Breaking the “revolving door” of people with mental illness in the courts

People with serious mental illness sometimes find themselves in what is now called a “revolving door” of the criminal justice system – back and forth in courtrooms, incarceration and involuntary hospitalization.

Measures are in place to help curb the problem, but gaps remain.

An attempt was made to close one of these loopholes in 2017 when Tim’s Law was passed. The purpose of the law was to allow Kentucky judges to order ancillary outpatient treatment for certain people with serious mental illness.

“We know that people with serious mental disorders are often hospitalized, stabilized and then released back into the community where they stop taking their medications and they don’t comply or adhere to treatment,” said Stephanie Burke, judge of the Jefferson County District Court. “And then they decline and decompensate and they’re back in the hospital.”

A lack of clarity in the language of the first version of Tim’s Law made it difficult to implement, Burke said. So she helped revise the law to make it clearer and expand the range of people who would meet the criteria for court-mandated care.

“Our problem was that the bill would not withstand the scrutiny of a higher court if it were reviewed,” Burke said. “So the tongue had to be cleared up.”

Kentucky is the 47th state to adopt assisted outpatient treatment. The revised law allows courts to review not only prior hospitalizations, but also prior arrests and incarcerations to determine whether a person would qualify for court-ordered outpatient treatment, Burke said.

In practice, Tim’s Law can be used for a very small percentage of the population — about 1.6%, Burke said. But it’s a segment of the population that is most likely to come into contact with law enforcement and be hospitalized or repeatedly arrested, she said.

The process begins when a family member, law enforcement officer, or other affected party petitions the district court. A judge then decides whether or not to impose ambulatory care.

For those involved, this kind of compulsory care has been shown to reduce homelessness by more than 74%, incarceration by more than 77% and hospitalization by 82%, Burke said.

“These are numbers that we can’t just ignore, and not take those numbers and say ‘we have to do this, it’s more humane, it’s the least restrictive measure to deal with these people,'” he said. Burke said.

There are other programs in place to help people with mental illness who find themselves charged with a crime.

mental health court

The Fayette County Mental Health Court is an out-of-county district court diversion program that allows some people with mental illness to go through a voluntary program and ultimately have their non-violent misdemeanor charges dismissed.

The program is funded by the Lexington-Fayette Urban County Government, and it is administered by NAMI Lexingtona local chapter of a national non-profit organization.

Through the program, those charged with non-violent offenses learn coping skills and ultimately have their charges expunged if they graduate.

A judge must approve each participant, but people come to the program and learn from it in many ways, said Jennifer Van-Ort Hazzard, mental health court coordinator at NAMI Lexington.

“My favorite is, ‘I heard from some guy in jail about mental health court, so I told my lawyer about it,'” Van Ort-Hazzard said. because these people are ready and willing to have these discussions.”

The program is entirely voluntary and it is up to the participants to agree to participate – and stick to it.

“The premise of our program is that if you don’t choose to participate, you probably won’t choose to engage,” Van Ort-Hazzard said. “So it wouldn’t make sense for us to spend this time together.”

Emergency detention

At the Lexington Police Department, most officers have had crisis intervention training that allows them to recognize when someone needs mental health help, said Fayette County assistant attorney Heather Matics.

Matics is the Fayette County Mental Health Court prosecutor and part of the city’s Crisis Response Team. It trains police officers in crisis intervention in Lexington and the region.

In extreme cases where a person proves to be a danger to themselves or others, the police may determine that an emergency detention is necessary. But taking that person to the hospital doesn’t always mean they’ll get the help they need.

“The problem is that this law written in Kentucky forces hospitals to find that there is no less restrictive place to treat them and they will get treatment,” Matics said. “And so a lot of people are… taken into emergency detention at the hospital and then they get out 45 minutes later.”

This sometimes happens because hospitals determine the person does not have an “acute need” for the mental health equivalent of emergency room treatment, Matics said.

“The problem is if you have someone who is seriously mentally ill, maybe they have economic limitations, maybe they don’t have insurance,” Matics said. “You can say, well, he can do outpatient therapy – does he have a car? A supplier? A way to pay for care? Does he even understand that he needs treatment at this point? »

The “revolving door” problem largely affects the chronically mentally ill, such as people who are homeless and have not been treated for years, Matics said.

“It frustrates me, my fellow officers, and it frustrates my partners in the mental health community,” Matics said. “And there’s a lot of discussion in the community about what we can do to go to the Legislative Assembly, to maybe reconsider the way this law is written. Because it traps so many people in the revolving door between the streets, the prison, the justice system and maybe a detour here and there to the hospital. they never really get the treatment they need.

Unfit to stand trial

Even with efforts to break down the so-called “revolving door” of people who repeatedly end up in courtrooms and jails because of mental illness, gaps in the system remain.

One such shortcoming is people found unfit to stand trial, who have their charges repeatedly dismissed and sometimes find themselves before a judge with new charges over and over again.

“Without them, again, being able to voluntarily engage in some kind of programming, and not crossing that threshold of harm to themselves or others, they’re really sitting in that gray area of ​​unhappiness,” said said Van Ort-Hazzard.

There’s hope that being found incompetent to stand trial would make someone realize they might need to seek mental health help, but that’s not always the case, a said Van Ort-Hazzard. Some people’s mental state is such that they don’t realize they might have a problem, she says.

“It’s possible to be told ‘you don’t have jurisdiction to be detained,’ actually watch your lawsuits be dismissed, and then go home as if everything is fine,” Van Ort-Hazzard said.

In these cases, it may be up to the community to make the difference.

“There’s not much else that great neighbors, or community members, or friends or whoever might start building a relationship with that person can do…until they can encourage them to get involved in something.”

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