Brain Injuries, Mental Health, PTSD and Substance Abuse Explain Criminal Behavior

Observations You can explain dysfunctional criminal behavior by looking at the data on traumatic brain injuries, mental health, PTSD and substance abuse. Author Leonard Adam Sipes, Jr. Retired. Thirty-five years of public relations for national and state criminal justice agencies. Interviewed multiple times by every national news outlet. Former Senior Specialist for Crime Prevention for […]

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Observations You can explain dysfunctional criminal behavior by looking at the data on traumatic brain injuries, mental health, PTSD and substance abuse. Author Leonard Adam Sipes, Jr. Retired. Thirty-five years of public relations for national and state criminal justice agencies. Interviewed multiple times by every national news outlet. Former Senior Specialist for Crime Prevention for […]

The post Brain Injuries, Mental Health, PTSD and Substance Abuse Explain Criminal Behavior appeared first on Crime in America.Net.


Judges Called ‘Last Line of Defense’ for Mentally Ill in Justice System

The lack of adequate alternatives to jail or prison to help mentally troubled individuals who run afoul of the law is a “horrible American tragedy,” judges and prosecutors from around the country were told at a New York University School of Law conference.

When police and prosecutors are unable to act, judges must be the “last line of defense” for mentally troubled individuals who run afoul of the law.

That was one of the conclusions at a conference of leading prosecutors and jurists at New York University’s School of Law examining the plight of the seriously mentally ill who are trapped in the justice system.

The use of jails and prisons as frontline treatment facilities for individuals with serious mental illness—for lack of adequate alternatives—is a “horrible American tragedy,”  Judge Steven Leifman of the Eleventh Judicial Circuit Court of Florida said.

Christina Klineman, a Superior Court Judge in Indianapolis, added that if local authorities fail to provide diversion programs that police or prosecutors can use, judges should still try to find ways of ensuring the mentally ill are kept out of jail.

They are “the last line of defense” for protecting the mentally ill, she said.

The two judges spoke during a panel Friday at NYU’s Tenth Annual Conference on the administration of criminal law. They joined other speakers, including advocates, in calling for greater attention to diversion programs for the mentally ill.

“The criminal justice system should be the last resort for the mentally ill, not the first,”  Leifman said, arguing that the lack of alternatives too often places the burden of care on prosecutors, judges and police officers, who lack the proper resources, training and funding to help mentally ill patients. 

Participants in the conference cited studies showing that 40 percent of individuals with a mental illness will come in contact with the criminal justice system at some point in their lives—usually because family members call 911, not knowing what else to do. 

Police receive 250 million calls each year, but only 25 percent of those calls are connected with an actual crime, said Rebecca Neuster of the Vera Institute of Justice. Ten percent of those calls are made because someone with a mental illness is experiencing a manic episode.

See also: Why Jail is No Place for the Mentally Troubled.

But when the police become involved, the individual is handed over to the justice system.

According to Ronal Serpas, a professor of Criminology at Loyola University of New Orleans, if police officers had an alternative to arrest, they would take it.

But all they have to offer mentally ill patients “is the back of their car,” Serpas said.

That, he added, was a solution for no one.

The police role as first responders puts them in a difficult position, but at the same time makes it critical for officers to know where to take people suffering from mental illness other than jail, said Travis Parker, senior project associate at Policy Research Associates.

“Officers need an answer to the question: ‘divert the mentally ill to what?'”

He noted that in some cities, police have been given iPads to contact mental health professionals, instead of taking troubled individuals to jail.

See also: How iPads Changed a Police Force’s Response to Mental Illness.

Once an individual with mental illness is arraigned, however, prosecutors can step in to ensure mentally ill defendants are diverted to counseling and social services, the panel was told.

“Public safety is not defined by convictions and arrests — people need to feel safe and secure, they need housing and a job—and the criminal justice system removes that for so many people,” said Vermont Attorney General T.J Donovan,  who argued prosecutors should use “restraint” in deciding whether to seek convictions.

Klineman brought up the case of a homeless man urinating in the street and raised the question, “what do I sentence him to?”

“If I put him on probation, I set him up for failure and we have more problems. If I release him, he doesn’t get any help,” Klineman said.

In Florida’s Miami-Dade County, home to the largest percentage of people with serious mental illnesses, decarcerating jails and providing an alternative for the mentally ill is a top priority for court officials.

Authorities there created the Criminal Mental Health Project to provide community-based treatment and support services to defendants suffering from serious mental illness and substance abuse disorders.

The program provides two types of services: pre-booking diversion training for law enforcement officers, and post-booking diversion to help individuals in jail and awaiting adjudication. 

Justin Volpe, a young man who suffered from paranoia and substance abuse, said he was able to avoid prison though the program. His sentence was tossed out, and instead he was offered a job by the courts.

“That’s what people need,” Volpe told the conference. “I went from having no insight of my mental illness to working with other people in same situation. I assist people in community and get them help. I also have opportunity to train law enforcement and share my recovery story.”

In fact, Volpe was able to train the police officer who first arrested him. The officer told Volpe, “I’m surprised you’re still alive.”

Volpe takes participants in the program to out to lunch, or coffee, or even to play basketball.

“People don’t need another person telling them about their court dates and doctors appointments- giving them a list of things to do,” he said. “I give them a person-to-person feel,” he said.

Laura Usher, senior manager at the National Alliance on Mental Illness, commented that Volpe’s point was critical.

“The only way to treat someone with a mental illness… is like a person,” she said. 

Megan Hadley is a reporter for The Crime Report. Readers’ comments are welcome.


Why Jail is No Place for the Mentally Troubled

For lack of alternatives, thousands of mentally ill individuals are trapped in the justice system. In a conversation with TCR, Alisa Roth, author of “Insane: America’s Criminal Treatment of Mental Illness,” says change will only happen when we reexamine our attitudes towards mental illness.

In her career as a journalist, Alisa Roth has written about people in what she calls “forgotten communities,” such as immigrants and the poor. But when she began focusing on the mentally ill trapped in the U.S. justice system, after a friend’s brother was locked up, Roth discovered what she came to realize was the most forgotten community of all.

“I can’t think of a group that’s more reviled and more misunderstood,” she told TCR. In a discussion with staff writer Isidoro Rodriguez about her new book, “Insane: America’s Criminal Treatment of Mental Illness,” Roth, a former Soros Justice Fellow, describes how jails and prisons have become the nation’s principal institutions for treating mentally troubled individuals, and suggests that strategies for developing more humane, treatment-oriented alternatives have to begin at the state and local levels.

The Crime Report: What was the catalyst for writing this book?


Courtesy Basic Books

Alisa Roth: I can’t think of a group that’s more reviled and more misunderstood than people with mental illness who are in the criminal justice system. We talk about the issue of race in the criminal justice system, we talk about the issue of poverty in the criminal justice system, but we don’t talk about mental illness. These three intersect and overlap, but we can’t think about global reform without addressing the mental health question.

As I mention in the book, I have a friend whose brother developed a severe mental illness and committed a horrible crime. As I was thinking about this whole system, it kept coming back to him. If we as a society can allow him to see an alternative outcome, and not spend the rest of his life in prison, we can allow that for other people who have done less morally or criminally complicated things.

TCR: Through the process of this book, what hurdles did you have to overcome?

AR: I chose two of the most closed systems to look into. The criminal justice system is extremely closed in terms of access, in terms of data, and in terms of information. Likewise, the mental health care system is bureaucratic and complicated. So just figuring out where treatment is being provided, and who should be providing that treatment is difficult.

Then there’s the whole health care aspect. People are not allowed to, or are unwilling to, share information about treatment. And there’s the stigma question in both systems. There is still shame attached to having a mental illness or having a family member with mental illness. We march for breast cancer or AIDS, but we don’t want to talk about mental illness and we don’t want to admit it. So, getting people to open up and say “yes, I do have this issue” or “yes, my child does have this issue and these are the struggles we are going through,” is very difficult. I am very grateful to all the people who were willing to share their stories with me.

TCR: How did dealing with this affect you, and how do you move forward after seeing what you have seen?

AR: I feel a great responsibility and duty to share these stories and spread them. I have the means to tell the world about these horrible situations, whether it’s the really awful abuses or just the day-to-day low-level abuses of being locked up with a mental illness. So, I feel privileged to share that.

Keeping that in mind was a way to mitigate the awfulness of it, but it’s traumatic reporting. I had a lot of nightmares about jail and prisons. I have a lot of friends who work in this universe, so it was great to be able to compare notes and talk about what we have seen. It is traumatizing and exhausting, but I kept thinking that I got to walk out of there at the end of the day, and I needed to take advantage of that to tell the world about how bad the problem is.

TCR: One of the subjects in your book is the practice of solitary, and you note that it is still in effect despite being considered a form of torture by the United Nations. Why do you think it is still being practiced in the U.S.?

AR: There are a lot of pieces that go into this answer. Unfortunately, we have abandoned the notion of reform and rehabilitation in our criminal justice system. We’ve moved back to the punitive notion. In some measure we think that people who are locked up in jail or prison deserve what they get. There is a dehumanizing aspect to the whole criminal justice system, and solitary confinement is part of that. If we don’t think of somebody as a full human being, then it becomes easier to do something really awful to them. If you think of this person as your brother, or our uncle, or your husband, it’s much harder to lock them in a box 23/7.

There’s also the fact that so many of us don’t know what goes on in the criminal justice system. The system as a whole is so abstract for such a large portion of our population, that we just don’t think or know about it. People have no idea that there are tens of thousands of people locked in solitary confinement on any given day. In a lot of places and for a very long time it’s just been how it’s done. It’s a very easy solution to put someone who is being unruly or difficult out of sight and out of mind. I think it speaks to a larger issue: We take people with mental illness, we lock them away, someplace we don’t need to see them. If we put them in jail or prison we don’t need to see them or step over them on our way to Starbucks in the morning. Solitary confinement is a reflection of that. But it makes everything so much worse.

Alisa Roth

Alisa Roth. Photo by Matthew Spence

TCR: Your book also criticizes the dangerous mistakes made by judges, and attorneys, who have no experience with the mentally ill. One example is your story of Jamie Wallace, a young boy suffering from mental illness and multiple physical disabilities, who eventually killed himself in prison due, in part, to a judge’s inability to understand his circumstances. How do we increase awareness and understanding of mental illness so that we may better avoid tragedies such as this?

AR: As awareness of the problem of large numbers of the mentally ill in the criminal justice system grows, judges and attorneys are more attuned to it. It’s not that people don’t know it’s there, but it’s as much as about changing attitudes as anything else. I talk to a lot of judges and I’ve said “Hey, in a lot of cases you’re being asked to make what’s effectively a medical decision and you’re not a doctor; you’re a judge. ‘

The best answer I heard, and it makes sense to me to a degree, is the judge who that’s what he does all the time. He takes the best information he can get and makes a decision based on that. So, he’s not making a medical judgement, per se; he’s taking the information that the psychiatrist, the therapist, and the attorneys give him and using that to make a decision. Jamie Wallace’s case was particularly egregious. He was so young, so sick, and had a developmental disability on top of it. I found it heartbreaking to think that the judge couldn’t see a way to understand. And the judge was playing very much by the rules.

Jamie Wallace was failed by the system at every level, over and over again. A forensic psychiatrist who read about him said he should never have been declared competent or even been standing in that courtroom. The judge made an awful decision, but he also made a mistake in letting him even be in that courtroom that day. You have to wonder how it would have been different if he had been wealthier, or his parents had been more educated, or if he had been in a different state.

TCR: Jamie Wallace’s story is an example of the mistakes that can be made as a result of the disorganized bureaucracy of the criminal justice system. At a time when so many are pushing for better training within that system to fix the problem, and others are fighting to keep the mentally ill out of that system entirely, which do you feel is the better option?

AR: In an ideal world, we would be able to keep everybody with a serious mental illness out of the criminal justice system. In an ideal world, we’d be able to keep a lot of people without a mental illness out of the criminal justice system. We lock up a lot of people very easily. I think that diversion is absolutely critical, but in order to make wide scale diversion possible, we can’t just look at this little tiny piece of the problem. We have to remember that we are operating in a very large ecosystem, not just of criminal justice but also of mental healthcare. We need to see wide-scale reform of both these systems so that people aren’t getting to the point where they’re so sick.

You see people in jail and prison who are sicker than a lot of people you see in psychiatric hospitals. We need to be catching the diseases earlier and treating them earlier. It’s great to train the cops to not arrest people, but if you don’t have some place for the cops to take them that’s not jail, they’re still going to wind up in jail. That’s what happened in San Antonio when they created their crisis center system. [They realized] you can train cops as much as you want, but they’re still going to take people to jail if there’s no other option. The other part of it is, as long as we are going to have people that end up in the criminal justice system, we have to make sure that when they’re there, they’re getting the treatment that they need and not just being warehoused in prisons.

TCR:A popular talking point now is de-institutionalization, starting when the majority of state-run mental health hospitals were closed during the 1960s. However, your book insists that there were other, more important, causes for the problem. Can you expand on that?

AR: De-institutionalization is a fabulous talking point. It has this very neat narrative: Dorothy Dix found people locked up in jail; realized this was not the place for them; they weren’t getting the treatment they needed; wardens were saying they couldn’t handle this; she pushed for the creation of the asylum system; everything was great until it all went to hell and we had to open up the doors and let everyone out. Then, without treatment, people were ending up in the criminal justice system. And it has a very neat solution: if this is how we got there, then all we have to do is treat the mental illness and we’ll get people out of the criminal justice system.

Unfortunately, it’s way more complicated than that. Even when you look at the heyday of institutionalization, during the middle of the last century, there were a lot of people in institutions, but it was not the majority. There were still a lot of people living at home or elsewhere, or getting treatment in the community. The population in institutions tended to be older, white, female, and very heavy on people with a diagnosis of schizophrenia. The people now locked in the criminal justice system are overwhelmingly young, male, and not white.

I think we also have to look at the story of mass incarceration. We’ve started locking up way more people than we ever did…and when you cast such a big net, of course you’re going to pull in a lot of people with mental illness. When you break it down even further and look at co-occurring substance use disorders, a very large majority of people with mental illness in the criminal justice system have a co-occurring substance use disorder. So, if we’re arresting tons of people for drug possession, drug use, drug selling, drug dealing, it makes perfect sense that we’ll pick up people with mental illness.

Using policing tactics such as “broken windows” and “stop and frisk,” allowed us to lock up huge amounts of people [and] made it easier to arrest people with mental illness. I think that the story of mental illness in the criminal justice system is as much a story of mass incarceration as it is of de-institutionalization. The one piece of the story that is important, even if we don’t quite tell it right, is that we do have a severe lack of mental health care in the community and we have made it extremely difficult to get treatment for mental illness. But it’s not that everybody was getting treatment in a hospital and now they can’t get it, we just don’t have that and we’ve never had it.

TCR: How can we get people to start viewing mental illness seriously?

AR: I think we’re starting to move in that direction, very slowly. We’re seeing more people acknowledging an issue with depression or anxiety. We’re still not seeing a lot of actors come up at the Oscars and mention that they have schizophrenia, but I think it’s becoming more socially acceptable to talk about these things. We know that people can change, and society can change. There was a time that people didn’t talk about HIV or cancer, and now we wave flags for it. We need to get over the fear and stigma [attached to] mental illness in our society. The narrative in the media and in politics that links mental illness and violence is very damaging. And it’s hard to get over that stigma when every time something bad happens somebody is out there pointing a finger at mental illness.

TCR: Are tools such as Crisis Intervention Teams (CIT), deescalation and community policing having a positive effect on the problem?

AR: Like so many things in criminal justice, there is not a ton of data or evidence-based research to show one way or another. The data in places such as Miami or San Antonio show that these things work. Miami says that it’s cut the number of officer-involved shootings. In San Antonio, the system has prevented them from expanding the jail. People who study policing say that CIT is just good policing—-going back to the kind of policing we had before “professionalized” law enforcement. It was the cop walking the beat who knew the people in the community. There’s no reason to run into every situation like it’s a battleground. Police officers always talk about how they see people on the worst day of their lives. That narrative is used sometimes as a reason why you need to be on your guard. But I’ve also heard it used as a reason to be gentle, kind, and thoughtful because they’re there to help.

Getting police to respond in a more thoughtful, more community/medically oriented way, instead of the tough, warrior way, is terrific. The big caveat is that if you don’t have the whole system set up to accommodate this it can only get you so far. You might deescalate a particular situation, but if you don’t have any longer-term solutions, you’re going to be back picking up the same person with no place to go. Often communities think CIT will be a step to solving the problem, but you have to think about how you’re going to divert, what’s the mental health treatment going to be, and how do we make sure we’re not picking people up again next week or next month.

TCR: Does change need to start at a federal level?  And do you see potential for change under the current administration?

AR: The thing about criminal justice is that so much of it happens on such a local level that, on the flip side, a lot of reform can also happen on a local level. If I’m in Manhattan, and get arrested, it could potentially be a different outcome then if I’m in the Bronx or New Jersey. Because it’s so local, I think the federal question is almost irrelevant. Even the laws of involuntary commitment are handled at a local level.  I think with a lot of laws, particularly with HIPAA (the Health Insurance Portability and Accountability Act) and involuntary commitment, it really comes down to a very narrow line of navigating between civil liberties and safety for the person and the public.

We obviously don’t want to go back to the time when somebody could have a child committed to a hospital for not being religious enough or dating the wrong person.  On the other hand, I think we’ve made it so difficult to get somebody hospitalized that we’re in this perpetual crisis management mode.  The way it’s set up now is that you really have to be at a crisis point in order to make involuntary commitment possible.  Likewise, with HIPAA, I don’t want my business broadcast all over the place.  On the other hand, the very nature of mental illness means that the person is not, necessarily, capable of making decisions for himself, or even providing the information that the doctors need.  I’ve heard families talk about managing to get their adult child hospitalized, but then not being able to convince the doctor to talk to them about what has or hasn’t worked in the past.  As with any other illness, the more information the clinician has, the better they can treat the problem.

Isidoro Rodririguez

HIPAA is also widely misunderstood. It’s used as an excuse for stonewalling families and other people trying to get information.  I think the more important question, is how do we figure out how to loosen these laws a little bit to make things easier and more effective without throwing all the civil liberties out with it.  As for the current administration, I think this is a big wildcard.  It doesn’t seem to be a big priority except on those occasions when something awful happens and suddenly there’s talk of bringing back asylums and more mental health care.  Between seeing real change at a local level or at a federal level, I have a little bit of hope that at the local level there is potential for reform.

Isidoro Rodriguez, a staff writer for The Crime Report, covers policing and mental health issues. He welcomes comments from readers.


Most Attackers in Mass Violence Showed Red Flags

A new report from the Secret Service National Threat Assessment Center says that most mass attacks in public spaces are preceded by behavior that worried other people. “There’s no such thing as an impulsive act,” says one expert.

The attacks sound numbingly familiar: five shot to death at an airport in Florida, 26 slain at a Texas church, five killed by a gunman rampaging through Northern California. These violent outbursts last year, and others like them, had key things in common. Long before the violence, the people identified as attackers had elicited concerns, red flags that littered their paths to wreaking havoc on unsuspecting strangers. This is a common thread in most of the mass attacks in public spaces last year, the majority of which were preceded by behavior that worried other people, says a new study from the U.S. Secret Service National Threat Assessment Center, reports the Washington Post.

“Regardless of whether these attacks were acts of workplace violence, domestic violence, school-based violence or terrorism, similar themes were observed in the backgrounds of the perpetrators,” the report stated. Every person blamed for a mass attack was a man. All of them “had at least one significant stressor within the last five years, and over half had indications of financial instability in that time frame,” the report found. That included issues with family relationships, being fired or suspended from work and facing unstable living situations. More than half had histories of mental health issues, criminal charges and substance abuse. Nearly half were fueled by some kind of personal grievance. Half of the attackers had patterns of making threats, while a third made specific threats to their eventual targets. “Direct threats should be investigated, because a threat unchecked could escalate into an act of violence,” said Matthew Doherty, who formerly led the National Threat Assessment Center. Doherty, now at Hillard Heintze, a law enforcement and security advisory firm, said, “There’s no such thing as an impulsive act.”


Prison Deaths Pile Up in South Carolina: Does Anybody Care?

Last year was the deadliest year in the history of the state’s prison system, but a spike in suicides this year may top even that. Authorities blame rising violence inside the prisons. A writer for Charleston’s Post and Courier also points to inadequate mental health care for inmates—and a troubling lack of attention from officialdom.

The South Carolina Department of Corrections website is a wealth of information. You can track the inmate population over almost a half century. It slices and dices the data in dozens of ways: by gender, race, age, marital status, type of crime and length of sentence.

You can see the number of people on death row, the escapes, and the mentally ill.

But what the state does not want you to know is that 2017 may have been the deadliest year in the history of the prison system. And this year, so far, is even worse — including a dramatic spike in suicides.

Eighteen people died in state prisons last year — 12 of them murdered by other inmates and six by suicide, according to the Department of Corrections. It took a Freedom of Information Act filing by me to pry these basic numbers out of the prison system and compare them with previous years.

That shouldn’t have been necessary.

No previous year came close, the data the prison system finally coughed up show. The body count has risen four years in a row. The record in 2017 exceeded the record in 2016, when five inmates were murdered and six committed suicide. In 2009, there were two deaths total.

Keep in mind the prison population has fallen every year since 2010 as the state has diverted low-level offenders from the system, a good thing. But the rising death toll has been driven by a desperate shortage of correctional officers — one in four jobs are vacant — and by the power of the gangs, who increasingly run the prisons.

Mental health care remains woefully inadequate.

The corrections department blames the rising violence on contraband cellphones “and the illegal activity conducted with them.” South Carolina is pushing the Federal Communications Commission to allow the state to become the first in the nation to use cellphone jamming technology.

The last two years saw an explosion in inmate-on-inmate assaults. Put simply, anyone who can has a knife. There were 250 assaults that required taking inmates to outside hospitals in 2016 and 2017. That was more than double the previous two years. Attacks on correctional officers also spiked.

Overall, deaths and serious assaults are running at a record pace this year. In the first two months, there were two murders and a shocking four suicides. There were six suicides in the three months from December through February. That compares with six suicides in each of the last two years. This mirrors a rise in prison suicides nationally, suggesting this is less a bad patch and more a deadly trend.

And this does not even include what is going on in the county jails, which typically house about 12,000 inmates compared with 20,000 in the state prisons.

In 2016, the Department of Corrections settled a decade-old class-action suit that committed the state to upgrade mental health treatment. In a ruling, South Carolina Judge Michael Baxley wrote that the state’s care of mentally ill inmates amounted to cruel and unusual punishment.

“Evidence in this case has proved that inmates have died in the S.C. Department of Corrections for lack of basic mental health care,” Baxley said.

Gloria Prevost, executive director of South Carolina’s Protection & Advocacy, which brought the lawsuit, said the violence continues because of inadequate security and medical staff.

“Understaffing of security staff significantly impacts the mental health programs, causing increased lockdown time and lack of access to programs,” she said.

Without more funding for staff, “the problems will not diminish,” Prevost added.

There were three suicides alone in January. One of those was Travis Marshall Steffey, convicted of distribution of methamphetamines in Aiken, S.C.

Travis Steffey

Travis Steffey. Photo courtesy The Post and Courier

Steffey was kicked out of two Georgia high schools and had a series of minor scrapes with the law for things like petty larceny, public drunkenness and assault and battery. Then in the spring of 2015, at the age of 19, he was busted for dealing drugs.

In years of Facebook posts, Steffey is a profane, angry gangster-wannabe. He likes Confederate flags and doesn’t like cops or snitches. But by December 2015, facing real prison time, Steffey’s posts were changing:

“#GOD #Sobriety #Happiness #FAT #Leader #Positive Many more hashtags of new me,” he wrote five days before Christmas.

And later the same day:

Pray pray pray things will make changes not fast but they do — and it feels good to spend a lot of money on stuff I want besides dope it was a waste when I did that … love y’all goodnight and God bless u all who are in need and even the ones that ain’t.

It was too late.

That May, at the age of 20, Steffey was incarcerated in Columbia; his projected release date was June 2019. He never made it.

Twenty-one months after going in, Steffey killed himself at Kirkland Correctional, a maximum security prison, by swallowing paper clips, according to Richland County Coroner Gary Watts. It would not have been an easy death, Watts said.

Steffey was 22.

The question, of course: Does anyone care?

The state prisons are filled with poor, uneducated men — 93 percent are male — and there are no Boy Scouts in there. Sixty-one percent are black, twice the statewide population. The average inmate has a 10th-grade education; 17 percent are considered mentally ill. And if the tepid reaction to my previous prison columns is any measure, nobody cares.

We don’t care at our peril.

As Bryan Stirling, the state’s prison director, likes to say, we should care because more than 85 percent of current inmates will be back in our communities in less than five years. These people aren’t going away.

This article was published earlier in the Charleston (SC) Post and Courier, and reproduced with permission. Steve Bailey writes regularly for the Post and Courier’s Commentary page. He can be reached at Follow @sjbailey1060. He welcomes comments from readers.


Can Better Health Care Help Ex-Inmates Avoid Returning to Jail?

Giving former inmates better health care through Medcaid and other coverage can “enhance public safety, reduce recidivism, and more efficiently use public resources,” says a new guide from the Urban Institute and the law and consulting firm Manatt, Phelps & Phillips.

Returning inmates need cooordinated and effective health care coverage to escape the “revolving door” that cycles many of them back to jail or prison, according to a policy guide released Friday by the Urban Institute.

The guide, prepared by the Urban Institute and the law and consulting firm Manatt, Phelps & Phillips, is aimed at helping justice-involved individuals enroll efficiently in Medicaid and other health coverage to obtain “coordinated physical and behavioral health care.”

Currently, the “revolving door” between incarceration and the community leaves many people alternating between correctional and community-based providers, the guide said.

Better-coordinated health coverage will “enhance public safety, reduce recidivism, and more efficiently use public resources,” wrote the authors of the guide.

If states can improve health care for released inmates, they “will be in a stronger position to address (the) substance abuse issues, chronic physical and mental illness, unemployment and employment instability, and homelessness that result in many justice-involved people cycling in and out of jail or the hospital,” the authors wrote.

Maintaining health coverage is a common problem for released prisoners.

Prison inmates have four times the rate of active tuberculosis found in the general population, nine to ten times the rate of Hepatitis C, eight to nine times the rate of human immunodeficiency virus (HIV) infection, three times times the rate of serious mental illness, and four times the rate of substance abuse disorders, the guide said.

Jail populations have similar high levels. Many inmates fail to get needed care, and when they are released, they often face disruptions in medical care that contribute to recidivism, drug use, and poor and costly health outcomes. One study found a 12-fold increase in the risk of death in the two weeks after release.

Another study of people returning from prison in Ohio and Texas found that, within 10 months of release, a fifth had been hospitalized, and a third had sought care in emergency rooms.

The project, supported by the U.S. Justice Department, is called the “Connecting Criminal Justice to Health Care Initiative” (CCJH), and was developed by corrections and health care officials in Maryland and Los Angeles County, Ca.

Ted Gest is president of Criminal Justice Journalists and Washington bureau chief of The Crime Report. Readers’ comments are welcome.


NYC Nanny Murder Trial Tests Insanity Defense

Yoselyn Ortega fatally stabbed two young children in her care in 2012. Will the rarely successful insanity defense help her avoid a conviction? The defense worked in New York murder cases only a half-dozen times in a decade.

As the grisly murder trial of a former nanny unfolds in a New York City courtroom, the prosecution and defense agree that in 2012, Yoselyn Ortega fatally stabbed two young children in her care. The fate of the 55-year-old ex-nanny rests on whether the jury believes her insanity defense—one of the most controversial, misunderstood concepts in criminal law, the Wall Street Journal reports. “To put it in lay terms, you would have to either not know what you were doing or not know that it was wrong,” said Charles Ewing, who wrote the book “Insanity: Murder, Madness and the Law,” referring to New York law. “That’s a really hard sell under any circumstances.” Valerie Van Leer-Greenberg, Ortega’s attorney, says “the lack of motive in this case is the hallmark of a mentally-ill offender.” The insanity defense is rarely used and even more rarely succeeds. In New York state, of 5,000 murder cases resolved from 2007 to 2016, six defendants were found not guilty by reason of insanity, says the state’s Division of Criminal Justice Services.

Prosecutors say Ortega was aware of her actions when she committed the acts. Ewing, a professor at University of Buffalo’s School of Law, says an insanity defense trial turns into a battle of the experts, with psychologists offering differing assessments of a defendant’s mental state. Most jurors are loath to agree with the insanity defense. Law Prof. Peter Arenella of the University of Southern California in Los Angeles says, “Their attitude is, ‘A lot of these killers are going to have mental illness, but we can’t acquit all of them.’ ”  Van Leer-Greenberg is expected to call on experts to testify that Ortega’s behavior before the killings resembled that of a mentally-ill person. Prosecutors said Ortega killed the children because of conflicts with their mother about workload issues.


Why Was Mentally Ill MA Killer on the Streets?

Little has been disclosed about whether Jeffrey Yao gave signs that his apparent mental illness was worsening before he used a kitchen knife to kill Deane Kenny Stryker, 22. Should he have been committed to a psychiatric hospital?

When a young man well-known to police and neighbors for bizarre and scary behavior suddenly stabbed a former schoolmate to death in Winchester, Ma., last month, many people asked why someone so seemingly dangerous was allowed to roam freely. It’s a natural question that has no easy answer, the Boston Globe reports. Little has been disclosed about whether Jeffrey Yao gave any signs that his apparent mental illness was worsening in the months before he used a kitchen knife to kill Deane Kenny Stryker, 22. Should he have been committed to a psychiatric hospital before it came to that? It’s possible that he had been.

It’s not now known what actions were taken after the five occasions between March 2013 and last September when police took him to a hospital. The behavior by the 23-year-old Yao that drew police attention included property damage, an attempted break-in, threats of suicide, yelling, and staring. Strange and annoying behavior doesn’t rise to the level of justifying involuntary commitment, said Paul Zeizel, a forensic psychologist who evaluates criminal defendants. “It’s really hard to say, ‘This guy’s going to be really dangerous in three months.’ We don’t know,” he said. The most dangerous people are those who have paranoid hallucinations in which they are commanded to take actions, especially if they also abuse drugs, Zeizel said. Patients never suddenly “snap,” he said, but their heightening paranoia may not always be evident to those around them. Mental health professionals say the focus on hospitalization misses the more relevant question: What care did Yao and his parents receive at home? Massachusetts is among a handful of states without a provision for mandating outpatient treatment, a possible solution for people who cycle in and out of hospitals and don’t follow their treatment plans.


How iPads Changed One Police Force’s Response to the Mentally Ill

A pilot project launched by the Harris County Sheriff’s Office in Texas uses “telepsychiatry” software to give police who encounter mentally troubled individuals an alternative to incarceration.

Some sheriff’s deputies in Houston have been using a new tool to respond to calls that involve mentally ill individuals.

An iPad.

In December 2017, the Harris County Sheriff’s Office in Houston, Tx., began equipping deputies with iPads as part of a pilot program aimed at developing new forms of intervention for mentally ill individuals who become involved with law enforcement.

The first phase of the program, involving three deputies, has now been completed, and participants say it’s a success.

“We wanted to make sure the technology works, the software works, and the concept works, and it worked perfectly,” Dr. Avrim Fishkind, CEO of JSA Health Telepsychiatry ,and one of the pilot program’s partners, told The Crime Report.

JSA Health provided the psychiatrists for the program, while Cloud 9, an Austin-based tech company, developed the software, named Cloud911.

Under the program, when deputies equipped with tablets arrive on the scene of a mental health emergency, the person in crisis is offered the option of talking to a psychiatrist through the Cloud 911 app on the deputies’ iPads.

These sessions are called “telepsychiatry appointments,” and they typically last 20 minutes.


A patient uses an iPad for a “telepsychiatry appointment.” Photo courtesy Harris County Sheriff’s Office

By the end of the session, the clinician makes a recommendation. Medication may be prescribed on the spot and picked up by a first responder if deemed necessary. Sometimes, no meds are necessary and a situation is deescalated enough for police to leave the scene.

If the clinician or first responder finds it necessary to take the distressed individual to a psychiatric hospital because de-escalation failed, the Cloud911 app can locate a facility with an available bed. This cuts down on time as officers no longer need to find out which hospital has availability.

The program’s organizers say this enables police to get back to their beat faster, and enables individuals experiencing mental health episodes to avoid arrest.

“One thing we learned very quickly is that people adapt to the technology very fast, the officers and patients,” Dr. Fishkind said. “I’ve done interviews with the patient lying on the ground who held the iPad and talked to me like it was nothing.

“So one of the best parts is the adoption of the technology is nearly 100 percent. We’ve had almost no refusals during the pilot.”

Frank Webb, Harris County’s Mental Health and Jail Diversion Bureau Manager, admitted the program faced initial skepticism among some mental health professionals.

“We did have some who said, ‘oh you know, if you have someone who’s psychotic, they’re not going to use it because they’re going to be freaked out by it,’ and that was not the case at all,” he told The Crime Report.

Dr. Fishkind provided one example of the interactions he witnessed during the course of the pilot program, between officers and a mother whose adolescent daughter was depressed and suicidal.

“She had tried to get in to see a psychiatrist but was told it would be a couple weeks, and here she is in her house talking to a psychiatrist because the deputy had the iPad and she could direct access him right there in her house,” he recalled.

According to statistics provided by Cloud 9, “10 percent of 911 calls are mental health crises, which ought to be handled by clinicians, freeing up police and avoiding tragedies. Fifty percent of jail inmates have mental illness, making jails the largest mental health facilities in the U.S. The cost of incarcerating mentally ill citizens is five times what community health treatment would cost, and this costs emergency rooms and jails annually $2.1 billion.”

Dr. Fishkind noted that the money saved by diverting mentally troubled individuals from jail had helped sell it to county officials concerned about the strains on their budget.

According to Webb, additional money might be forthcoming from the county and even other sources “because they see the value” of the program.

The county’s Center for Mental Health, along with Intellectual Disabilities and Autism Services, the Local Mental Health Authority, together have applied for a grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), under its Law Enforcement and Behavioral Health program. The community health organization would provide additional funds for phase two, Webb said, but he added “we’re going to do phase 2 regardless.”

The next phase, expected to last six months, would provide tablets for 25 deputies.

John Ramsey is a TCR news intern. Readers’ comments are welcome.


Bring Back Asylums to Prevent Shootings? Not So Fast

After the school shootings in Parkland, Fl., President Trump has called for building or reopening mental institutions. He has echoed an argument made by some experts who study the mental health care system. It’s not that they believe that having more institutions would prevent spree killings. The majority of these murderers appear to be angry, antisocial individuals with access to guns whom the mental health system probably could not have spotted in advance.

After the school shootings in Parkland, Fl., President Trump has called repeatedly for building or reopening mental institutions. He has echoed an argument made by some experts who study the mental health care system. It’s not that they believe that having more institutions would prevent spree killings, as Trump apparently does. The majority of these murderers appear to be angry, antisocial individuals with access to guns whom the mental health system probably could not have spotted in advance. The proposal to bring back asylums is very much alive for other reasons among some policy experts, psychiatrists and bioethicists, the New York Times reports.

A modern incarnation of asylums does not impress advocates for people with mental disabilities, who want the idea dead and buried, along with transorbital lobotomy, insulin-shock therapy and other cruelties visited on people with mental disorders in times past. The intensity of the debate provides a guide to the maze of the mental health care system. “When people are going back and forth from prisons to hospitals, that’s a sign they might have benefited from longer-term treatment options,” said Dominic Sisti, a medical ethicist at the University of Pennsylvania School of Medicine and co-author of a 2015 paper subtitled “Bring Back the Asylum” in the journal JAMA. “For this really seriously mentally ill population, our resources have dried up, and I find that to be an ethical social-justice violation.” Jennifer Mathis of the Bazelon Center, which litigates for people with mental disabilities, called the idea offensive. “It took a lot of effort to move away from the practice of warehousing people,” she said. “Locking people up long-term is no treatment at all. The idea that we could be going back to those days — we did this before, and it failed and failed badly — it’s crazy and discriminating.”