............................................. 11
Professor John Monahan, Ph.D., Henry and Grace Doherty Professor
of Law, University of Virginia, and Director, MacArthur
Research Network on Mandated Community Treatment
Oral Testimony................................................. 12
Prepared Statement............................................. 14
Mrs. June P. Poe, Past President, National Alliance for the
Mentally Ill of Roanoke Valley, Roanoke, VA, on behalf of the
National Alliance for the Mentally Ill
Oral Testimony................................................. 17
Prepared Statement............................................. 19
APPENDIX
Material Submitted for the Hearing Record
Prepared Statement of the Honorable Ted Strickland, a
Representative in Congress From the State of Ohio.............. 30
Prepared Statement of the Honorable Ms. Sheila Jackson Lee, a
Representative in Congress From the State of Texas............. 33
Prepared Statement of the Honorable William D. Delahunt, a
Representative in Congress From the State of Massachusetts..... 38
Letter from Jamie Fellner, Director of Human Rights Watch........ 41
Letter from Larry E. Naale, Executive Director of the National
Association of Counties........................................ 43
MENTALLY ILL OFFENDER TREATMENT AND CRIME REDUCTION ACT OF 2003
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TUESDAY, JUNE 22, 2004
House of Representatives,
Subcommittee on Crime, Terrorism,
and Homeland Security
Committee on the Judiciary,
Washington, DC.
The Subcommittee met, pursuant to notice, at 3:03 p.m., in
Room 2141, Rayburn House Office Building, Hon. Howard Coble
(Chair of the Subcommittee) presiding.
Mr. Coble. Good afternoon, ladies and gentlemen. The
Judiciary Subcommittee on Homeland Security, Terrorism, and
Crime will come to order.
Before I begin, I am told, Ms. Nolan, you need to depart at
4:15 today, so we will try to accommodate you to that end.
The Bureau of Justice Statistics estimated in 1999 that 16
percent of State prison inmates, seven percent of Federal
inmates, and 16 percent of those in local jails who are on
probation reported either a mental condition or an overnight
stay in a mental hospital. According to BJS, white inmates or
Caucasian inmates were more likely than blacks or Hispanics to
report a mental illness, and offender mental illness was
highest for those between the ages of 45 and 54.
According to this study and others, homelessness and
unemployment are more prevalent among the mentally ill.
Additional statistics show that six in ten mentally ill State
inmates were under the influence of alcohol or drugs at the
time of the offense, and a third of all mentally ill offenders
were alcohol dependent.
BJS also found that six in ten of the mentally ill received
treatment while incarcerated. These statistics show the
importance of mental health treatment as well as additional
assistance for the mentally ill non-violent offenders who end
up in the criminal justice system. The statistics also reveal
the importance of treatment of not only the drug or alcohol
abuse issues, but also the underlying mental illness.
This hearing will examine the prevalence of mental illness
in the criminal justice system and explore methods of
addressing this problem. Currently, the Department of Justice
administers a Mental Health Court grant program in some States.
This legislation, which we will review today, S. 1194, the
``Mentally Ill Offender Treatment and Crime Reduction Act of
2003,'' would create a grant program to encourage more States
to address this issue.
Now, I have discussed this bill in detail with Senator
DeWine, and he is enthusiastically supportive, as am I, but I
have some second thoughts about the authorized cost. We can
talk about that another day or perhaps today.
But I look forward to hearing from our witnesses today to
shed some light on this important issue, and I am now pleased
to recognize the distinguished gentleman from Virginia, Mr.
Bobby Scott, the Ranking Member.
Mr. Scott. Thank you, Mr. Chairman. I am pleased that you
have scheduled this hearing on the ``Mentally Ill Offender
Treatment and Crime Reduction Act of 2003.'' This bill, which
passed the Senate by unanimous consent on October 27, 2003, is
sponsored by Senators DeWine and Leahy. It is essentially the
same as H.R. 2387, sponsored by Representative Strickland,
except for the provisions to include substance abuse programs
among those with which there is required collaboration under
the bill.
This legislation represents phase two of an effort that
started in the 106th Congress when Congressman Strickland and
Senator DeWine led a successful effort in getting, quote,
``Americans Law Enforcement and Mental Health Project Act''
passed. That bill created a Department of Justice grant program
which helped State and local governments establish Mental
Health Courts. These courts provide specialized dockets which
bring mental health professionals, social workers, public
defenders, and prosecutors together to divert mentally ill
offenders into a treatment plan.
The indication is that the pilot Mental Health Courts
projects that we authorized have been proven successful. We
will hear the details from our witnesses, but it is clear that
a significant number of Mental Health Courts and other
diversion programs have sprung up since the law was passed. It
is also clear that they have successfully diverted individuals
with mental health problems from the criminal justice system
into treatment, restoring individuals to healthy, productive
lives, and saving money, comparing the lower cost of treatment
to incarceration.
S. 1194 will build on the Law Enforcement and Mental Health
Project Act's success by providing additional resources for
communities that wish to create Mental Health Courts. The bill
will make a significant commitment to addressing the needs of
both the criminal justice system and the mentally ill offender
population. It offers grants to communities to develop
diversion programs, mental health treatments in jails and
prisons, and transition and after-care services to facilitate
reentry into the community. The bill also requires
collaboration between criminal justice, mental health
treatment, and substance abuse and other agencies at the local
level in collaboration with the Federal level through creation
of an interagency task force.
This is clearly necessary, appropriate, and helpful
legislation to address a serious problem in the criminal
justice and mental health treatment administration. I look
forward to the testimony of our witnesses and working with you
and our colleagues, Mr. Chairman, in getting this bill signed
into law.
Mr. Coble. I thank the gentleman, and I am pleased to
welcome, as well, the distinguished gentleman from Florida, Mr.
Feeney, and the distinguished gentleman from Virginia, Mr.
Goodlatte.
Mr. Goodlatte. Mr. Chairman?
Mr. Coble. The gentleman from Virginia?
Mr. Goodlatte. Mr. Chairman, I would ask unanimous consent
that a statement from Representative Strickland from Ohio be
entered into the record.
Mr. Coble. Without objection, it will be received.
[The prepared statement of Mr. Strickland follows in the
Appendix]
Mr. Coble. Our first witness today is Ms. Cheri Nolan. Ms.
Nolan was appointed as Deputy Assistant Attorney General for
the Office of Justice Programs in July of 2001. She has served
four Attorneys General and three Presidents. Prior to her
service at OJP, Ms. Nolan worked for the television show
``America's Most Wanted,'' known to all of us, as well as
serving in the White House staff of President Ronald Reagan and
in various cabinet agencies, including the Departments of
Commerce, Energy, and Treasury.
Our second witness is Mr. Ted Sexton. Mr. Sexton has been
the Sheriff of Tuscaloosa County since January 1991 and is
currently serving in his fourth term. As Sheriff, Mr. Sexton
served eight courts and has law enforcement jurisdiction over
1,340 square miles within Tuscaloosa County. He is currently
Vice President of the National Sheriffs Association and will be
President of the Association in 2005. Mr. Sexton earned his
Bachelor of Arts degree at the University of Alabama and is a
graduate of the FBI National Academy. And Mr. Sexton--pardon my
immodesty, I am a fairly decent geographer--I assume Tuscaloosa
County is in Alabama. I didn't know that was certain, but I
figured that. [Laughter.]
Next, we have Dr. John Monahan. Dr. Monahan is a
psychologist and holds the Doherty Chair of Law at the
University of Virginia, where he is a professor of psychology
and psychiatric medicine. Dr. Monahan has been appointed to the
Committee on Law and Justice of the National Research Council.
His work has been cited in numerous court decisions, and he has
received distinguished awards for two of his books, The
Clinical Prediction of Violent Behavior and Rethinking Risk
Assessment.
Finally, we welcome Mrs. June Poe. Mrs. Poe, I believe you
are a constituent of Congressman Goodlatte, and he has
requested the honor of introducing you.
Mr. Goodlatte. Mr. Chairman, thank you very much. Thank you
for holding this hearing on what is clearly a very important
issue that needs to be carefully examined because I don't think
we are giving our courts and our prison system, frankly, the
kind of flexibility they need to have treatment and punishment
fit the circumstances of the individuals who present themselves
to them.
We have somebody here with us today who can speak from
personal experience. She is speaking on behalf of the National
Alliance for the Mentally Ill, but she has five children. She
is a widow, and I know that that has been a challenge for her
because one of her children does have a mental illness and has
had some problems with our criminal justice system as a result.
So I very much welcome her and am delighted to have the
opportunity. I thank you, Mr. Chairman, for inviting her to
testify today.
Mr. Coble. I thank the gentleman from Virginia.
Representative Strickland, the gentleman from Ohio, I know
you have been very interested in this legislation, and even
though you don't sit as a Member of this Subcommittee, we would
be happy to have you join us up here. You would not be able,
however, to participate and question the witness. If you would
like to come up and sit with us, you would be welcome to do so.
Mr. Strickland. Thank you, Mr. Chairman.
Mr. Coble. Ladies and gentlemen, it has become the practice
of the Subcommittee to administer the oath to our witnesses
appearing before us, so if you all would please stand and raise
your right hands.
Do each of you solemnly swear that the testimony you are
about to give this Subcommittee shall be the truth, the whole
truth, and nothing but the truth, so help you, God?
Ms. Nolan. I do.
Mr. Sexton. I do.
Mr. Monahan. I do.
Mrs. Poe. I do.
Mr. Coble. Let the record show that each of the witnesses
has answered in the affirmative and you may be seated.
Again, I welcome you all. Folks, so you will be familiar
with the drill, we operate under the 5-minute rule here. When
you see that red light illuminate in your eye, that is your
warning that the 5 minutes have elapsed, and if you don't cease
and desist I am going to order Sheriff Sexton to take you----
[Laughter.]
Mr. Scott and I are not that hard-hearted, but in view of
Mrs. Poe's schedule, as well, we do try to do the 5-minute
rule. Your testimony has been examined. The amber light will
appear first and the amber light will tell you that the ice is
becoming thin, then the red light, the 5 minutes have expired.
Ms. Nolan, if you will commence.
TESTIMONY OF CHERI NOLAN, DEPUTY ASSISTANT ATTORNEY GENERAL,
OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE
Ms. Nolan. Thank you, Mr. Chairman. Mr. Chairman, Mr.
Scott, and Members of the Subcommittee, I am Cheri Nolan,
Deputy Assistant Attorney General of the Office of Justice
Programs. I am pleased to be here on behalf of the United
States Department of Justice, especially the Office of Justice
Programs, to discuss how the criminal justice system responds
to individuals with mental illness who are involved with the
system.
This is an issue that cuts across Federal, State, and local
boundaries, with mentally ill individuals being held everywhere
from city lockups to Federal prison facilities. For example,
OJP's Bureau of Justice Statistics reported that in the year
2000, 13 percent of State prisoners were receiving some mental
health therapy and nearly 10 percent were receiving
psychotropic medications. Those figures translate to 143,000
prisoners receiving mental health therapy and 110,000 on
medications.
Another BJS report found that 16 percent of correctional
detainees self-reported that they had a mental illness. This
increasing number of people with mental illness in the criminal
justice system has become one of the most pressing problems
facing law enforcement in corrections today and it is an issue
with both major public safety and fiscal implications.
However, we need to be clear at the outset that individuals
who are found guilty of committing crimes must be held
accountable. If they commit a serious crime, then they need to
be incarcerated whether or not they are mentally ill. We will
not absolve someone of responsibility for committing a crime
simply because he or she has a mental illness.
At the same time, we hear from police, prosecutors, judges,
and correctional administrators that they are frustrated with
existing responses to people with mental illness who commit
less serious non-violent crimes. On the one hand, when these
individuals are not incarcerated and remain in the community,
they continue to tax public safety resources and can be a
threat to public safety. On the other hand, even when those
with mental illness do spend time in jail, the criminal justice
system is a revolving door with extremely high recidivism rates
for persons with mental illness.
Without connections to treatment, support services, and
housing, mentally ill individuals will continue to re-offend
and jeopardize public safety. That is why pre-release planning
and cross-agency collaboration are vital to the successful
reentry of these individuals into the community.
Today, however, this collaboration is the exception, not
the rule, but we believe that OJP can be a valuable resource to
State and local governments in these efforts. We can promote
promising practices, provide technical assistance, and conduct
research that will stimulate the development and replication of
programs and policies that will increase public safety and make
the justice system more efficient.
For example, OJP's Bureau of Justice Assistance has
published a monograph which is the first in-depth examination
of Mental Health Courts and will be a guide to communities in
developing their own courts. BJA has also provided grants
totaling approximately $5.5 million to 37 jurisdictions in 29
different States to fund Mental Health Courts. These 2-year
grants, totaling about $150,000 per site, have helped some
existing courts add key components to their programs and have
helped other courts launch their operations.
BJA sponsored the first ever national meeting of mental
health court practitioners in Cincinnati, Ohio, this past
January, which was part of OJP's overall goal of providing
information and technical assistance to the field. We will also
publish guides for implementing and operating Mental Health
Courts later this year.
Through these activities and through our own interagency
collaboration with the Department of Health and Human Services,
as well as with the Council of State Governments, we are able
to demonstrate to State and local governments that the
collaboration between mental health and criminal justice
agencies is not only possible, but extremely valuable.
My experience over the years and most recently at OJP tells
me that no one sector or one agency alone can resolve the
issues surrounding the involvement of mentally ill individuals
in the criminal justice system. However, together, we can come
closer to an outcome that will both provide necessary treatment
and preserve public safety.
I thank you for your interest in this critical issue and I
will be pleased to answer any questions that you might have.
Mr. Coble. Thank you, Ms. Nolan.
[The prepared statement of Ms. Nolan follows:]
Prepared Statement of Cheri Nolan
Mr. Chairman, Mr. Scott, and Members of the Subcommittee, I am
Cheri Nolan, Deputy Assistant Attorney General of the Office of Justice
Programs. I am pleased to be here this afternoon on behalf of the U.S.
Department of Justice (DOJ) and especially the Office of Justice
Programs to discuss how the criminal justice system responds to
individuals with mental illness who are involved with the system.
This is an issue that cuts across federal, state, and local
boundaries, with mentally ill individuals being held everywhere from
city lockups to federal prison facilities.
It is becoming clear that the increasing number of people with
mental illness in the criminal justice system is one of the most
pressing problems facing law enforcement and corrections today. This
issue has both major public safety and fiscal implications.
To understand the policy implications facing us, I would like to
highlight some data about what prisons and jails are doing, and what
has become a more and more common profile among offenders. According to
a special report by the Office of Justice Programs' Bureau of Justice
Statistics (BJS), in 2000, nearly all (95 percent) state adult
confinement facilities screened inmates for mental health problems. Of
the nation's 1,558 state public and private adult correctional
facilities, 1,394 reported they provided mental health services to
their inmates. Nearly 70 percent of facilities housing state prison
inmates reported that as a matter of policy they screened inmates at
intake, 13 percent of state prisoners were receiving some mental health
therapy or counseling services at midyear 2000, and nearly 10 percent
of state prisoners were receiving psychotropic medications. BJS's
report was based on the ``2000 Census of State and Federal Adult
Correctional Facilities,'' which included--for the first time--items
related to facility policies on mental health screening and treatment.
Another BJS report found that 16 percent of correctional detainees
self-reported they had a mental illness. We all recognize that the
accuracy of this estimate depended on the ability and willingness of
inmates to report such problems, which makes a strong argument for
using uniform, proven assessment and screening tools. However, if this
prevalence rate of mental illnesses among correctional detainees were
used as the actual rate for program planning, there would be
approximately 2 million individuals with serious mental illnesses
admitted to U.S. jails and prisons each year.
I'm sure that we agree that all individuals who are found guilty of
committing crimes must be held accountable. If the crime is serious,
incarceration is the appropriate response, regardless of whether the
perpetrator has a mental illness. Our policy is clear: we will not
absolve someone of any responsibility for committing a crime simply
because he or she has a mental illness.
At the same time, police, prosecutors, judges, and corrections
administrators regularly voice their frustrations about existing
responses to people with mental illness who commit low-level, less-
serious crimes. When incarceration is not the answer, individuals with
mental illness often are returned to the community, where, without
access to appropriate housing and comprehensive mental health care and
support services, they are more likely to be picked up for low level
crimes once again in a costly and repetitive cycle.
Yet, even for those with mental illness who spend time in jail, the
criminal justice system is a ``revolving door.'' Recidivism rates for
individuals with mental illness are extremely high. Let me cite two
examples: first, according to an October 1998 article in Psychiatric
Services, more than 70 percent of inmates with mental illness released
from the Lucas County, Ohio jail were re-arrested over the course of 3
years, and second, according to the Los Angeles County Board of
Supervisors' Task Force on Incarcerated Mentally Ill, about 90 percent
of Los Angeles County jail inmates with mental illness are repeat
offenders, and almost one-third of the inmates have been incarcerated
10 or more times.
These figures are a testament to the difficulty of ensuring that
people with mental illness leaving correctional facilities are
connected to needed treatment, support services, and housing. Without
those connections, these individuals will continue to re-offend and
public safety will continue to be jeopardized.
The involvement of people with mental illness in the justice system
also is extremely expensive. County jails are forced to use huge
portions of their pharmacy budgets for mental health treatment.
According to Oregon's Lane County Sheriff's Office and Tennessee's
Benjamin Harrington/Knox County Mental Health Association,
respectively, in the past year, 58 percent of the pharmacy budget in
Lane County and 80 percent in Knox County were spent on psychotropic
medications. Many inmates with serious mental illness require 24-hour
suicide watch. The New York Monroe County Sheriff's Office, which
houses just over 1,000 inmates in its jail, spent $315,000 in 1 year
alone on overtime for officers assigned to this responsibility.
Managing individuals with mental illness in prison is no less
costly. The Pennsylvania Department of Corrections estimates that an
inmate with serious mental illness costs $140 per day to incarcerate,
nearly twice as much as an inmate without serious mental illness.
In response to the need to address the combined problems of
offender management and increasing costs, state and local governments
across the country are developing programs and policies unique to their
jurisdiction's criminal justice systems that aim to improve the
response to people with mental illness from the initial contact with
law enforcement through the offender's re-entry to the community from
prison.
For example, state and local governments have encouraged police
departments to form crisis intervention teams, developed pretrial
screening for defendants with mental illness, established mental health
courts, specialized caseloads for probation officers, introduced new
instruments to screen newly admitted inmates for mental illness,
implemented therapeutic communities in jails and prisons for offenders
with co-occurring substance abuse and mental health disorders, and
formed multidisciplinary teams to work on inmates' re-entry planning.
At the heart of each of these emerging strategies is collaboration
between the criminal justice and mental health systems, the crucial
involvement of substance abuse treatment providers and other social
service providers, and the need for affordable housing and employment.
As we have demonstrated in the cross-agency Serious and Violent
Offender Re-entry Initiative in which DOJ has partnered with the
Department of Labor and the Department of Health and Human Services, no
one sector or agency can solve this problem working alone. Together,
they can make a difference.
Today, however, this collaboration is the exception, not the rule.
As we have learned, even those leaders in the criminal justice and
mental health systems who are interested in working together are unsure
of what they can do, and, despite the possibility of generating
significant savings to the state and county, the limited budgets in
most jurisdictions make it very difficult to experiment with new ideas.
Yet, I believe that OJP can be a valuable resource to state and
local governments. By promoting promising practices, providing
technical assistance, and working with other DOJ agencies as well as
with both the Substance Abuse and Mental Health Services Administration
(``SAMHSA'') (in the Department of Health and Human Services) and NIMH
to conduct research, we can stimulate the development and replication
of programs and policies that will increase public safety and make the
justice system more efficient.
For instance, the Bureau of Justice Assistance (BJA) has supported
the investigation and implementation of mental health courts. In 2000,
BJA published the first in-depth examination of mental health courts,
``Emerging Judicial Strategies for the Mentally Ill in the Criminal
Caseload.'' This monograph described the organization and operation of
four of the earliest mental health courts and has helped guide
communities in developing their own mental health courts.
In the Fiscal Year 2003 appropriation, BJA received funding for
mental health courts, which we have administered according to the
parameters established in P.L. 106-515, ``America's Law Enforcement and
Mental Health Project.'' BJA has provided grants totaling approximately
$5.5 million to 37 jurisdictions in 29 different states. These two-year
grants, totaling approximately $150,000 per site, have helped some
existing mental health courts add key components to their program and
helped other courts in the planning stages launch their operations.
Beyond direct grant funding, it is our responsibility to the field
to provide information and technical assistance grounded in research
and representing sound criminal justice practice, regardless of whether
the project receives OJP funding. That is why, in addition to the grant
funding, OJP promotes technical assistance. Through this technical
assistance, BJA sponsored the first-ever national meeting of mental
health court practitioners in Cincinnati, Ohio this past January. In
addition, grantee courts are receiving guidance on issues such as
connecting court clients to housing, responding to the particular needs
of women, and gathering outcome data.
Later this year, BJA will publish guides for implementing and
operating mental health courts. As with all of our programs, we are
working with the field to collect outcome data, which will further
inform our policy decisions in this area. OJP's National Institute of
Justice (NIJ), is one of BJA's partners in these endeavors. NIJ plans
to publish the results of its examination of the referral and decision-
making processes of seven BJA-funded mental health courts.
While mental health courts can be a component of addressing the
problems associated with offenders with mental illness, other
approaches are needed as well. That is why BJA has supported the
Criminal Justice/Mental Health Consensus Project, which is coordinated
by the Council of State Governments. The landmark Consensus Project
Report provides hundreds of recommendations that policymakers and
practitioners agree will improve the response to people with mental
illness who come in contact with the criminal justice system.
In recent months, we have taken several steps at BJA to help state
and local governments think about this issue from arrest through re-
entry.
First, the Director of BJA has appointed a senior policy advisor
for criminal justice and mental health issues. This is the first time
the agency has had such a position. It demonstrates our recognition
that the involvement of people with mental illness in the justice
system is becoming one of the most important issues facing local and
state criminal justice agencies and that BJA must be responsive to
their needs.
Second, some grantees are using Serious and Violent Offender Re-
Entry Initiative funds, better known as ``re-entry,'' to improve the
transition that people with mental illness make from prison to the
community.
Third, BJA is currently developing a strategic plan to support the
efforts of law enforcement, corrections, and courts in dealing with
individuals with mental illness. In fact, earlier this month, a group
of court and mental health experts met to develop recommendations to
BJA on what activities we and our federal partners could undertake to
support court-based efforts to better address defendants with mental
illness.
Increasing collaboration between criminal justice and mental health
agencies is essential at the state and local levels, as well as at the
federal level. We are coordinating our efforts with SAMHSA,
particularly with regard to their Targeted Capacity Expansion (TCE)
Grants for Jail Diversion Programs. While the programs are similar in
nature, SAMHSA is providing grants for pre- and post-booking diversions
that do not involve continuous judicial oversight, treatment, and case
disposition. BJA is funding models that provide continuous judicial
oversight and intensive case management, ensuring that offenders remain
accountable throughout the process. Our cooperative efforts with SAMHSA
will also help ensure that the federal government does not fund
overlapping grant programs.
In addition, the technical assistance providers for both agencies'
programs, the Council of State Governments and the TAPA Center for Jail
Diversion (part of the GAINS Center funded by DOJ and SAMHSA), are
working closely to coordinate their efforts. These organizations meet
quarterly and are working together on a number of key issues, including
promoting judicial leadership and better understanding the fiscal
impact of mental illness in the justice system.
This coordination helps us maximize the value of each agency's
grant program. Furthermore, this collaboration enables us to leverage
each agency's resources, expertise, and credibility with our respective
constituencies in state and local governments. Most important, it
allows us to demonstrate to state and local governments that the
collaboration between mental health and criminal justice agencies is
not only possible, but extremely valuable.
And, BJA is working with SAMHSA to implement the policies
identified in the July 2003 report of the President's New Freedom
Commission on Mental Health to maximize the utility of existing
resources, improve coordination of treatments and services, and promote
successful community integration for adults with a serious mental
illness.
Mr. Chairman, from my work at OJP I have come to believe that the
increasing number of people with mental illness in the criminal justice
system is one of the most pressing issues facing our police
departments, jails, prisons, and courts. State and county governments
have demonstrated that thoughtful policies and programs can be
developed to address this problem. The federal partners are committed
to doing all we can to support practitioners through our grant programs
and technical assistance.
We very much appreciate the interest you and your colleagues have
shown in this critical issue. I welcome the opportunity to answer any
questions that you may have.
Mr. Coble. Sheriff Sexton.
TESTIMONY OF TED SEXTON, SHERIFF, TUSCALOOSA COUNTY SHERIFF'S
OFFICE, TUSCALOOSA, AL
Mr. Sexton. Mr. Chairman, my name is Ted Sexton and I am
the Sheriff of Tuscaloosa County. I serve on the Executive
Committee and Board of Directors of the National Sheriffs
Association. I appreciate the opportunity to share with you
some thoughts from NSA and the larger enforcement community on
the need for S. 1994, the ``Mentally Ill Offender Treatment and
Crime Reduction Act'' now under consideration by this
Committee. Before I begin, let me say that we strongly
supported S. 1194, which passed the United States Senate
unanimously and welcome these hearings in the House.
Most of the people suffering mental illness with whom law
enforcement officers interact are non-violent, low-level
offenders who are demonstrating signs of untreated mental
illness in public. For the most part, these individuals pose a
low risk of harming others, but act inappropriately enough to
cause members of their community to be concerned. Many of the
calls my office receives are actually placed by family members
who are seeking law enforcement help to control behavior of
someone who is off their medication.
It is clear that without proper training on how to respond
to these individuals, law enforcement may not be able to
appropriately handle the situation. These contacts have a great
potential for rapid escalation of both threat and force. Minor
situations can easily escalate into a violent confrontation
that jeopardizes the safety of both officers and the
individual.
In many circumstances, arresting the mentally ill
individual is an inappropriate response, even if the officer
believes that arresting the individual for a criminal charge is
appropriate under the circumstances. County jails are not
equipped to house a large number of mentally ill offenders.
Jails are jails. They are not treatment facilities nor are they
hospitals. Jails ought not to be the treatment option of first
resort, but sadly, they have become just that because there is
nothing else readily available.
In my own community, we have seen a steady rise in the
number of calls related to mentally ill individuals. This rise
in calls for response has largely corresponded to the decline
in population of large institutions within my community that
have traditionally provided services to the mentally ill. As
these individuals have been moved from an institutional setting
to community based programs, we have seen a rise in the number
of contacts that officers have with them.
In response to the increased frequency in calls for service
relating to this particular population of our community, my
senior staff and I set out to develop a program within our
office that trains officers to more effectively deal with
mentally ill individuals. The training program provides
officers with a better understanding of mental health issues
and provides a number of suggested options other than arrest.
The training is not limited to patrol officers who are most
likely to come in contact with mentally ill individuals, but
also includes dispatch officers who field the calls for
service. In addition, we provide the training to other law
enforcement agencies, fire/rescue squads, EMTs, and our
volunteer fire departments. Last year, the training program was
presented to more than 100 officers from various agencies, and
currently there are more than 180 officers scheduled to receive
the training. The Alabama Peace Officers Standards and Training
Commission has recently established this program as a pilot for
eventual State-wide implementation.
Providing this training to law enforcement officers is a
critically important element of providing service to the
mentally ill in our community, but it is only one of the
elements. Providing meaningful alternatives to incarceration is
another equally critical component. As things stand now, the
officer in the field is often left to choose between the
unappealing alternatives of locking up the mentally ill
individual or leaving them on the scene. Right now, there is
very little middle ground and no real other options.
The problems with these choices are obvious. Simply leaving
the individual at the scene is unacceptable and serves neither
the sick individual nor the public. Taking these individuals to
jail, however, is often just as problematic. County jails are
not equipped to handle mentally ill individuals. There is
limited space in which to house these individuals apart from
the general population at the jail.
Of course, they are in jail because they were causing
problems outside. Their offensive behavior does not magically
improve in the jail setting. In fact, behavior often
deteriorates in jail. Conflicts with other detainees or the
inability to follow the rules of the facility often escalate
into situations that threaten the safety of an officer or the
individual.
Providing medical care for these individuals in a jail
setting is a tremendous concern, as well. Tuscaloosa County
houses approximately 600 inmates. At any given time, roughly 10
percent of the jail population is on some sort of psychotropic
medication. The vast majority of those are on multiple
medications. In the final quarter of last year, the cost of
those medications cost my office and the taxpayers of
Tuscaloosa almost $75,000. Additional costs are incurred
because the staff of the jail has to be extra vigilant in
monitoring mentally ill individuals. Frequently, they are on
suicide watch, which requires additional detention officers to
monitor them, thus increasing manpower needs.
A mentally ill person in jail receives very basic and
limited mental health assistance. I would hesitate to call it
treatment. The fact is, they receive far less mental health
care than they need and are subsequently released back into
society without either a safety net or a system in place to
ensure compliance with a treatment plan. Frequently, the cycle
is repeated over and over again. The mentally ill are being
arrested after they have failed to keep up the prescribed
medication regime.
The still unresolved problem for us, as for virtually all
sheriffs' offices across the country, is finding an alternative
placement for those individuals for whom jail is not
appropriate. As I said earlier, the jail is not designed nor
equipped to provide treatment for mentally ill. Jails are
designed for holding those individuals awaiting trial or
incarceration of those serving sentences and should not be
viewed as an alternative treatment facility for mentally ill.
For those who do require incarceration, placing them in the
appropriate setting will help minimize the time that they
actually spend in custody.
Additionally, a system for monitoring these individuals
once they are released from jail is also needed to ensure that
we can break the cycle I have outlined. It is a disservice to
everyone involved if we cannot arrange some more appropriate
treatment than locking up the mentally ill in jail.
For our part in Tuscaloosa, we are partnering with mental
health professionals within our community to try to address
these issues and we believe that H.R. 2387 will provide the
resources and guidance we need to develop and implement
creative solutions. Thank you.
Mr. Coble. Thank you, Sheriff.
[The prepared statement of Mr. Sexton follows:]
Prepared Statement of Sheriff Ted Sexton
Mr. Chairman, my name is Ted Sexton, and I am the Sheriff of
Tuscaloosa County, Alabama. I serve on the Executive Committee and
Board of Directors of the National Sheriffs' Association where I am the
incoming First Vice President. I appreciate the opportunity to share
with you some thoughts from NSA and the larger law enforcement
community on the need for S. 1194, the Mentally Ill Offender Treatment
and Crime Reduction Act now under consideration by this committee.
Before I begin, let me say that we strongly support S. 1194, which
passed the U.S. Senate unanimously and welcome these hearings in the
House.
Most of the people suffering mental illnesses with whom law
enforcement officers interact are non-violent, low-level offenders who
are demonstrating signs of untreated mental illness in public. For the
most part, these individuals pose a low risk of harming others, but act
inappropriately enough to cause members of the community to be
concerned. Many of the calls my office receives are actually placed by
family members who are seeking law enforcement help to control the
behavior of someone who is ``off their medication.''
It is clear that without proper training on how to respond to these
individuals, law enforcement officers may not be able to appropriately
handle the situation. These contacts have a great potential for rapid
escalation of both threat and force. Minor situations can easily
escalate into a violent confrontation that jeopardizes the safety of
both the officers and the individual.
In many circumstances, arresting the mentally ill individual is an
inappropriate response. Even if the officer believes that arresting the
individual for a criminal charge is appropriate under the
circumstances, county jails are not equipped to house a large number of
mentally ill offenders. Jails are jails; they are not treatment
facilities nor are they hospitals. Jails ought not be the treatment
option of first resort, but sadly they have become just that because
there is nothing else readily available.
In my own community, we have seen a steady rise in the number of
calls related to mentally ill individuals. This rise in the calls for
response has largely corresponded to the decline in the population of
large institutions within my community that have traditionally provided
services to the mentally ill. As these individuals have been moved from
an institutional setting to community-based programs, we have seen a
rise in the number of contacts that officers have with them.
In response to the increased frequency in calls for service
relating to this particular population of our community, my senior
staff and I set out to develop a program within our office that trains
officers to more effectively deal with mentally ill individuals. The
training program provides officers with a better understanding of
mental health issues, and provides a number of suggested options other
than arrest. The training is not limited to patrol officers who are
most likely to come in contact with mentally ill individuals, but also
includes our dispatch officers who field the calls for service. In
addition, we provide the training to other law enforcement agencies,
fire/rescue squads, EMTs, and our volunteer fire departments. Last
year, the training program was presented to more than 100 officers from
the various agencies last year and currently, there are more than 180
officers scheduled to receive the training. The Alabama Peace Officers
Standards and Training Commission has recently established this program
as a pilot program for eventual statewide implementation.
Providing this training to law enforcement officers is a critically
important element of providing service to the mentally ill in our
community; but it is only one of the elements. Providing meaningful
alternatives to incarceration is another, equally critical component.
As things stand now, the officer in the field is often left to choose
between the unappealing alternatives of locking up a mentally ill
individual or leaving them on the scene. Right now, there is very
little middle ground and no real other options.
The problems with these choices are obvious. Simply leaving the
individual at the scene is unacceptable and serves neither the sick
individual nor the public. Taking these individuals to jail, however,
is often just as problematic. County jails are not equipped to handle
mentally ill individuals. There is limited space in which to house
these individuals apart from the general population at the jail. Of
course, they are in jail because they were causing problems on the
outside. Their offensive behavior doesn't magically improve in the jail
setting. In fact, behavior often deteriorates in jail. Conflicts with
other detainees or the inability to follow the rules of the facility
often escalate into situations that threaten the safety of an officer
or the individual.
Providing medical care for these individuals in a jail setting is a
tremendous concern as well. The Tuscaloosa County Jail houses
approximately 600 inmates. At any given time, roughly 10 per cent of
the jail population is on some type of psychotropic medication. The
vast majority of those are on multiple medications. In the final
quarter of last year, the cost of those medications cost my office and
the taxpayers of Tuscaloosa almost $75,000. Additional costs are
incurred because the staff at the jail has to be extra vigilant in
monitoring mentally ill individuals. Frequently they are on suicide
watch, which requires additional detention officers to monitor them,
thus increasing manpower needs and costs.
A mentally ill person in jail receives very basic and limited
mental health ``assistance''. I would hesitate to call it treatment.
The fact is that they receive far less mental health care than they
need and are subsequently released back into society without either a
safety net or a system in place to ensure compliance with a treatment
plan. Frequently, the cycle is simply repeated over and over again with
the mentally ill being arrested after they have failed to keep up with
their prescribed medication regimen.
The still unresolved problem for us, as for virtually all Sheriff(s
Offices across the country, is finding an alternative placement for
those individuals for whom jail is not appropriate. As I said earlier,
the jail is not designed nor equipped to provide treatment for the
mentally ill. Jails are designed for the holding of individuals
awaiting trial or incarceration of those serving sentences and should
not be viewed as an alternative treatment facility for the mentally
ill. For those who do require incarceration, placing them in an
appropriate setting will help minimize the time that they actually
spend in custody. Additionally, a system for monitoring these
individuals once they are released from jail is also needed to ensure
that we can break the cycle I've outlined. It is a disservice to
everyone involved if we cannot arrange some more appropriate treatment
than locking up the mentally ill in jail.
For our part in Tuscaloosa, we are partnering with mental health
professionals within our community to try to address these issues, and
we believe that HR 2387 will provide the resources and guidance we need
to develop and implement creative solutions to this chronic problem.
Mr. Chairman, I am ready to take your questions and I look forward
to working with you to address this issue in a way that is helpful to
the mentally ill and provides them with the treatment and services that
they need.
Mr. Coble. I failed to mention earlier, folks, your entire
statements will be made a part of the record.
Dr. Monahan.
TESTIMONY OF JOHN MONAHAN, Ph.D., HENRY AND GRACE DOHERTY
PROFESSOR OF LAW, UNIVERSITY OF VIRGINIA, AND DIRECTOR,
MACARTHUR RESEARCH NETWORK ON MANDATED COMMUNITY TREATMENT
Mr. Monahan. Thank you, Chairman Coble, Congressman Scott,
and Members of the Subcommittee for inviting me here this
afternoon. In addition to my day job at the University of
Virginia School of Law, I direct the Research Network on
Mandated Community Treatment for the MacArthur Foundation. The
network is now engaged in a partnership with the National
Institute of Justice to evaluate seven of the Mental Health
Courts funded by Congress 2 years ago that Mr. Scott mentioned.
I will begin with the bottom line. The ``Mentally Ill
Offender Treatment and Crime Reduction Act'' is the most
evidence-based piece of Federal legislation on mentally ill
offenders that I have seen in my 30 years as a researcher in
this field.
I say this for five reasons. First, the evidence is that
the number of people this Act will affect is staggering. As you
mentioned early on, Mr. Chair, 16 percent of adults in contact
with the justice system are estimated to be mentally ill. This
means that on any given day in the United States, there are
over 200,000 prison inmates, 100,000 jail detainees, and
700,000 people under the supervision of community corrections--
over one million people in all--with a serious mental illness.
Three-quarters of these mentally ill people also have a co-
occurring substance abuse disorder.
Women in the justice system have nearly twice the rate of
mental illness as the male, but only one-third of the men and
one-quarter of the women with a mental illness in jail report
receiving any treatment for that mental illness while they were
in jail.
Another piece of evidence about the magnitude of this
problem is the large number of communities that have taken it
upon themselves to do something about people with mental
illness in the justice system. The number of Mental Health
Courts in the United States has mushroomed from one in 1997, to
a dozen in 2002, to close to 100 this month.
By the most recent count, there are almost 300 jail
diversion programs now operating in the United States. This
means that 7 percent of all counties have a police or a court-
based program to divert defendants with a mental illness from
jail. This also means that 93 percent of all counties are
without any program to keep non-violent defendants with a
mental illness from crowding their jails and from committing
more crime.
Second, the evidence is that we can make a difference.
Offenders with a mental illness can, in fact, be dealt with in
ways that can reduce crime, save taxpayers money, or both.
In terms of crime reduction, consider the MacArthur
Violence Risk Assessment Study of over 1,000 people who have
been hospitalized for mental illness, about half of whom had a
prior contact with the criminal justice system. Now, the people
who received no medication or therapy in the community after
they get out of the hospital, 14 percent soon committed a
violent act. Of the people who received an inadequate amount of
treatment, about one treatment session a month, the violence
rate was reduced from 14 percent to about 9 percent. But of the
people who received the amount of treatment that they needed,
about one session a week, the violence rate went from 14
percent to less than 3 percent. Amazingly enough, the people
with mental illness who were receiving adequate treatment in
the community were actually less violent than their neighbors
who were not mental illness at all.
In terms of saving taxpayer money, consider the pioneering
Broward County, Florida, Mental Health Court. Compared to a
nearby county without a Mental Health Court, the Broward
defendants are twice as likely to actually receive service for
their mental illness and are no more likely to commit a new
crime, despite the fact that the number of days they spent in
jail is reduced by 75 percent, at enormous savings to the
public.
Third, the evidence is that one size does not fit all in
terms of effectively dealing with mentally ill offenders. This
Act is remarkably adaptable to local conditions in the
pragmatic approach it takes to mentally ill offenders. Funded
programs may include pretrial diversion in one jurisdiction, a
Mental Health Court in another, a reentry program from jail or
prison in a third, and some combination of these options in a
fourth jurisdiction.
Fourth, the evidence is that collaboration is essential to
get anything accomplished having to do with mentally ill
offenders. As the Council on State Government's Criminal
Justice/Mental Health Consensus Project concluded after 5 years
of intensive study, and as Ms. Nolan just noted, neither mental
health nor criminal justice can do the job alone. This Act
creates powerful incentives for cooperation between the
Department of Justice and the Department of Health and Human
Services and among agencies at the Federal, State, and local
levels. Crime and mental illness deeply affect all of our
communities, and perhaps for this reason, the turf battles that
doom many reform efforts seem to have been carefully avoided in
drafting this Act.
Finally, the evidence is that we need more evidence. We
know a lot about how to deal with mentally ill offenders,
vastly more than we knew even 5 years ago. But by no means do
we know all we need to state with confidence what the best
practices are for dealing with different kinds of mentally ill
offenders in different kinds of American communities. By
imposing strict requirements for objective assessments of the
measurable outcomes of the programs that are implemented with
its funds, the Act will generate a self-correcting body of
knowledge that uses findings about the effectiveness of past
practice to shape improvements in future practice.
As Sheriff Sexton noted, the Act was born of the
frustration of criminal justice officials in seeing ever more
people with mental illness further crowd the already
overcrowded jails, rarely receive the mental health treatment
that they so plainly need, and continue to appear before them
for the commission of yet another crime. The Act before you can
set State and local governments on a course to put a stop to
this revolving door.
The evidence is there. I urge you to pass the ``Mentally
Ill Offender Treatment and Crime Reduction Act''.
Mr. Coble. Thank you, Doctor.
[The prepared statement of Mr. Monahan follows:]
Prepared Statement of John Monahan
Thank you, Chairman Coble and Congressman Scott, for inviting me to
testify before you today. I am Dr. John Monahan, a psychologist, and I
hold the Doherty Chair in Law at the University of Virginia, where I am
also a Professor of Psychology and of Psychiatry. I have been involved
in Federally-funded research on mentally ill offenders since the
publication of my first book, Community Mental Health and the Criminal
Justice System, in 1976. I currently direct the Research Network on
Mandated Community Treatment for the John D. and Catherine T. MacArthur
Foundation, which is concerned with how the criminal justice system can
be used as ``leverage'' to get offenders with a mental disorder to
accept treatment for their illness.\1\ The Network is now engaged in a
productive partnership with the National Institute of Justice to
evaluate seven of the mental health courts funded by Congress as part
of the 2000 America's Law Enforcement and Mental Health Project Act.\2\
---------------------------------------------------------------------------
\1\ A list of Network publications can be found at http://
macarthur.virginia.edu
\2\ Redlich, A., Steadman, H., Monahan, J., Petrila, J., & Griffin,
P. (in press). The second generation of mental health courts.
Psychology, Public Policy, and Law.
---------------------------------------------------------------------------
I will begin with the bottom line: the Mentally Ill Offender
Treatment and Crime Reduction Act of 2003 is the most evidence-based
piece of federal legislation on mentally ill offenders that I have seen
in 30 years as a researcher in this field. I say this for five reasons.
FIRST, THE EVIDENCE IS THAT THE NUMBER OF PEOPLE THIS ACT
WILL AFFECT IS STAGGERING.
In its initial finding, the Act notes that the Bureau of Justice
Statistics, using a broad definition of mental illness, concludes that
over 16 percent of adults in contact with the justice system are
mentally ill. This means that on any given day in the United States,
there would be over 200,000 prison inmates, 100,000 jail detainees, and
700,000 people under the supervision of community corrections--over one
million people in all--with a serious mental illness. Three-quarters of
these mentally ill people also have a co-occurring substance abuse
disorder.\3\ Women in the justice system have nearly twice the rate of
mental illness as men.\4\ But only one-third of the men and one-quarter
of the women with a mental illness in jail report receiving any
treatment while they were detained.\5\
---------------------------------------------------------------------------
\3\ Abram, K., & Teplin, L. (1991). Co-occurring disorders among
mentally ill jail detainees. American Psychologist, 46, 1036-1045.
\4\ National GAINS Center. (2002). The prevalence of co-occurring
mental illness and substance abuse disorders in the justice
system.Delmar, NY: GAINS Center.
\5\ Massaro, J. (2004). Working with people with mental illness
involved in the criminal justice system: What mental health service
providers need to know (2nd ed.). Delmar, NY: TAPA Center for Jail
Diversion.
---------------------------------------------------------------------------
Another piece of evidence about the magnitude of the problem that
the Act addresses is the large number of communities that have taken it
upon themselves to do something about people with mental illness in the
justice system. The number of mental health courts in the United States
has mushroomed from one in 1997, to a dozen in 2002, to close to 100
this month.\6\ By the most recent count, there are almost 300 jail
diversion programs now operating in the United States.\7\ This means
that 7 percent of all counties have a police or court-based program to
divert defendants with a mental illness from jail.\8\ This also means
that 93 percent of all counties are without any program to keep non-
violent defendants with a mental illness from crowding their jails and
committing more crime.
---------------------------------------------------------------------------
\6\ Survey of Mental Health Courts. (2004). Available at http://
www.mentalhealthcourtsurvey.com
\7\ TAPA Center for Jail Diversion. (2004). What can we say about
the effectiveness of jail diversion programs for persons with co-
occurring disorders? Available at http://www.gainsctr.com/pdfs/tapa/
WhatCanWeSay.pdf
\8\ Steadman, H. (2004). A national perspective on diversion and
linkage to community-based services. Available at http://
www.gainsctr.com/ppt/NationalPerspectiveon DiversionanLinkage.ppt
---------------------------------------------------------------------------
SECOND, THE EVIDENCE IS THAT WE CAN MAKE A DIFFERENCE: OFFENDERS WITH A
MENTAL ILLNESS CAN IN FACT BE DEALT WITH IN WAYS THAT REDUCE CRIME,
SAVE TAXPAYERS' MONEY, OR BOTH.
In terms of crime reduction, consider the macarthur violence risk
Assessment Study of over 1,000 people who had been hospitalized for
mental illness, about half of whom had a prior contact with the
criminal justice system.\9\ Of the people who received no medication or
therapy in the community after they got out of the hospital, 14 percent
soon committed a violent act. Of the people who received an inadequate
amount of treatment--about one treatment session a month--the violence
rate was reduced from 14 percent to about 9 percent. But of the people
who received the amount of treatment that they needed--about one
session a week--the violence rate went from 14 percent to less than 3
percent. Amazingly enough, the people with a mental illness who were
receiving adequate treatment were actually less violent than their
neighbors in the community who were not mental ill.
---------------------------------------------------------------------------
\9\ Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins,
P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001). Rethinking
risk assessment: The MacArthur study of mental disorder and violence.
New York: Oxford University Press.
---------------------------------------------------------------------------
In terms of saving taxpayers' money, consider the pioneering
Broward County (Ft. Lauderdale), Florida, Mental Health Court, whose
rigorous evaluation is also being supported by the MacArthur
Foundation. This court presents mentally ill misdemeanor defendants
with the choice of accepting mental health treatment in the community,
or having their cases processed in the business-as-usual way, which may
well mean jail time. Perhaps not surprisingly, 95 percent of the
defendants given this option choose treatment. Compared to a nearby
county without a mental health court, the Broward defendants are twice
as likely to actually receive services for their mental illness \10\
and are no more likely to commit a new crime, despite the fact that the
number of days they spend in jail for the current offense is reduced by
75 percent, at enormous savings to the public.\11\ While the NIJ/
MacArthur-funded evaluation of mental health courts receiving federal
grants is still in progress, the Broward study demonstrates that courts
have a central role to play in responding to people with mental illness
in the justice system.
---------------------------------------------------------------------------
\10\ Boothroyd, R., Poythress, N., McGaha, A., & Petrila, J.
(2003). The Broward Mental Health Court: Process, outcomes, and service
utilization. International Journal of Law and Psychiatry, 26, 55-71.
\11\ Cristy, A., Poythress, N., Boothroyd, R., Petrila, J., &
Mehra, S. (submitted for publication). Evaluating the efficiency and
community safety goals of the Broward County Mental Health Court.
---------------------------------------------------------------------------
THIRD, THE EVIDENCE IS THAT ONE SIZE DOES NOT FIT ALL IN TERMS OF
EFFECTIVELY DEALING WITH MENTALLY ILL OFFENDERS.
``First and foremost,'' leading researchers have concluded, ``it
must be clear that there is no one best way to organize a program [of
diverting mentally ill offenders from jail]. An approach that works in
one community may not be practical somewhere else.'' \12\
---------------------------------------------------------------------------
\12\ Morris, S. & Steadman, H.J. (1994). Keys to successfully
diverting mentally ill jail detainees. American Jails, July/August, 47-
49.
---------------------------------------------------------------------------
The Act is remarkably adaptable to local conditions in the
programmatic approach it takes to mentally ill offenders. Funded
programs may include pre-trial diversion in one jurisdiction, a mental
health court in another, a re-entry program from jail or prison in a
third, or some combination of these options in a fourth.
What Justice Brandeis wrote in 1932 and the Supreme Court has
quoted on three dozen subsequent occasions is true today. ``It is one
of the happy incidents of the federal system that a single courageous
state may, if its citizens choose, serve as a laboratory; and try novel
. . . experiments without risk to the rest of the country.'' This Act
is one of those happy incidents.
FOURTH, THE EVIDENCE IS THAT COLLABORATION IS ESSENTIAL TO GET ANYTHING
ACCOMPLISHED HAVING TO DO WITH MENTALLY ILL OFFENDERS.
Neither mental health nor criminal justice can do the job alone.
This Act incentivizes cooperation between the Department of Justice and
the Department of Health and Human Services, and among agencies at the
federal, state, and local levels. Crime and mental illness deeply
affect all of our communities, and perhaps for this reason the turf
battles and the narrow single-issue concerns that doom many reform
efforts seem to have been carefully avoided in drafting this Act.
As the Council of State Government's Criminal Justice/Mental Health
Consensus Project concluded after five years of intensive study: \13\
---------------------------------------------------------------------------
\13\ Council of State Governments. (2002). Criminal Justice/Mental
Health Consensus Project. Available at www.consensusproject.org
---------------------------------------------------------------------------
The single most significant common denominator shared among
communities that have successfully improved the criminal justice and
mental health systems' response to people with mental illness is that
each started with some degree of cooperation between at least two key
stakeholders--one from the criminal justice system and the other from
the mental health system (p. xx).
FINALLY, THE EVIDENCE IS THAT WE NEED MORE EVIDENCE.
We know a lot about how to deal effectively with mentally ill
offenders--vastly more than we knew even five years ago. But by no
means do we know all we need to state with confidence what the ``best
practices'' are for dealing with different kinds of adult and juvenile
mentally ill offenders in different kinds of American communities. By
imposing strict requirements for objective assessments of the
measurable outcomes of the programs that are implemented with its
funds, the Act will generate a self-correcting body of knowledge that
uses findings about the effectiveness of past practice to shape
improvements in future practice. In mandating empirical evidence of
program performance, the Act avoids simply throwing money at a problem.
Instead, it assigns accountability and it demands results.
The Act was born of the frustration of criminal justice officials
in seeing ever more people with mental illness further crowd their
already over-crowded jails, rarely receive the mental health treatment
that they so plainly need, and continue to appear before them for the
commission of yet another crime. The Act before you can set state and
local governments on a course to put a stop to this revolving door.
The evidence is there. I urge you to pass Mentally Ill Offender
Treatment and Crime Reduction Act of 2003.
Mr. Coble. Mrs. Poe.
TESTIMONY OF JUNE P. POE, PAST PRESIDENT, NATIONAL ALLIANCE FOR
THE MENTALLY ILL OF ROANOKE VALLEY, ROANOKE, VA, ON BEHALF OF
THE NATIONAL ALLIANCE FOR THE MENTALLY ILL
Mrs. Poe. Thank you, Chairman Coble, Representative Scott,
and other distinguished Members of the Committee for this
opportunity to speak to you on the importance of S. 1194. I
also thank my representative, Congressman Goodlatte, for being
here, and also thank Congressman Strickland for his leadership
on the issues that we are discussing today.
I am June Poe from Roanoke, Virginia, and I have one of my
five children who suffers from severe mental illness. I have
worked in the field of psychiatry as a Licensed Clinical Social
Worker and my husband was a physician. My family has
experienced the heartbreaking lack of vital services needed to
help prevent unnecessary contacts of people with mental
illnesses with the criminal justice system.
I am also pleased to be here today to testify on behalf of
NAMI, the National Alliance for the Mentally Ill, and at the
outset, I would also like to recognize the support of the
Campaign for Mental Health Reform, representing the broad
mental health community for S. 1194.
You have heard these distinguished witnesses. Now, my son
and I want to put a human face on this bill. In 1974, John, a
brilliant student and athlete, suffered his first psychotic
break as an 18-year-old freshman at Wake Forest University. He
was diagnosed with paranoid schizophrenia. For the next 12
years, he struggled courageously to try to continue his
education and employment as he dealt with the pain of his
chronic severe mental illness. He was hospitalized nine times
and received some community mental health services, but in
those days, the 1970's and 1980's, psychiatric treatment and
services for people with severe mental illness was still in the
dark ages.
In 1987, unfortunately, he stopped taking his medication
and we finally had to call the police because we did not feel
safe due to his psychotic behavior. He was arrested and jailed
for breaking and entering our home, destroying property. My
husband and I were very well educated about medicine and the
mental health system. We sought help from every possible
source. Despite this, John had to suffer the horrible
experience of being locked up in jail and treated as a
criminal. He was becoming sicker without treatment.
The darkest day in my memory was that day when I realized
that the court did not have the ability to provide him the help
he desperately needed. A felony conviction was the worst thing
that could have happened to him. Physicians take an oath of
``do no harm.'' Lawyers should take the same oath. The judge
sent him back to jail with no other than an admonition to take
his medication. John was not able to comply because of his
mental illness. When John was psychotic, he did not know he was
sick.
The horrendous manner in which my son's case was handled
demonstrates the profound need for education and cross-training
of criminal justice and mental health personnel. Most of the
individuals involved in my son's case at that time had no
knowledge about schizophrenia, its symptoms, and its
treatments, and there was no system in place for coordinating
services between the criminal justice and mental health.
The story gets worse. While in jail, John's condition
continued to deteriorate. After his release from jail, the
mental health professionals could not make him take his
medications. He was jailed two more times. Having to call the
police about your own child and then visiting him in jail is an
agony that I pray no one in this room will ever have to endure.
John's incarcerations only made his psychiatric symptoms
worse and we could do nothing to help him. The services he
needed to recover were not available.
Finally, in 1990, a gifted probation officer and mental
health professional helped my son begin a tortuous journey back
to recovery. The road has not been smooth. John was
hospitalized on three more occasions and even attempted to
commit suicide. Throughout the 1990's, John had periods when he
was able to maintain a degree of independence and periods when
he was very ill and symptomatic.
In 2001, John again stopped taking his medication and
became psychotic. He had a paranoid delusion that neighbors
were harming their dogs, so he opened the gate and let them
escape from being hurt by their owners and the owners wanted to
call the police and have him arrested. This time the Assertive
Community Treatment, the PACT team, intervened and prevented
his arrest and incarceration. With this excellent, intensive
community care he is now back on medication, has an
understanding of his illness, and is stabilized. Unfortunately,
these high-quality mental health services and supports are not
available to most people.
I am excited about the purpose of S. 1194, to foster local
collaborations. In our Roanoke Valley, we have developed
collaborations for providing better services for people like
John who need treatment, not punishment. The only thing lacking
are resources to implement our ideas and our plans. S. 1194, if
enacted, will provide the needed resources.
In conclusion, I strongly urge passage of S. 1194, a bill
that will greatly benefit both people with serious mental
illnesses and entire communities. In 1974, John, a brilliant
young freshman at Wake Forest University, suffered paranoid
schizophrenia. In 1987, he was cast away by the criminal
justice system. Today, at age 48, John, instead of being
incarcerated as a criminal, is living independently in the
community. He is truly a courageous survivor.
I have asked permission to read a very short statement that
he asked me to read to you. ``Thank you for this opportunity to
testify why I support S. 1194. I am John Poe, June Poe's son. I
am mentally ill and have been sent to jail on two misdemeanors
and one felony, non-violent and non-drug abuse crimes. If the
Mental Health Court and the PACT team had been in effect at
that time, it would have made my life more comfortable. Jail is
a very bad place for people with mental health. People with
mental health cannot get proper treatment in jail. I urge you
to vote for this bill. Signed, John Poe.''
Thank you for giving me the opportunity to testify.
Mr. Coble. Thank you, Ms. Poe. You indicated John was a
courageous young man. I think his mom is a pretty courageous
person in her own right.
Mrs. Poe. And I have three of my children back here who are
courageous, too.
Mr. Coble. It is good to have all of you in the audience
with us today.
[The prepared statement of Mrs. Poe follows:]
Prepared Statement of June P. Poe
Thank you, Chairman Coble, Representative Scott and other
distinguished members of the Committee for this opportunity to speak to
you on the importance of S. 1994, a bill that would foster
collaborations to ensure that resources are effectively and efficiently
used to develop alternatives to incarceration for individuals with
mental illnesses charged with non-violent crimes.
I am June P. Poe from Roanoke, Virginia, a widow with 5 children,
one of whom suffers from severe mental illness. I have worked in the
field of psychiatry as a Licensed Clinical Social Worker and my husband
was a physician. My family has experienced the heartbreaking lack of
vital services needed to help prevent unnecessary contacts of people
with mental illnesses with the criminal justice system. My husband,
until his death in 1994, and I have continued to fight for my son,
John, and many others who fall between the cracks.
I am pleased to be here today to testify on behalf of NAMI (the
National Alliance for the Mentally Ill). At the outset, I would also
like to recognize the support of the Campaign for Mental Health Reform
for S. 1194. It is very important to note that the mental health
community as a whole stands behind this bill.
You will hear from the other distinguished witnesses how critical
the problems are and what is needed to alleviate them. My son John and
I want to put a human face on this bill. John has given me permission
to tell this story. This is our story but we are not alone. I am
speaking for many many families who have similar stories. In most
cases, these stories would have been far happier had the services
envisioned in S. 1194 been available to people like my son.
In 1974, John, a member of the High School National Honor Society,
former Captain of his High School Track team (voted most valuable
member of that team), artist, and a brilliant freshman at Wake Forest
University suffered his first psychotic break. He was diagnosed with
paranoid schizophrenia. For the next 12 years he struggled courageously
to try to continue his education, and employment as he dealt with the
pain of his chronic severe mental illness. He was hospitalized nine
times and received some community mental health services but these
services were not adequate to keep him stabilized. He struggled with
the side effects of the old medications. In those days (1970s and
1980s) psychiatric treatment and services for people with severe mental
illnesses were still in the dark ages. Our family has continued to give
him love and support through it all.
In 1987 unfortunately he stopped taking his medications and we
finally had to call the police because we did not feel safe due to
behaviors that were the product of his deteriorating psychiatric state.
He was eventually arrested and jailed for breaking and entering our
home at 5:30 AM and destroying property. John said ``I just wanted to
get some sleep.'' The Commonwealth's attorney recommended a felony
charge, explaining that this was the only way to get John treatment. My
husband and I were very well educated about medicine and the mental
health system. We had sought help from every possible source--judges,
lawyers, and many mental health programs and mental health
professionals. John had to suffer the horrible experience of being
locked up in a jail and treated as a criminal. We suffered the painful
agony and grief of visiting our son in jail. He was becoming sicker
without medication and treatment. The Commonwealth's attorney and his
assistant and even our own attorney (my cousin) did not know what to
do.
The darkest day in my memory was that day in court when I realized
that the court did not have the ability to provide him the help he
desperately needed. We had been advised that pleading guilty to a
felony was the only way to get John treatment. In actuality, a felony
conviction was the worst thing that could have happened to him. The
judge sent him back to jail, with no treatment whatsoever, other than
an admonition to take his medication. When the judge told my son to
take his medication, he was not able to comply because of his mental
illness. When John was psychotic he did not know he was sick.\1\
---------------------------------------------------------------------------
\1\ Amador, Xavier, ``I'm Not Sick, I Don't Need Help'', Vida
Press, revised 2004.
---------------------------------------------------------------------------
The horrendous manner in which my son's case was handled
demonstrates the profound need for education and cross training of
criminal justice and mental health personnel. Most of the individuals
involved in my son's case at the time had no knowledge about
schizophrenia, its symptoms, and its treatments. And there was no
system in place for coordinating services between criminal justice and
mental health. I am very gratified that S. 1194 will allow communities
to use available funds to provide the training necessary to ensure that
those responding to individuals like my son in the future will be
better prepared to do so in a humane and effective way.
The story gets worse. While in jail, John's condition continued to
deteriorate.
For the next 3 years my son and the rest of our family went through
hell. After his release from jail, the mental health professionals
could not make him take or stay on his medications. The services he
needed to recover, such as assertive community treatment, were not
available.\2\
---------------------------------------------------------------------------
\2\ Assertive community treatment programs are characterized by
intensive, outreach-oriented services, available on a 24 hour, seven
day a week basis, for people with severe and persistent mental
illnesses who are at risk of hospitalizations. These programs have
proven effectiveness in reducing involvement with criminal justice
systems, homelessness and other adverse consequences of lack of
treatment.
---------------------------------------------------------------------------
We had to call the police again. Having to call the police about
your own child, and then visiting him in jail is an agony that I pray
no one in this room will ever have to endure. Research proves that
people with severe mental illnesses get sicker when they do not get
necessary medical treatment. We saw our son get sicker and could do
nothing to help him. His incarcerations only made his psychiatric
symptoms worse.
Finally, in 1990, a gifted probation officer who is also a gifted
mental health professional, helped my son get released from jail and
begin his tortuous journey back to recovery. This is not to say that
the road was smooth. John was hospitalized on several occasions and
even attempted to commit suicide. Schizophrenia is a disease known to
be episodic in nature. Throughout the 1990's, John had periods when he
did quite well, and periods when he was very ill and symptomatic.
In 2001 John again became psychotic when he stopped taking his
medication. He had a paranoid delusion that neighbors were harming
their dogs so he opened the gate and let them ``escape from being hurt
by their owners''. After he had done this the third time the neighbors
called the police and brought charges to have him arrested. This time
his Assertive Community Treatment (PACT) team intervened and prevented
his arrest and incarceration. With this excellent intensive community
care he is now back on medication, has an understanding of his illness
and need for medication and is stabilized. He has received excellent
acute care at Catawba Hospital (our regional state psychiatric
hospital) and excellent services through Blue Ridge Behavioral
HealthCare (our regional community mental health services). I am
grateful that mental health care is now available to prevent a repeat
of the horror of those 3 years when he was in jail. Unfortunately,
these high quality mental health services and supports are not
available to most people.
I am excited that the purpose of S. 1194 is to ``foster local
collaborations'' which will ensure that resources are effectively and
efficiently used to reduce the unnecessary incarceration of non-violent
offenders with mental illnesses. In the Roanoke Valley, we have
numerous examples of such collaborations. For example, in 2001, under
the leadership of Police Chief Ray Lavender of Roanoke County, the
County established a police Crisis Intervention Team (CIT) program, the
first of its kind in the Commonwealth of Virginia. The Mental Health
Association of Roanoke Valley and NAMI-Roanoke Valley worked closely
with Chief Lavender in creating this important new program.
In 2002, I, representing NAMI-Roanoke Valley, helped to establish a
Task Force to better address the needs of people with mental illnesses
who come into contact with the criminal justice system in the Valley.
Its mission is to ``identify those issues inhibiting the effective
delivery of services for offender populations with a mental illness and
encourage the development and implementation of a continuum of
community based care for persons with mental illness that will reduce
the prevalence and incidence of offenders with mental illness within
the criminal justice system.'' The Task Force members represent state
and federal criminal justice professionals, (judges and probation
officers in the 23 Judicial Circuit and District Courts and US Federal
Court) public mental health professionals (the Medical Director of
Catawba Hospital, Blue Ridge Behavioral Health staff) and advocates
(NAMI-Roanoke Valley and the Mental Health Association of Roanoke
Valley).
Despite the severe cutbacks in mental health agencies and
facilities and criminal justice systems due to the state budget crisis,
this Task Force, in just its first year accomplished the following:
Established communication between the professionals
(including judges) in the criminal justice system, mental
health agencies, and advocates, which previously did not exist
because they did not have a forum to communicate with each
other;
Identified 11 issues and challenges inhibiting the
effective and efficient treatment of offenders who have mental
illness within the Roanoke Valley;
Assessed current capabilities of mental health
agencies and facilities and criminal justice systems to
effectively respond to offenders who have mental illness and
avoid re-hospitalizations and re-incarcerations;
Achieved some non-cost approaches to improve the
efficiency and effectiveness in responding to the needs of this
population;
Developed coordination of services between jails,
mental health community agencies and hospitals;
Eliminated duplication of services in the transition
of services from jail to community; and
Provided training this past Spring, 2004, to more
than 60 attorneys, judges and probation officers about mental
health issues and treatment resources.
In the Roanoke Valley we are well down the path of developing more
humane and cost-effective responses to individuals with mental
illnesses who, due to non-violent offenses, come into contact with
criminal justice systems. The only thing lacking are resources to
implement our ideas. S. 1194, if enacted, will provide communities like
ours with opportunities to implement services to break the endless
cycle of deterioration and arrests for people like my son, who are not
criminals but desperately need treatment!
In conclusion, I strongly urge passage of S. 1194, a bill that will
greatly benefit both people with serious mental illnesses and entire
communities. Jail diversion programs and community reentry services,
coupled with comprehensive community mental health treatment such as
PACT, are less expensive than a criminal justice system without
treatment. The benefits are obvious. Today, my son, instead of being
incarcerated as a criminal, is living independently in the community,
volunteering weekly in the psychosocial rehabilitation program at
Catawba Hospital, participating actively in treatment, and is well
along the road to recovery. And, I once again feel safe, as do others
in my family and community.
In 1974, John, a brilliant young freshman at Wake Forest University
suffered a biologically based brain disorder. In 1987, he was ``cast
away'' by the criminal justice system. Now, John is truly a courageous
survivor. He wrote the following statement urging the passage of S.
1194. He asked me to read it to you.
__________
(Written statement of John Poe, read by June P. Poe).
Thank you for this opportunity to testify why I support S. 1994.
I am John Poe, June Poe's son. I am mentally ill and have been sent
to jail for two misdemeanors and one felony, non-violent and non-drug
abuse crimes.
If the mental health court and PACT had been in effect at that time
it would have made my life more comfortable. Jail is a very bad place
for people with mental illness. People with mental illness cannot get
proper treatment in jail.
I urge you to vote for this Bill.
(signed: John Poe)
__________
Thank you for giving me the opportunity to testify before you
today.
Mr. Coble. Folks, we impose the five minute rule against
us, as well, so if you all could keep your answers tersely, we
would be appreciative.
Ms. Nolan, one of the criticisms of the Drug Court program
is the lack of evaluation and the lack of reporting by the
grantees. Is there any effort in the Mental Health Court
program to require grantees to provide information for
evaluations, and how is the program being evaluated?
Furthermore, is there an effort to establish best practices for
the grantees?
Ms. Nolan. Yes, sir, yes, sir, and yes----
Mr. Coble. It is a multi-faceted question. [Laughter.]
Ms. Nolan. The quick answer to your question, sir, is yes
to all the questions that you posed. The National Institute of
Justice, a component of the Office of Justice Programs, is
currently overseeing a process evaluation of all the currently
funded sites. Following that, as was mentioned in the
testimony, the MacArthur Treatment Foundation will be
conducting an outcome evaluation of seven of the sites that we
are funding.
In addition, each one of the grantees on a semi-annual
basis is required to report to us on various performance
measures, both from the client standpoint and from the
community's standpoint.
Mr. Coble. I thank you.
Sheriff, law enforcement officials must collaborate with
mental health professionals to most effectively address the
lack of treatment of mentally ill non-violent offenders. Have
you experienced or do you anticipate any difficulties or
impediments or road blocks in this collaborative effort?
Mr. Sexton. No, sir.
Mr. Coble. And you have had good experience with it?
Mr. Sexton. Yes, sir.
Mr. Coble. All right. When I said terse, I think they took
me literally. [Laughter.]
Mr. Coble. Dr. Monahan, according to your testimony, 95
percent of defendants, when faced with the option of treatment
or jail time for an active sentence--they choose treatment. In
your opinion, should these defendants have that option, A, and
why do you believe these individuals do not seek treatment on
their own without court intervention? Is this generally the
first treatment these individuals will be involved with?
Mr. Monahan. Sir, many individuals who need mental health
treatment oftentimes unfortunately don't avail themselves of
it, sometimes because of the side effects of those treatments.
I think that the 95 percent of the defendants in Broward who
accept treatment do so in part because the criminal justice
system is being used as leverage to get them into treatment. As
I mentioned, they are no more likely to commit a crime if they
are diverted from the criminal justice system. It saves the
community 75 percent on jail days, and I think if you can
either reduce the crime rate or keep the crime rate constant
but drastically reduce the cost at no additional risk to the
public, that sounds like a winning strategy to me.
Mr. Coble. I thank you.
Mrs. Poe, you mentioned in your testimony that the Roanoke
Valley Task Force initially identified challenges inhibiting
the effective and efficient treatment of mentally ill offenders
within your community. Identifying these challenges and
assessing current capabilities seems essential to developing a
strategy to address the issue. During this phase, did you
discover deficiencies inherent within the criminal justice
system or the mental health community regarding the treatment
of mentally ill offenders?
Mrs. Poe. Yes, sir. In the mental health system, there was
a strong--there was not enough money to provide for the
services that were needed. Money was one issue.
There are difficulties in the collaboration--well, there
are difficulties with the criminal justice system in dealing
with the issues of medication, serious problems there which we
have been trying to address. The problems of having the
appropriate medications that the doctor has, the psychiatrist
has prescribed needs to be with that patient. They do not
always get those medications in the jail. We have been working
hard on trying to solve that problem.
There is also a need for greater education of the people in
the criminal justice system to understand what mental illnesses
are. One of our groups, one of our projects has been to have an
educational program where we trained this spring with 60 of the
lawyers, the judges, and probation officers to begin to
understand what mental illnesses are and what the medication
issues are.
Mr. Coble. I see my red light, but before I yield to Mr.
Scott, let me ask you this question, Mrs. Poe. Is it your
belief that the bill before us appropriately addresses these
problems?
Mrs. Poe. Yes. There is in education--in the bill, there is
cross-training and education that is crucial. Money for the
services are very important, but the collaboration, fostering
the collaboration between the systems is of major importance.
It is--one of the things we found was that until we had this
task force, they weren't speaking to each other. Coming
together, communicating with each other, they found out what
their problems were and began to work on ways of solving those
problems, that when we didn't have any money, we could still be
a little bit more efficient in communicating on those problems.
Mr. Coble. I thank you, and I will say to the gentleman
from Virginia, I owe you a minute and 3 seconds. [Laughter.]
Mr. Scott. Thank you. Thank you, Mr. Chairman.
Dr. Monahan, you went to great lengths to talk about the
evaluation and research and importance in that. Is this
something unusual in criminal justice legislation, to actually
evaluate and study what you are doing before you do it?
Mr. Monahan. Well, it is certainly not unheard of, sir, but
I think it is unusual to have the emphasis on evaluation be so
integral a part of the bill as it is a part of this bill. I
think, ideally, people will learn from what they try in the
beginning. They will see what works and doesn't work. They will
do less of the former and more of the latter.
Mr. Scott. Thank you, and I think that is something new. We
don't usually do a lot of studying before we jump into it.
Ms. Nolan, what are the costs involved in setting up a
program?
Ms. Nolan. It varies, sir. Funding is available currently
through the Edward Burn Memorial Justice Assistance grant
programs as one of the purpose areas that States can use to
help fund start-up of Mental Health Courts. In addition, there
are a number of jurisdictions that have been able to, through
existing resources, been able to basically cobble together
through existing resources some courts.
As far as specific numbers as to the extent to which, at
the low end, what courts may cost, and at the high end, I would
be happy to try to get that information for you and back to
you.
Mr. Scott. Thank you. There are two parts of it. One is the
administrative expense in setting up the court. You have got
the set-up costs, administrative, if you have got to hire an
administrator or a computer or a desk and that kind of thing,
and they are ongoing administrative expenses. Also, if it is
going to work, you have to have some services available for the
defendants. Do the courts that you have funded have adequate
services to refer the defendants to?
Ms. Nolan. On those that I am familiar with, yes, there are
adequate funds, but again, we are funding only some
demonstration projects. My understanding of what is going to be
offered under the pending legislation is that there will be
planning and implementation grants so that jurisdictions will
be able to determine really what their needs are going to be in
that particular jurisdiction, what kind of funds will be
needed.
Mr. Scott. Because this is one of the problems. We have
gone to community-based mental health rather than
institutional-based mental health, and Sheriff Sexton has
mentioned that some of his people run into people in the
community that are not getting all of the services that they
actually need. We run into this with juveniles occasionally.
The only way they can get services is if you arrest them on
something and then the court can provide the services.
But it is your understanding that in these courts, there
are adequate services available once someone gets into the
system?
Ms. Nolan. What I would like to focus on, sir, is the
importance of the collaborative efforts that are involved in
each of these Mental Health Courts, that it is not just a
criminal justice problem, it is not just a mental health
problem, but there are various systems with their resources
that can all come together to help generate the resources that
are needed.
One thing that I have found under my leadership with the
Serious and Violent Offender Reentry Initiative and the work
with the other Federal agencies that I do, it is impossible for
just one Government agency or one segment of the services that
are provided to be able to do it alone. It is very important
that we are able to leverage the resources that we have to be
able to address the problem.
Mr. Scott. It has been mentioned also that a lot of the
defendants have, what did you call them, co-occurring problems,
not only mental health but also substance abuse. Are they dealt
with in this legislation?
Ms. Nolan. I am sorry, sir, I don't know. I am not that
familiar with the specifics of the legislation.
Mr. Scott. Dr. Monahan, do you----
Mr. Monahan. They are explicitly. Defendants with a mental
disorder who also have a co-occurring secondary substance abuse
disorder are indeed--can have programs for them funded under
this legislation.
Mr. Scott. Sheriff Sexton, if you don't arrest the mentally
ill, what happens to them?
Mr. Sexton. That is a great question. Oftentimes, it
depends on what the family wants to do. Normally, the family
calls us in order to try to get something done. It also depends
on the economic status and well-being of the family at the
time. But a majority of the times, unfortunately, the only
option out there is arrest, so they end up coming into the
facility. In our particular community with the program that we
have now, we are using the local cooperative venture that we
have, the collaborative effort to bring in local mental health,
to channel that person to another mechanism.
The problem comes, as Ms. Nolan mentioned, is when you have
a felony, you are dealing with a felon. Virtually, there is no
way to deal with the problem on the front end. It has to be
dealt with at the back through a circuit judge. In those
situations, we are somewhat limited, but again, the
collaborative effort of this particular bill and the problem of
the tennis game of batting the client back and forth between
the agencies, I think everybody, at least in our community, has
finally settled in to--and other communities is settling down
on focusing the problem and solving it.
Mr. Scott. Now, can they get that kind of effort going
without an arrest?
Mr. Sexton. Yes, sir.
Mr. Scott. So they don't have to be arrested to get
services?
Mr. Sexton. No, sir. We have crisis intervention, suicide
intervention, or get them to the local community mental health
officials.
Mr. Scott. Do you have sufficient mental health services to
address the need in your community?
Mr. Sexton. We are the mental health capital of Alabama.
[Laughter.]
Yes, sir, we have, and then we also serve several hospitals
for the State. So yes, sir, we do.
Mr. Scott. Ms. Nolan, is $150,000 enough to get these
things going? Are there things that the programs are not doing
because of insufficient funding?
Ms. Nolan. If I may be able to get back with you, sir, with
specific information regarding the sites that we are going to
be doing specific evaluation of and see what their needs are, I
would be happy to get back to you with that specific
information. I do not have that with me right now.
Mr. Scott. Mr. Chairman, I know Virginia doesn't spend as
much for mental health as some other areas, but I am delighted
to see that some don't have the funding problems that I believe
we do in Virginia.
Mr. Sexton. Mr. Scott, if I may, Alabama would be more than
glad to accept grants---- [Laughter.]
Let me not shortchange the State.
Mr. Scott. Thank you.
Mr. Coble. I thank the gentleman.
Folks, since only Mr. Scott and I are here and it appears
we are going to be able to release Ms. Nolan by 4:15, let us do
a second round.
Sheriff, supporters contend that this legislation will
result in a huge cost savings. How will this program save local
government money, A, and how about Federal programs, if you are
able to comment to that?
Mr. Sexton. Well, the taxpayers immediately would have a
mechanism to deal with especially the low-level non-violent
offender. As I mentioned in my statement, $75,000 was spent in
the last quarter of our budget last year for psychotropic
drugs. This will allow us to have other mechanisms.
One of the problems that we do have when it comes to
funding is that many community-based health programs can
support the psychotropic drugs under particular drug programs
that are available in the Federal Government now, but as soon
as that person is incarcerated, we lose the ability of having
that same drug coverage. I think it is called a 207(b) program.
So, therefore, we are having to pay that additional coverage.
So once somebody becomes incarcerated, we have more strings
that tie us up in a jail situation.
As far as the Federal programming, the ability to be able
to possibly intervene in situations earlier, an earlier
intervention than what we have now, would ultimately save
family, save local government, State, and incarceration medical
costs. And then we experienced the loss of three police
officers in Birmingham last week, substance abusers and
potential mental health problems. We could save the loss of
life.
Mr. Coble. I thank you.
Ms. Nolan, does the Bureau of Justice Statistics continue--
I don't think we have touched on this--continue to collect data
on the number of mentally ill within the system and have you
seen any reduction in the number since you began the Mental
Health Court grant program?
Ms. Nolan. Yes, sir. The Bureau of Justice Statistics is
continuing to collect data and the next round of data will be
available in 2005. We expect in early 2005, the new data will
be available.
And the next part of your question? I am sorry.
Mr. Coble. I just discarded it.
Ms. Nolan. Okay. [Laughter.]
Mr. Coble. Have you seen the reduction?
Ms. Nolan. It is too early to tell, sir, because the Mental
Health Courts have been in existence for such a short period of
time. It is too early to be able to tell exactly what the
results are.
Mr. Coble. I thank you.
Dr. Monahan, you indicated in your testimony that you have
done research on the Mental Health Court program the Department
of Justice is currently managing. How does that program differ
from the program described in this bill, A, and what are the
advantages and disadvantages of this approach?
Mr. Monahan. Yes, sir. I think that the bill envisions
Mental Health Courts that could function very much as the
courts that are currently funded by the Office of Justice
Programs. I am involved in the evaluation of the first seven of
those programs funded by the National Institute of Justice. We
have a few more months of that evaluation, and then the
MacArthur Foundation is going to fund the evaluation, as Ms.
Nolan said, of the actual outcomes, which will take longer.
Some of the initial results of this process evaluation, it
seems like the seven Mental Health Courts, early on, Mental
Health Courts accepted primarily misdemeanors. The new Mental
Health Courts, many of them are accepting felonies, primarily
non-violent felonies. But they are demanding that the defendant
plead guilty before he or she can get in the Mental Health
Court. They are not just suspending prosecution.
And indeed, early on, the Mental Health Courts were very
reluctant to place people in jail if they didn't adhere to
mental health treatment. The newer Mental Health Courts, if you
don't go to treatment, then you do go to jail. And they are
also, finally, increasing using the criminal justice system
supervision, for example, probation rather than some kind of
social work.
Mr. Coble. I thank you, Doctor, and I say to my friend from
Virginia, now you owe me a minute and 4 seconds. [Laughter.]
Mr. Scott. Thank you. Dr. Monahan, do insanity defenses get
involved in these?
Mr. Monahan. No, sir, they do not. Insanity defense,
despite many people's views to the contrary, are generally
raised in about one percent of prosecutions. It fails three-
quarters of the time that it is raised. So only one-quarter of
1 percent of criminal cases are disposed of by the insanity
defense. Those people usually spend at least as much time in
the hospital as they would have spent in jail.
Mr. Scott. Mrs. Poe, in your testimony, you ended up that
your son ended up getting arrested. Were you able to get
services for him without him being arrested?
Mrs. Poe. No. No. When he became psychotic, he was off of
his medication--and I could not get the help.
Mr. Scott. And after he was arrested, did you get the help?
Mrs. Poe. No. The treatment, the help only came in 2001
when the Assertive Treatment Team became involved, and that did
the trick. That is a very important part.
Mr. Scott. And was that a result of the criminal justice
system or the mental health system?
Mrs. Poe. It was a part of the mental health system and
June Poe. [Laughter.]
Mr. Scott. Okay. Dr. Monahan, we have been talking about
coordinating the service delivery system. There is a slight
difference between coordinated and integrated services, that is
whether you have two different services, one for drugs and one
for mental health, or they are provided together. Does this
bill address that situation, where they might be coordinated
but not integrated?
Mr. Monahan. Yes, sir, I think it does. I think, Mr. Scott,
exactly as you mentioned before, there are two different kinds
of funding issues here. The first is either the coordination or
integration, what my colleague Henry Steadman has called the
boundary spinner. You need somebody to be at that boundary
between mental health and criminal justice.
But then, secondly and more expensively, are the services
themselves. We often talk about diversion from the criminal
justice system. Well, that is important, but the more important
issue is diversion to what? Where are these people going? You
can't divert people to services that don't exist.
So I think that on the integration versus coordination
issue, in the treatment of co-occurring disorders, the research
is clear. What you need is integrated, not simply coordinated,
services. You can't simply bus people to mental health
treatment here and the substance abuse treatment someplace over
there. You have to have the same people provide treatment for
both disorders. This bill certainly allows that. It doesn't
mandate it.
Mr. Scott. That is all.
Mr. Coble. I thank the gentleman and we thank you all. This
has been a very productive hearing, I believe. Ms. Nolan, Mr.
Scott and I have accommodated you with your request. You will
be out of here by 4:15.
I am going to depart from our normal format and let Mrs.
Poe--would you like to close out for a minute or two, Mrs. Poe,
because you have been with this problem far closer than any of
the others?
Mrs. Poe. Thank you, sir. I want to state in a positive way
that I am so grateful for the legislators at the State and the
national level that are recognizing this problem. I appreciate
so much working with the NAMI, National Alliance for the
Mentally Ill. I am not alone. We have many families, many
consumers who recognize the seriousness of this and we
appreciate being heard.
We appreciate the opportunity to educate everyone working
in the system, from professors and teachers in the schools to
understand what serious mental illness is, or are, and also the
importance of the criminal justice system involvement. This is
a very, very complicated problem. The more education we can
give to the public about what struggles you gentlemen are
having in trying to come up with the money for this is major.
We need to give you the support, as consumers of this important
issue.
I have fought a long time and I appreciate what you said.
If we had only had the Mental Health Courts back there in the
very beginning when John needed that back in his first jail
experience, it would have been a far different story. I am
delighted to know of evidence-based practices going now in what
I have heard.
I wish you gentlemen the very best in continuing to help us
in solving this problem. And anything that we can do as family
members and as consumers, let us know.
Mr. Coble. Thank you, Mrs. Poe, Dr. Monahan, Sheriff
Sexton, and Ms. Nolan. We are delighted to have you all with
us. We thank you for your testimony today.
This concludes the legislative hearing on S. 1194, the
``Mentally Ill Offender Treatment and Crime Reduction Act of
2003.'' Thank you for your cooperation, and the Subcommittee
stands adjourned.
[Whereupon, at 3:59 p.m., the Subcommittee was adjourned.]
A P P E N D I X
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Material Submitted for the Hearing Record
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Prepared Statement of the Honorable William D. Delahunt, a
Representative in Congress From the State of Massachusetts
I would like to thank Chairman Coble and Ranking Member Scott for
holding this hearing on the ``Mentally Ill Offender Treatment and Crime
Reduction Act'' of 2003. I would also like to commend my colleague Rep.
Ted Strickland for his continued leadership on this bill and other
initiatives to improve our nation's mental health systems. I appreciate
your courtesy in permitting me, as a former member of this
subcommittee, to add my voice in support of this much-needed
legislation.
As the distinguished witnesses testified, the mental health
community and law enforcement are united behind this legislation. And,
in a rare instance within the current session of Congress, the Senate
has already moved forward and passed this bill by unanimous consent. I
hope that my colleagues on the House Judiciary Committee will join me
to see that the House moves this legislation quickly in the same
bipartisan spirit.
As Thomas J. Conklin, M.D., Director of Health Services of the
Hampden County Correctional Services of Massachusetts, has observed,
``It can be safely said that American jails and prisons have become the
nation's default mental health system.'' Our nation's jails and prisons
are in a state of crisis as they struggle to provide mental health
services for incarcerated individuals. Congress should proceed with
haste.
It is simply wrong that families must resort to the police in order
to obtain treatment for a loved one suffering from an extreme episode
of mental illness. Yet, during times of extreme distress, families face
no alternative because an individual experiencing symptoms like
paranoia, exaggerated actions and impaired judgment may be unable to
recognize a need for treatment.
It is unconscionable and, may well be, unconstitutional, that these
vulnerable individuals become further marginalized once incarcerated,
often denied even minimal treatment as a result of inadequate
resources. Most mentally ill offenders that come into contact with the
criminal justice system are charged with low-level, non-violent crimes.
However, once behind bars, these individuals may face an environment
that only further exacerbates symptoms of mental illness, which may
otherwise be manageable with proper treatment. Then, caught in a
revolving door, they may soon be back in prison as a result of
insufficient and inadequate transitional services upon release. This
comprehensive legislation is a step in the right direction in order to
move away from laws that criminalize mental illness. Through this
legislation, state and local correctional facilities will be able to
create appropriate, cost-effective solutions. And low-level, nonviolent
mentally ill offenders will have greater access to continuity of care.
Congress must also address an unfunded mandate that has been
imposed on the states for decades. In Estelle v. Gamble (1967), the
Supreme Court held that deliberate indifference to serious medical
needs of inmates is unconstitutional ``whether the indifference is
manifested by prison doctors in their response to the prisoner's needs
or by prison guards in intentionally denying or delaying access to
medical care or intentionally interfering with the treatment once
prescribed.'' Further, in Ruiz v. Estelle (1980), the Supreme Court
established minimum standards for mental health services in
correctional settings. It is hard to imagine that more than twenty
years later, state and local facilities still do not have nearly enough
resources to come even close to meeting these constitutional
requirements.
Congress must do its part to assist state and local governments in
meeting this burden. We cannot tolerate a system that fails to meet
constitutional safeguards. Further, we cannot tolerate a system that
fails to dedicate resources effectively in order to ensure that people
are getting help instead of jail time. And as a result of state budget
cuts, communities are looking to the federal government for help.
For example, a few years ago Sheriff Michael J. Ashe of Hampden
County created an innovative inpatient mental health care unit within
one of his prisons, providing a resource to four counties within the
state. A highly successful facility, the unit allowed inmates to be
treated in a safe and structured environment, thereby reducing costly
emergency calls and transfers to the state-run hospital for behavioral
disorders. Unfortunately, the Sheriff was forced to shut down this
program in 2001 as a result of a decision by the Commonwealth's
Department of Mental Health to eliminate all funding for mental health
services at correctional facilities. Now, Sheriff Ashe is struggling to
provide minimum treatment to inmates, many of whom are repeatedly
returning to jail as a result of the lack of diversion programs and
transitional services. Across the state, other correctional facilities
and members of law enforcement are battling the same problem--
struggling to create innovative solutions with very limited resources.
The Massachusetts Mental Health Diversion & Integration Program
(MMHDIP) is one such program that continues to advocate for new
networks to facilitate the diversion of mentally ill persons. The
MMHDIP seeks to promote extensive collaboration between police, health
and social service providers, consumer advocates, judges, and probation
officers and, in the past two years, the program has achieved many
significant accomplishments. The MMHDIP has developed and provided in-
service training on crisis intervention, de-escalation and risk
management techniques to members of several police departments,
including Boston, Worcester and Fitchburg. The program also intends to
develop a ``No Wrong Door'' triage center to receive persons who are
mentally ill and/or chemically dependant at a downtown Boston hospital.
Through these types of initiatives, persons in crisis who are
chargeable with non-serious crimes can be referred to community
treatment in lieu of arrest. Despite significant progress, the MMHDIP
faces significant hurdles to develop and implement their goals based on
the far-reaching needs of communities due to statewide funding cuts.
Consistent with the federal average, 12 to 16 percent of those
incarcerated in Massachusetts are suffering from serious mental
illness. Compared to the average rate of mental illness in the general
population, inmates in Massachusetts are more than twice as likely to
have a mental illness. And, consistent with nationwide statistics, the
recidivism rates of the mentally ill are much higher than average.
Unfortunately, the situation in my state is not unique. In every
state, the interaction between law enforcement and individuals
suffering from mental illness continues to rise. In a very tragic
situation just last week in Indiana, a law enforcement officer shot and
killed one young man, John Montgomery, diagnosed with bipolar disorder.
With four other sheriffs, the deputy had arrived at Mr. Montgomery's
home to carry out a court order obtained by the parents of this 29-
year-old as the only recourse to help him get medical treatment. Even
though the deputies knew the young man was mentally ill based on
previous calls to Mr. Montgomery's home, the officers resorted to
deadly force when Mr. Montgomery became violent as a result of his
psychotic state. Perhaps this tragic outcome could have been avoided
with greater resources allocated for adequate training and education
for state and local law enforcement. And Mr. Montgomery's parents would
have seen their son obtain treatment rather than plan for his funeral.
Having spent over two decades as a state prosecutor, I support the
goals of this bill to ``foster local collaborations'' between law
enforcement and mental health providers. What works in one community
will not necessarily work or be desired in another--solutions must take
into account the existing landscape as well as the social and political
dynamics within each community. Given the complexity of the issues
surrounding the intersection of mental illness and the criminal justice
system, no magic solution will solve the problems faced in communities
across America. Accordingly, this legislation does not seek to impose a
standardized model that must be adopted by all state and local
jurisdictions. To the contrary, S. 1194 encourages funding for
specialized programs that will most effectively address the needs of
local communities.
Consistent with one of the key objectives set forth by President
George W. Bush in his State of the Union Address, it is important to
note that the Department of Justice has endorsed this bill. The federal
government needs to provide communities with the tools to reduce
recidivism among returning inmates. The statistics speak for
themselves. This year alone the majority of the 600,000 prisoners who
will be released will return to prison after committing another crime.
Congress must continue do all that it can to ensure that state and
local law enforcement can address this problem, especially given its
disproportionate impact on the mentally ill.
Although I am encouraged that the Judiciary Committees in both
chambers are giving this issue serious consideration, Congress must
continue to address other extraordinary gaps in our current system--
such as the ability of prisoners to have continued access to affordable
medications, case management and affordable housing following release.
Looking ahead, federal and state government must not ignore these
challenges, as nearly 57% of offenders are sent back into our
communities without any supervision or support.
With this legislation, Congress can join with local communities in
their response to this problem. Individuals and their loved ones are
struggling with countless challenges and barriers during a mental
health crisis. In addition, members of state and local law enforcement
need access to training and alternatives to improve safety and
responsiveness. Without adequate funding, projects like those in the
Commonwealth of Massachusetts will take much longer to achieve their
goals due to limited staff and resources. Therefore, federal grants
must be made available for innovative programs that address the
challenges presented by mental illness to public safety in our
communities. With this bill, Congress can provide significant support
to collaborative efforts between law enforcement and mental health
experts. Without unnecessary delay, I urge my colleagues on the
subcommittee to move forward on their consideration of this legislation
so that the House has an opportunity to consider it for final passage
before the end of this current session of Congress.
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