When Mental Illness Causes Charges to Be Dropped, Patients Often Go Without Stabilizing Care

For seven years, Timothy Jay Fowler oscillated between prison, forced psychiatric hospitalization and freedom.

In 2014, in Great Falls, Montana, a man was charged with assaulting two detention officers while in jail, charged with theft. A mental health evaluation concluded that Fowler, who was diagnosed with schizophrenia, was unfit to stand trial, according to court documents. After Fowler received psychiatric treatment for several months, a judge ruled he was unlikely to become competent anytime soon. His file was dismissed and after a stay in the public psychiatric hospital, he was released.

About eight months after the dismissal, Fowler was arrested again, charged with beating a stranger with a metal pipe. As before, he was declared unfit to stand trial, the charges were dropped and he was eventually released.

At least five times from 2014 to 2021, Fowler went through the same cycle: he was arrested on serious charges, mental health professionals ruled him incompetent, and his case was thrown out. Fowler declined to be interviewed for this article. As of July, he had not faced felony charges in over a year.

In the United States, criminal prosecutions are terminated if an accused is found to be incompetent. What happens after that varies from state to state. nobody follows how often criminal charges are dismissed because the defendants’ mental illness prevents them from understanding the court process to aid in their defence.

Some states have policies to transition inpatients to independence after their criminal charges are dropped. But in others, like Montana, there are few landing spots for these patients outside of jail or a hospital to ease that transition. Medical professionals, county prosecutors and defendants have said those found unfit to stand trial could undergo a short stay in a psychiatric hospital before being released without further supervision.

The vast majority of people with a chronic disease mental illness is not violent, and they are much more likely to be victims of crime than the general population. Additionally, medical professionals say that most defendants found to be incompetent become stable enough with treatment to continue their cases.

Some never do. The criminal justice system has long been a revolving door for defendants with mental illness. The national association Treatment Promotion Centerwhich advocates making treatment for serious mental illness more accessible, found that in 2017, 21 states makes little or no effort to create programs that deal with these accused. This failure leaves individuals without stability, and some continue to hurt themselves or others.

“They only receive emergency care, followed by no care,” said Lisa Dailey, the center’s executive director. She added that people are not treated until they face new charges: “You are creating a system that requires a victim.

Dr. Karen B. Rosenbaumforensic psychiatrist and vice president of the American Academy of Psychiatry and Law, said experiments like Fowler’s show a system that fails people who have been discharged from psychiatric care. “There should be a lot of steps before going back to the community,” Rosenbaum said.

Some states have created such stages. Colorado has a team of navigators to help coordinate care for those deemed unfit to stand trial and a restoration program to provide treatment to patients close to home. In Oregon, a psychiatric examination board works with the public hospital to supervise those deemed incompetent to reduce the risk of future dangerous behaviors.

But even in states with programs aimed at stabilizing people with serious mental illness, this treatment is not guaranteed, often because of the limited availability psychiatric services.

Minnesota has a process to identify, treat, and manage risks for people considered “mentally ill and dangerous.” However, maintaining appropriate levels of staff in treatment facilities has been an issue, as has finding enough community-based options for people who need a higher level of care than homes. typical groups can offer. Last year, a statewide KARE 11 survey found dozens of cases in which people accused of serious crimes — including assault, rape, and murder — were found to be mentally incompetent and released without regular treatment or supervision. As a result, more people were injured, according to the investigation.

Forcing someone into psychiatric care is controversial, creating a tension between autonomy and public safety. For decades, mental health advocates have pushed for local services, such as intensive outpatient treatment programs and transitional placements. But as psychiatric hospitals have been reduced, local options often lack the resources to meet the needs.

In Montana, when cases are dropped because defendants are deemed incompetent, local officials must file a motion seeking a judge’s order to admit them to psychiatric care. People may be required to follow outpatient treatment options, although lawyers and state officials said these services often do not exist or are overstretched. More often, people are being admitted to the understaffed public psychiatric hospital, which earlier this year lost federal funding due to unsafe conditions and patient deaths.

The Montana court and state officials have said cases that are thrown out because a defendant is incompetent are outliers. However, the state has no way of knowing when this is happening or how many people in this situation are receiving additional treatment.

Lewis and Clark County District Attorney Leo Gallagher said people are sometimes released as soon as their case is dismissed. Involuntary commitment to mental illness requires people to be an imminent threat to themselves or others. Gallagher said that was a high bar to hit.

By the time a recognizance petition is presented to a judge after a person has been deemed unlikely to become fit to stand trial, the accused could have been imprisoned or hospitalized for months. That delay makes it difficult to prove an imminent threat, Gallagher said, and a judge is likely to deny the recognizance.

“There is a hole in the system,” he said, adding that he had filed motions knowing they would be dismissed because he could not meet the burden of proof.

Daylon Martin, a Great Falls defense attorney, said if clients whose charges were dropped due to illness are hospitalized, their discharge is often the end of their care. “People are just released back into the community with the expectation that they’ll take their medications,” Martin said. “There has to be a better transition.”

The public hospital long had a waiting list. Dr. Virginia Hill, a recently retired psychiatrist who worked at Montana State Hospital for more than 35 years, said legislators this spring that a typical stay is two to four weeks, “a short engagement in the grand scheme of things when you’ve been charged with a very serious crime”. She said a patient usually leaves the hospital with medication in hand and local appointments booked, but then the patient leaves the system.

“That’s the revolving door population we have,” Hill said. “The charges are dismissed and they leave. And they’re usually pretty sick.”

She asked legislators to consider define in state law a way to deal with determined individuals unlikely to become competent. To understand what problems exist, Hill said she would like to see more data on who the public hospital treats, whether they receive care elsewhere, and the outcomes.

Montana lawmakers drafted a proposal for next year’s legislative session aimed at strengthening treatment coordination for people discharged from psychiatric care after being convicted of a crime. Matt Kuntz, executive director of the Montana chapter of the National Alliance on Mental Illness, is happy to see the proposal, but said it does not include people whose charges were dismissed on a jurisdictional issue. .

“Sometimes people just prefer to let the status quo continue,” Kuntz said, “even though there’s something clearly not working.”

This article was taken from khn.org Courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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