How Neuroscience is Reforming Criminal Justice

New research into how the brain works is contributing to innovative strategies for reducing recidivism and developing alternatives to incarceration.

In the courtroom, testimony or evidence about abnormalities or damage to a defendant’s brain has been used to assess the level of responsibility for criminal behavior. But new research into how the brain works is contributing to innovative strategies for reducing recidivism and developing alternatives to incarceration.

The Mind Research Network, a non-profit based in Albuquerque, N.M., has been on the forefront of discovering how the brains of psychopaths and violent offenders differ from the average person’s.

Psychopaths make up a substantial part of prison population and are 20 to 25 times more likely to be in prison than non-psychopaths.

Dr. Kent Kiehl, a lead researcher for the network, says the research can help target appropriate treatment for example, for youths who have demonstrated violent behavioral  traits.

“This will improve our ability to predict which kids are high-risk, and how to individually tailor treatment to help kids change,” he told The Crime Report.

Using a portable MRI machine, Kiehl and his team studied and scanned the brains of roughly 4,000 violent juvenile and adults offenders from 10 prisons in two states over the last decade. The process yielded the largest neuroscientific database of violent offenders in the world.

One focus of the research was to examine the differences in the brains of juveniles who have committed homicides and juveniles who haven’t.

“Scanning is the easy part,” said Kiehl about the intensive process that goes into examining each inmate he studies.

In addition to scanning, Kiehl and his team conducted intensive clinical interviewing which examined IQ, past trauma and socioeconomic history, as well as personality.

Kiehl and the Mind Research Network have partnered with the Today=Tomorrow Program at Mendota Juvenile Treatment Center (MJTC).  in Madison, Wi., a cognitive behavioral treatment program that tries to help juvenile offenders with psychopathic traits, according to its website,  by educating “youth of the connection between their thoughts, attitudes, and emotions to their behaviors; to identify ‘thinking barriers’ and substitute responsible thinking, and to increase pro-social thinking and skills through modeling and role-play practices.”

The Today=Tomorrow Program at the MJTC has garnered some attention in recent years and has been covered in-depth by several outlets like NPR and The Atlantic.

Similarly, a study by the Douglas County Juvenile Department in Wisconsin found an 85 percent decrease in recidivism after one year among 48 subjects who went through the program, and a 94 percent decrease in recidivism after two years with a smaller sample size of 12 subjects.

The program is not likely to make these troubled juveniles into model citizens, but it tries to teach them a practical form of empathy that can help them avoid the impulse to commit violent or criminal acts.

Kiehl has been scanning subjects in the program three times during the process of treatment to understand mechanisms of change in those who don’t come back for repeat offenses.

Research like Kiehl’s is helping neuroscientists map out which brain regions should be targeted for treatment that will translate to improved behavioral and life outcomes.

This approach has been likened to working on a muscle that has atrophied from not being used.

“That’s the holy grail, to show which therapies and treatments adjust and help these circuits adapt,” Kiehl said.  “What is the brain mechanism of change, and is it sustainable?

“That’s what we’re working on now.  And if we figure that out we can get carefully derived measure of treatment efficacy.”

The concept of brain age and maturity is at the heart of Kiehl’s work with juveniles and psychopaths. Neuroscience can be a way to help determine how mature a person’s brain is more accurately than their numerical age.

Kiehl says that this is the essence of neuro-prediction.

“If you can measure the brain components that predict something rather than a proxy, like impulsivity, that circuit will indicate someone’s future impulsive behavior better than self-reports or other ways of measurements,” he said.

“Brain age is a better predictor if you re-offended than your date of birth.”

Drawing conclusions about people’s behavior based on brain imaging presents challenges and pitfalls for neuroscientists.

One danger involves a term called reverse inference, which can amount to researchers overestimating how much a certain area of the brain is involved or responsible for determining a specific behavior or cognitive process.

Kiehl argues that having strong data that can allow for good predictive power helps lessen the need for interpretation, and therefore creates the possibility of errors that stem from things like reverse inference.

Scientists may disagree about the exact function and role of the amygdala, for example, which has been linked to fear and aggression. But, according to Kiehl, “an amygdala deficit is an amygdala deficit.  We can academically argue about the interpretation, but what’s really important is the data.”

Other than the obvious benefit of reducing future violent acts and the damage that ripples from them, the kind of treatment offered at the MJTC can ultimately be much cheaper than it is to incarcerate people in the long run if reoffending can be reliably reduced.

A 2006 study in the Journal of Research on Crime and Delinquency found, “Over the 4.5 year follow–up, the return on the investment in the MJTC amounted to over 700 percent.”

Dr. Daniel Martell, a forensic expert at Park Dietz & Associates, and assistant clinical professor at the David Geffen School of Medicine at U.C.L.A., says that even though neuroscience is starting to tackle problems that were once thought to be unsolvable, like how psychopathy can be effectively treated, it has a long way to go before it’s ready for widespread implementation.

“We get great findings, but the problem is getting researchers to actually replicate those findings,” said Martell.

“We don’t really even have first generation studies to be replicated, so that’s where people like Kiehl are contributing.”

Martell went on to say that in terms of overall progress, “we’re still crawling.”

Dr. Francis Shen, an associate professor of law at the University of Minnesota who specializes in what’s called neurolaw, thinks that neuroscience will need to work in tandem with other developing sciences, such as genetics and psychology, in order to make the most valuable contributions to law and other fields.

Shen notes that neuroscience presently doesn’t show a lot of new ways to successfully alter the brain, and it is currently best thought of as a tool to aid in behavioral interventions, not only for juveniles but in other areas of law as well, such as poverty.

Shen used the example of poverty law to describe how neuroscience can make contributions to data we already have from other disciplines about the effects poverty has on people.

“We are starting to open the black box,” Shen said in an interview with The Crime Report. “We don’t need neuroscience to tell us that poverty’s bad, but neuroscience will let us understand the mechanisms allow for earlier and more targeted interventions and reframe discussion for policies.”

As mentioned above, neuroscience offers opportunities to extrapolate brain data and make claims about human behavior that aren’t justified.

However, Shen and Kiehl have both pointed out that neuroscience, as well as other human sciences, usually make predictions based on a spectrum.

Neuroscience deals in probabilities, and tries to predict the likelihood someone will behave a certain way.

Someone who is diagnosed as highly psychopathic may never actually commit a violent crime, although the probability they will is higher compared to the average person.

While one should always be wary of both the past mistakes that have been made in the name of brain science, and the obstacles that lie ahead, the work mentioned by Kiehl and others is trying to up-end the determinism that many fear results from a neuroscientific perspective of behavior.

Dane Stallone is a TCR news intern. He welcomes comments from readers.

from https://thecrimereport.org

Restoring Mental Competency: Who Really Benefits?

Today, states spend hundreds of millions on evaluating and restoring the “mental competency” of individuals to stand trial. But such restoration is a far cry from the comprehensive mental health treatment needed by defendants who many experts say should never have been incarcerated in the first place.

When Morgan learned that her son Tyler had been taken to the hospital after being accused of stealing someone else’s hamburger in a buffet line in January 2017, she had no idea that the incident would spark a 17-month-long entanglement with the local justice system.

The police officers who responded to calls about the buffet disturbance had found Tyler, who has a history of mental health issues and has been diagnosed with bipolar disorder with psychotic features, “acting strange and irrational,” and had called an ambulance to take him to a hospital. Though Tyler had gone voluntarily, he had struggled with an Emergency Medical Technician (EMT) on the ride over who he claimed had tried to give him a shot of antipsychotic medication.

He remained at the hospital emergency room less than 24 hours and was discharged early the next morning.

In March, Tyler received a felony summons for assaulting the EMT officer. He was ordered to appear in court but was never detained, “so he obviously was not a public safety risk,” Morgan said.

At some point late that summer, over eight months after the original incident, a request came that Tyler be evaluated for competency, and Morgan and Tyler (whose real names and geographical location have been withheld to protect their anonymity) heard the words “competency restoration” for the first time.

The Fifth Amendment right to due process has been interpreted to mean that in order for cases to progress, defendants must be competent to stand trial. That is, they must be capable of understanding the nature and the consequences of the charges brought against them and must be able to assist in their defenses.

As the number of mentally ill individuals enmeshed in the criminal justice system grows, more and more defendants are being found incompetent. (Note that competency is different from pleading innocent by reason of insanity, as the former refers to a defendant’s mental state at trial, while the latter refers to a defendant’s mental state when the crime was committed.)

In such cases, the court is required to “restore” the defendant to competency before the trial can proceed.

Competency concerns can be raised by any court actor, judge, prosecutor, or defense attorney, at any stage of a hearing. Though a state-appointed physician assesses the defendant and provides a recommendation, a judge makes the ultimate determination of whether someone is competent to stand trial or not.

Once a court orders that a defendant be evaluated for competency or that an incompetent person go through restoration, that individual typically remains in jail until those services are provided.

Competency is a legal term, not a medical one, and competency restoration is not the same as mental health treatment. Restoration’s primary goal is to coach defendants to get through a trial, teaching them about the roles of different court actors, the meaning of various charges, and the potential penalties they will face if convicted.

“Unless they’re from a foreign country, once they’re stable [defendants] can pretty much figure it out,” said Judge Steve Leifman, an associate administrative judge for the Eleventh Judicial Circuit Court of Florida and the creator of the Criminal Mental Health Project, a program that diverts people with mental illnesses who have committed low-level offenses from incarceration to community-based care.

Competency and Not-So-Speedy Trials

Though the Sixth Amendment guarantees defendants’ right to a speedy trial, that right often exists in name only in competency cases.

The speedy trial statute is meant to prevent the prosecution from engaging in careless or intentional delay that prejudices the defense. But because postponements due to competency issues are outside the prosecutor’s control, they do not count as speedy trial delays.

Mentally ill defendants, therefore, can sometimes languish indefinitely while they wait to be deemed competent.

In the past, competency was rarely an issue in courtrooms. For much of the 20th century, mentally ill people were isolated from society, siloed in the kinds of psychiatric institutions that inspired works such as One Flew Over the Cuckoo’s Nest and Shutter Island.

At their height, public psychiatric hospitals housed over 558,000 people, 0.3 percent of the nation’s population at the time. This proportion would translate to over 1.1 million individuals in today’s population, a far cry from the approximately 35,000 individuals with serious mental illness remaining in state hospitals, according to the Treatment Advocacy Center.

In the 1950s and 1960s, several abuse scandals and a movement that advocated treating individuals in their home communities set in motion a wave of de-institutionalization. Hospitals around the country rapidly emptied of patients and shuttered their doors.

But while many people lauded the closing of asylums and other psychiatric institutions, no real alternative sprang up to cater to the populations they had served.

Today, there are very few inpatient and long-term care beds available, even for those who could benefit from more intensive care. Mental health professionals put the ideal number of state hospital beds at about 50 per 100,000 people. In most of the states where data is available, there are roughly 10 to 12 beds per 100,000, Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania, told NPR’s Jeremy Hobson.

“They’ve basically evaporated over the past 50 years in their capacity to take care of people on an inpatient basis for more than 72 hours,” Sisti said. “The community care movement has been successful in many contexts, but there is a population that still requires significant structured inpatient care. And this population doesn’t often get it.”

As hospitals closed without a concurrent investment in other forms of mental health treatment, mentally ill individuals began ending up on the streets and in trouble with the law.

“Many times, individuals who require intense psychiatric care find themselves homeless or in prison,” said Sisti.

“Much of our mental health care for individuals with serious mental illness has been shifted to correctional facilities.”

Released from Hospital Over Parent’s Objections

Tyler experienced for himself the lack of appropriate care available in the years leading up to his arrest. Morgan and her husband had Tyler involuntarily committed in 2010 and again in 2017 after he exhibited psychotic behavior and threatened to harm himself. Within days of his second commitment, hospital staff announced that his condition had stabilized and released him, despite Morgan’s pleas for longer treatment.

“He was physically shaking,” she said. “The drugs [Tyler had been medicated while hospitalized] were not agreeing with him.”

“I was frantic and got him in to a therapist, and the therapist on my request got him in to a psychiatrist right away, and he was hospitalized again within days.”

It was shortly after this third commitment that Tyler received the felony summons, which Morgan said “totally destabilized him.”

Approximately 20 percent of inmates in jails and 15 percent of inmates in state prisons have a serious mental illness, the Treatment Advocacy Center estimates. Based on the total number of inmates in this country, this means that there are roughly 356,000 inmates with serious mental illness in jails and state prisons nationwide.

Each of these inmates is held at an average annual cost of $33,274, according to the Vera Institute for Justice, if not more: the average cost of incarcerating a mentally ill individual is often much higher than the cost of housing a typical inmate.

Today, states collectively spend hundreds of millions on restoration for individuals that many experts say should never have been incarcerated in the first place. In Florida, for instance, the Tampa Bay Times found that the state government spends at least $50 million annually restoring the competency of defendants whose nonviolent crimes are so minor they never spend a day in prison.

Part of the issue is backlog. With the dearth of hospital beds, defendants who have been judged incompetent can wait months or even years for restoration, despite their being relatively few in number.

In 2014, the National Association of State Mental Health Program Directors (NASMHPD) conducted a survey on the forensic mental health services provided around the country.

Asked for an average daily census of inpatients who are incompetent to stand trial (IST), the 32 states that answered responded as followed: eight states reported a daily average of zero to 25 IST inpatients; seven states reported 26 to 75; nine states reported 76 to 150; three states reported 151 to 250; three states reported 251 to 400; and two states reported having a daily average of more than 1,000 IST inpatients.

To extrapolate to the whole country, this would mean that, on average, between 4,500 and 9,400 people are waiting for restoration at any one time.

NASMHPD also asked states to provide the average length of stay for defendants committed for being incompetent. Of the 30 states that responded, five said defendants wait an average of zero to 60 days; 13 states said 60 to 120; seven states said 120 to 180 days; three states said 180 to 360 days; and two states reported an average length of stay of over a year.

Every state surveyed reported that courts sometimes found defendants unrestorable to competency.

In 1972, the Supreme Court ruled in Jackson v. Indiana that defendants found unrestorable must be civilly committed or released, and that continued commitment for purposes of restoration would violate the Constitution.

Many states (69 percent, the survey found) do set a cap on length of stay, ranging from as little as 90 days in a few states to the maximum sentence specified by law for the most serious offense charged in others. But several studies suggest that courts in some places routinely ignore Jackson requirements and keep defendants hospitalized long after it is apparent that their prospects for restoration are dim.

Even when restoration is possible, certain states frequently flout their own legal parameters for how long incompetent defendants can be held. An investigation in December by the Denver Post found that people with mental illness who are accused of crimes in Colorado were waiting up to four times as long as legally permitted for evaluations and treatment because the system is so overwhelmed.

Similar reports have come out of California.

In 2015, the American Civil Liberties Union led a class action lawsuit charging that Washington State was taking too long to provide competency evaluations and restorations. In Trueblood v. DSHS, a federal court ordered the state to provide competency evaluations within 14 days of a court order, and competency restoration services within seven days of the evaluation.

In Tyler’s case, he was not originally held in jail, because the judge who ordered that he undergo competency restoration specified that restoration would be administered in his community. But although his state (Colorado) has a statutory requirement that counties provide outpatient competency restoration, Tyler’s hometown did not have such a program in place.

‘We Have a Delay Problem’

In February, 13 months after the original incident that brought him to court, the judge on Tyler’s case ordered him into custody and mandated that he be taken to the state hospital for competency restoration. The hospital, however, did not have any beds available. Instead, Tyler was placed on the restoration wait list and moved to a county jail.

Morgan described herself during that period as frantic.

“I called everybody,” she said. “I called the governor’s office, I called the state legislator, my representatives, my senator, the office of behavioral health, the state psychiatric hospitals, local providers, community mental health providers, I was in constant contact with the jail; no one would do anything other than say to me, ‘We have a delay problem.’

“I was appalled…they did nothing for him except hold him in a county jail. They were more than aware of the problem and simply failed to do anything for him.”

Finally, after 55 days on the waitlist, Tyler was placed in a jail-based competency restoration program that Morgan called “abominable.” Though she reached out to county officials multiple times, she was never able to get any information on what services or treatment Tyler was being provided, and he has been reticent to talk about his time there since.

After ten days in the restoration program, Tyler was told he was being referred for an early evaluation. The physician who evaluated him suggested that he was competent to stand trial.

“Coincidentally,” Morgan said, he had a status court hearing scheduled for later that week. The judge deemed Tyler competent, he pled to a misdemeanor, was placed on probation with a mental health component, and was released from custody on that day⸺more than 17 months after his initial arrest.

The delays in providing restoration would perhaps seem less egregious if ultimately defendants were given access to the services they need to get better. But in most places, restoration is a far cry from comprehensive mental health treatment.

“The court’s first response when somebody with a serious mental illness is arrested is not to treat them but to restore them, because that’s what all the rules and the law requires them to do,” Leifman said.

“Competency restoration is not treatment…it’s not about recovery, it’s not about getting well so that you can get out. It’s about restoring you so that you can be tried.”

This can mean anything from watching reruns of Law & Order to playing parts in scripted mock trials to becoming contestants in a courtroom version of Wheel of Fortune.

The Tampa Bay Times was able to obtain access to a state training video used in restoration in Florida that depicts “defendants” participating in a game show called “Trial and Error.” In the video, the contestant spins a wheel, which lands on first degree felony. She is asked what the maximum sentence is for a first-degree felony, and when she answers correctly, the host congratulates her: “You are now considered competent to return to court and face your charges. And we’ll see you next time right here on Trial and Error!”

Each time a patient watches the video, it costs roughly $8, the Times reports. Leifman and others think that money would be better spent on mental health treatment and social services.

“Most people who are ‘restored’ either have the charges dropped because the witnesses disappeared while they were in the hospital, they get credit for time served while they’re in there, which they’re entitled to, or they get probation,” Leifman said.

“Under all three scenarios, most people leave the courthouse without access to treatment.”

Because the mental illness that drove criminal behavior in the first place remains untreated, many defendants reoffend. Studies have found that individuals with serious mental illness tend to recidivate more quickly and at higher rates than similarly situated adults who are not mentally ill.

This means that the majority of people who go through competency restoration end up right back in jail.

Competency Restoration and the Mental Health Crisis

At the heart of the debate over competency restoration is the use of the criminal justice system to address a mental health problem. Competency restoration is not a solution to the mental health crisis, and often serves to exacerbate the issue further: because restoration is a right and health care is not, states often allocate money from the community health system to fund restoration programs.

“Ironically, you’re not entitled to treatment, but you are entitled to restoration if you’re charged with a crime,” said Leifman. “That’s the absurdity of our system.”

He added: “The states are making the problem worse by reducing community treatment by taking money away for the criminal mental health system and making it harder for more people to get services, and making it more likely that people get pushed into criminal justice.

“It’s created this terrible revolving-door problem, and the costs, both financial and human, are extraordinary.”

Morgan is still not sure what the costs have been for Tyler.

“He’s trying to do everything right,” she said. “But he’s so quiet. It’s too soon to tell.”

Since his release, Tyler has been seeing a therapist once a month per court order, as well as periodically checking in with his probation officer. He moved into a new apartment in the mountains near his family, signed up for exercise classes, and got a job with a local company where he works four days a week.

“Since he’s been out, I’ve tried to keep him focused on positive practical kind of stuff,” Morgan said.

“But he has been extraordinarily quiet. I think he has been traumatized. I don’t know yet. I really don’t know.”

Elena Schwartz is a TCR news intern. She welcomes comments from readers.

from https://thecrimereport.org

How the Justice System Can Learn From ‘Frequent Flyers’

For some Americans, health care and criminal justice are not two separate systems, but components of one big system that too often fails them. Frustrated cops call them “frequent fliers” because they regularly cycle between jail and hospital, so why do we  think we can fix one without the other?  

If a patient commits suicide within 72 hours of discharge, the Joint Commission (the accrediting body for hospitals) requires that a hospital conduct a “sentinel event” review.

That review will include a root cause analysis designed to uncover any mistakes or latent system weaknesses that contributed to the death.  It tries to learn whatever can be learned, and to report on steps aimed at preventing repetition.

But suppose the suicide is a “suicide-by-cop”:  A distraught former patient succeeds in forcing the police to shoot him in order to protect their colleagues or a hostage or a bystander.

Then, the familiar mechanisms of the criminal justice system will automatically activate too.

There will be a homicide investigation and a coroner’s report.

The performances of the officers who pulled their triggers will be examined by prosecutors and department officials.  Did the cops have another choice?   Did they act in self-defense? Was the shooting “within policy”?  Is prosecution called for?  Discipline?

Currently, the National Institute of Justice (NIJ) and the Bureau of Justice Assistance (BJA) are providing support (through a technical assistance grant to the Quattrone Center for the Fair Administration of Justice at the University of Pennsylvania Law School) for state and local criminal justice systems that want to go beyond the typical punishment-oriented reviews of the practitioners on the sharp end of the system, and to conduct “sentinel event” reviews of their own derived from the medical model when something goes wrong.  Jurisdictions are being recruited.

This will be a new thing in criminal justice.

These inquiries are focused not only on the choices of the individual cops, or forensic scientists, or lawyers, implicated in a surprising outcome, but rather on the whole constellation of system factors.

Like the hospital reviews, they ask not only “What happened?” but also “Why did it happen?” The goal is safety, and not just the safety of suicidal people, but also of the police who are forced to confront them—officers who, even if they survive their encounters, are traumatized by the experience.

So, in a criminal justice “sentinel event” review of a suicide-by-cop the role of training and supervision could be examined.   Was the cop trained in de-escalation techniques and equipped with non-lethal options?  Did the department have a Crisis Intervention capacity?

Had the 911 dispatcher gathered⸺and then conveyed⸺the useful information?  To the right people?  If not, why not?  How was this fatal situation created?  How can it be avoided?

These are system-oriented  event reviews, not personnel-focused  performance reviews; they look forward,  and they  aim at prevention, not at blame.

Are two reviews (or even three, if your city or state has opted into the NIJ/BJA  Sentinel Event effort) better than one?

An innovative recent study in Camden, N.J., (reported in The Crime Report by two of its leaders) casts doubt on that proposition.

In fact, the Camden findings (in my opinion, anyway) argue that we don’t need multiple parallel studies, but rather unified, collaborative learning reviews that enlist not only medical and criminal justice stakeholders working together, but members of the communities and the sub-groups they serve.

We need these learning reviews not only for the spectacular officer-involved fatalities, but for the “high frequency/low impact” missteps characteristic of daily criminal justice life in what a recent book called “Misdemeanorland.”

See: The Crime Report’s Q&A with Issa Kohler-Hausmann, author of “Misdemeanorland.”

The Camden study, conducted by the Camden Coalition of Healthcare Providers with support from the Laura and Jay Arnold Foundation, broke down the walls of multiple data silos in healthcare and criminal justice in Camden and used the numbers to illuminate the lives of a specific group of individuals entangled with both sets of practitioners.

To pull just one telling statistic from among the study’s many: 67 percent of the people who cycled through Camden’s Emergency Departments over the course of the study also cycled through its criminal justice system.

What I think the members of this group—“super-utilizers” to the public health practitioners, “frequent flyers” to the cops—could tell us is that from their perspective, health care and criminal justice are not two systems.  For frequent fliers, health care and criminal justice constitute one big system that dominates their daily efforts to survive.

It is pointless to think of a jail or an emergency room as “upstream” or “downstream.”  Each is simultaneously upstream and downstream of the other.

People who think about safety in other contexts draw a contrast between a complicated system and a complex system.  A jet airplane is a very complicated machine, but it can still be thought of in linear, sequential terms:  if x component fails, then y will happen.  So, find and fix the component.

But jet airliners in operation “become complex because they are opened up to influences that lie way beyond engineering specifications and reliability predictions.”   This is true of hospitals, police departments, prosecutors’ offices, courts, and correctional institutions too.

It looks even more true once you realize that these complex entities are themselves only elements of a more complex encompassing systems environment.

Decisions made in one part of this swirl are seldom automatic “causes” of effects in in other parts; usually they are “influences” that affect the probabilities, not switches that turn things on or off.

Look at the problem of how to launch “Abe,” one of the patient/defendants described by the Camden studies leaders, into a safe, healthy, law-abiding life (that drains fewer public resources) and you can see that you are not dealing with a simple mechanical challenge.

Over five years Abe was treated in emergency departments two dozen times, arrested more than fifteen times:  “A seemingly unbreakable cycle of hospital stays and arrests and incarceration, punctuated by periods of housing instability and homelessness, all of which appear to be driven largely by untreated substance abuse and lack of social supports.”

Some framework for collecting and disseminating cross-sector data will be an important step in breaking the cycle.  The authors of the Camden study are certainly right when they say that their work shows that there is “enormous value in fostering collaborative data sharing among agencies.”

But we should probably remember that data-measuring outputs casts only a pretty oblique light on processes. These processes, involving “lived realities of the people in the criminal justice system,” have to include the “lived realities” of the frontline emergency room nurse, patrol officer, sheriff, prosecutor, and judge who are making the decisions that keep Abe on his treadmill.

It would be surprising if these frontline practitioners greeted the Camden study’s findings with astonished shouts of “Eureka!”  The overlap of homelessness, medical issues, and criminal contacts is something they confront all day, every day.

(Innovative efforts such as the San Francisco Wraparound Project violence prevention initiative at Chan Zuckerberg San Francisco General Hospital have recognized the criminal/hospital nexus as a vital point of entry for community safety.)

Data-derived policies, even very good ones, won’t dispense with the people who have to execute them.  The reality is that the work the frontline workers actually do will seldom be identical to the work that policy wonks are able to describe in advance.

There is, as the Camden study notes, a tremendous variety in frequent fliers’ experiences.  That variety requires innovation, improvisation, choices between conflicting rules, and sometimes even rule-breaking—in short, workmanship—from practitioners.

With all of these actors involved, deciding how to rescue “Abe” is a complex socio-technical riddle, not a straightforward mechanical repair like mending a clockwork.

At 4:30 on some Friday afternoon, with the docket list still bulging, it made sense to each member of the “courtroom workgroup” of prosecutor, defender, and judge to offer Abe a plea to a greatly reduced charge and a sentence of “time served.”

It made sense to Abe to accept the offer and walk out the door.

That this was a mistake becomes clear only later (and in a different place, to different people) when it turns out that the record of conviction meant Abe is booted out of the family home in public housing that provides social support and allowed for medical continuity, or when it disqualifies him for a job or a program.

One of the things we can learn from looking at the general safety literature is that all of the decisions that we now deplore in hindsight as choices that kept Abe cycling were “locally rational” when they were made.

They may not have been heroic, prescient, or admirable, but they made sense to frontline people who were trying to get through their days.  Going “down and in” to focus tightly on one practitioner’s decision won’t be enough; we also have to go “up and out” to see why that decision was made. Leave the same inducements in place and the next practitioner may do the same thing.

When Diane Vaughan looked at the disastrous space shuttle Challenger launch decision she rejected the conventional view of amoral NASA administrators overriding safety concerns to meet the budgetary and political pressures driving the launch schedule.

Vaughan found that the decision was “a mistake embedded in the banality of organizational life.”  It had roots in the “normalization of deviance,” the accumulated drift, by small workarounds, informal work rules, and locally rational adaptations into accepting dangerous risks.

It was supported by a kind of structural secrecy:  that is, by “the way that patterns of information, organizational structure, processes, and transactions, and the structure of regulatory relations systematically undermines the attempt to know.”

Some part of this pattern as it applies to a frequent flyer is made up of formal confidentiality regulations:  the nurse is bound by HIPAA rules, the public defender by attorney-client privilege.  But more derives from mutual unfamiliarity: from a lack of insight into what counterparts in medicine (or public safety) are trying to do, why they are trying to do it, and how they are constrained by their environments.

Look at an avoidable suicide-by-cop or a re-entry failure or medical crisis dooming a frequent flyer like Abe to another downward loop on his spiral and you’re likely to see something of the kind.

Collecting and marshaling the data is crucial, but something like Vaughan’s ethnographic approach—complementing the data with the narratives of individual events and the “thick data” those narratives can provide—is crucial too, if we want to renovate a system that is currently keeping secrets from itself.

There is no reason to choose between, say, the Arnold Foundation’s data analysis and Jennifer Gonnerman’s rich narratives of Kalief Browder’s story.  They inform each other.

James Doyle

James Doyle

But to do this we need everyone’s perspective and on a constantly shifting variety of events.  Narratives confined in silos are no better than data confined in silos.

If everyone is doing “sentinel event” reviews anyway, why not do some together?

Editor’s Note: For another perspective on the Learning Review Process, see Ivan Pupulidy in The Crime Report, “Making Sense of Justice Tragedies.”

James M. Doyle is a Boston defense lawyer and author, and a frequent contributor to The Crime Report. He welcomes readers’ comments.

from https://thecrimereport.org

Austin PD Addresses Lingering Trauma Officers Can Face

Involvement in traumatic events like shootings can lead to years of anxiety and worse for police officers. Austin Police Chief Brian Manley, acting on an increase in alcohol-related incidents among officers this year, says he has made their mental health a priority.

Police officers often endure years of anguish after they are involved in shootings and other traumatic events. The stress, trauma and burnout from these life-or-death encounters have prompted the Austin Police Department to examine whether it provides the necessary resources to police and civilian staff, reports the city’s American-Statesman. Seeing an increase in alcohol-related incidents among officers this year, Chief Brian Manley has made mental health in the department a priority. He has commissioned a group of experts — including physicians, wellness specialists, peer-support officers and chaplains — to look at how to identify symptoms of post-traumatic stress and how to prevent and treat mental health crises.

“This is an issue that is problematic for police departments across this country,” Manley said. “We recognize that there is probably more that we can and should be doing…We care about them as people, and I think that we have a duty to do everything we can to enhance their health and well-being.” During their career, an officer experiences an average of 188 critical incidents, including being beaten, shot at or threatened with a gun, a 2018 study by the Ruderman Family Foundation found. Law enforcement officers are five times more likely to suffer from post-traumatic stress in their lifetime than the general population, according to the report. First responders, including police and firefighters, also are more likely to die by suicide than in the line of duty, it found. “This is a career where you can’t unsee things that you have seen,” Manley said. “Every officer walks around with visions of things that they have experienced during their career. That impacts you.”

from https://thecrimereport.org

Did California Authorities Suppress Research on Sexually Violent Predators?

Evidence indicating that individuals imprisoned for sexually violent offenses have a low likelihood of recidivating was never made public, according to two California scholars─perhaps because it called into question the constitutional legitimacy of state laws making sex offenders subject to indefinite civil commitment long after they served their sentences.

State laws that allow sexually violent predators to be locked up even after they have served their sentences are based on questionable assumptions that they continue to pose a danger to society, according to a study published in the American Criminal Law Review.

The study focused on California where, according to the authors, research indicating that sexually violent predators (SVPs) are less likely to re-commit crimes than other offenders was suppressed because it challenged the constitutional legitimacy of the state’s SVP laws.

The research in the mid-2000s by Dr. Jesus Padilla, a clinical psychologist at Atascadero State Hospital, a California maximum-security institution that houses mentally ill offenders, found that just 6.5 percent of untreated sexually violent predators were arrested for a new sex crime within 4.8 years of release from a locked mental facility.

But the research was halted and its findings hidden in what, in effect, was an attempt to “bury” information that might challenge the constitutional basis for the $147.4 million program operated by the California Department of Mental Health that supervised the involuntary commitment of SVPs, the study claimed.

The authors, Tamara Rice Lave of the University of Miami School of Law; and Franklin Zimring, of the University of California, Berkeley, wrote they learned about the concealed study from a former public defender who is now a Superior Court judge in San Diego, and then contacted Dr. Padilla.

“Dr. Padilla was very responsive and gave us a detailed account of what had happened,” the authors wrote. “We then submitted a FOIA request to the newly created Department of State Hospitals (DSH). But we were told that they were ‘unable to verify any study on recidivism conducted by Jesus Padilla, PhD.’

“We shared DSH’s response with Dr. Padilla, and he sent us a packet of documents pertaining to the study including internal memoranda, emails, and the signatory page granting approval for the study.”

An examination of the study, which was originally commissioned to assess the value of clinically treating SVPs, revealed the lower recidivism rates—a result that surprised researchers at the time, but also paralleled the findings of a 2003 study by the Department of Justice’s Bureau of Justice Statistics (BJS) that showed 2.5 percent of rapists were rearrested for rape within three years of release from prison, and just 3.3 percent of child molesters were arrested for another sex crime against a child during that same period.

In contrast, during that same three-year period, the BJS researchers found that 13.4 percent of robbers were rearrested for robbery, 23.4 percent of burglars were rearrested for burglary, and 41.2 percent of drug offenders were rearrested for a drug crime.

The recidivism statistics call into question the entire basis for the involuntary civil commitment of sexual offenders, wrote the authors.

Currently, 20 states and the federal government have similar SVP laws, and as of 2016, there were 5,355 persons committed as SVPs across the country, with an additional 1,001 detained pending commitment, the study said.

Because the Constitution prevents a person from being punished multiple times for the same crime in criminal cases, the courts have enforced civil commitments in the cases of many SVPs, which allow for a post-sentence detention in an effort to prevent further offenses.

“We have no way of knowing the real reason why California halted the Padilla study and then tried to bury it,” wrote the authors. “Although our FOIA request asked why the study was terminated, we never received an answer.

“Perhaps higher-ups at DMH (the California Department of Mental Health) had not initially paid attention to the study because they did not expect the results….DMH may have realized the study had to be stopped because it threatened the legitimacy of the entire SVP program.

“The only constitutionally acceptable rationale for SVP commitment is that offenders are so dangerous that they must be locked away, and this study showed otherwise. If the SVP law were to be declared unconstitutional, it would threaten the $147.3 million annual budget DMH (and now Department of State Hospitals) receives for the civil commitment program.

“People have done far worse than bury a study for a hundred million dollars.”

The authors noted that the use of SVP laws was given the stamp of approval by a 1997 U.S. Supreme Court Case Kansas v. Hendricks, which accepted claims that SVPs are “extremely dangerous” and that their “likelihood of engaging in repeat acts of predatory sexual violence is high.”

In that case, defendant Leroy Hendricks “admitted that he was an uncured pedophile who could not control his desire to molest children.” But, as the authors argue, Hendricks does not represent the greater SVP population.

“If the Court had asked what the basis was for this conclusion, they would have been sorely disappointed,” the study says. “We searched the legislative minutes for the 1994 Kansas law and found no citations to data on prospective danger.”

The unwillingness to substantiate the claims may be be rooted in fears of inflaming public opinion, argued the authors. A 2010 national opinion poll found that 72 percent of respondents believed that at least half, if not most, of convicted sexual offenders would commit additional sex crimes later on, according to the study.

A separate study from the Washington State Institute (WSI) reported that recidivism rates were as high as 25 percent in Washington. But the authors note a variance in age demographics between WSI and Padilla’s studies, with WSI’s largely consisting of a younger demographic.

Data from the Department of Justice released in 2016 shows that recidivism rates among sex offenders for other non-sexual crimes was around 60 percent. Only 5.6 percent were re-arrested for rape or sexual assault.

“If SVPs are no different than the dangerous but typical recidivist convicted in an ordinary criminal case, then the state has no constitutionally permissible reason to continue locking them away,” the study says.

California’s use of indeterminate civil commitment means that it is unlikely that the state’s SVPs, most of whom are over 50, will ever be released, the study said—based on the presumption that the risk posed by an offender at 40 remains the same when he is 50, 60 “or even 90.”

The rediscovery of the Padilla study should spur California and other states to make it a requirement that SVPs are regularly examined to prove they are likely to recidivate—a system that California used before the onset of SVP laws, the authors wrote.

“The politics of crime and fear of sex offenders mean that someone like Mr. Hendricks, who is now 83 and confined to a wheelchair, will never prevail,” they added.

“The ironic result of allowing state governments to make up their own theories of prospective sexual danger and never to test their hunches goes beyond the wasteful and unjust incarceration of elderly men with histories of sex offenses.

“Detailed and careful empirical study could provide much better evidence of the age and other characteristics of persons who have significant offending risks.”

The authors called on the Bureau of Justice Statistics to resurrect and continue the Padilla study.

“Until such research is conducted, we will never know whether the true legacy of Kansas v. Hendricks includes not just unjust confinement but also an allocation of limited resources with no focus on populations of maximum danger.

“Justice and community safety demand the truth.”

A complete copy of the study can be downloaded here.

TCR News Intern Marianne Dodson contributed to this summary. Readers’ comments are welcome.

from https://thecrimereport.org

Rural (In)Justice: The Hidden Crisis in America’s Jails

The use of jails to house individuals with serious mental illness is contributing to the skyrocketing growth in jail populations across the U.S.—particularly in rural and small counties—experts told a conference at John Jay College Tuesday.

Soaring jail populations, particularly in rural areas, are now driving America’s crisis of mass incarceration, a conference at John Jay College was told Tuesday.

Christian Henrichson, research director for the Center on Sentencing and Corrections at the Vera Institute of Justice, said the number of individuals in pretrial detention in rural or small counties with fewer than 250,000 inhabitants began surpassing urban detention rates in 2008—and continues to increase even as urban jail populations are falling.

“In the last couple of decades, mass incarceration has metastasized from the largest cities to almost every community in America,” Henrichson, author of a recently released Vera study on incarceration trends, told rural journalists participating in a conference on “Rural (In)Justice:Covering America’s Hidden Jail Crisis.”

More than 11 million jail admissions are recorded every year, yet few Americans realize that jails are a primary engine of mass incarceration in the U.S. Polls show that rural residents continue to think of it as a problem largely facing urban areas, Henrichson said.

Among the factors driving the increase is the growing use of jails to house the mentally ill.

Srteven Leifman

Judge Steven Leifman, 11th Judicial Circuit, Florida. Photos by John Ramsey/TCR

“When I became a judge, I had no idea I was actually becoming the gatekeeper to the largest psychiatric facility in the state of Florida,” said Judge Steven Leifman, Associate Administrative Judge for the 11th Judicial Circuit Court, referring to the Miami-Dade County Jail.

Judge Leifman said people with mental illness are nine times more likely to be incarcerated than hospitalized, and that at any given time, about 550,000 people with serious mental illnesses are in jails or prisons, and another 900,000 are under correctional supervision.

It’s a “horrible, shameful American tragedy,” but it can be reversed with targeted crisis intervention programs for law enforcement working in collaboration with health and social services, he said.

Judge Leifman noted that since Miami-Dade implemented a program eight years ago that trains police officers how to identify people in crisis, and direct them to treatment and counseling services rather than arrest them, the county’s jail population has sharply reduced with no discernible increase in threats to public safety.

More than 450 counties across the U.S. are now implementing some version of the program, called the Stepping Up Initiative, a collaboration with the National Association of Counties, the Council of State Governments, and the American Psychiatric Association Foundation.

The swelling number of mentally ill individuals who are locked up is a consequence of the reduction of psychiatric beds in state facilities across the country. But analysts say it is part of a much larger problem: an increase in the numbers of individuals held awaiting trial because they or their relatives cannot afford the cost of money bonds.

Cherise Fanno Burdeen

Cherise Fanno Burdeen, CEO, Pretrial Justice Institute

“Almost all of the jail growth in the U.S. since 2000 has been in pretrial detention,” said Cherise Fanno Burdeen, CEO of the Pretrial Justice Institute, a Washington, DC-based non-profit.

“If you’re a person of color, you’re more likely to have a high bond for the same offense than your white counterpart, as well as being less likely to make that bond.”

Other factors contributing to the high jail numbers include the opioid epidemic that has ravaged much of the American heartland, a rise in referrals of state inmates to county jails to relieve overcrowding in penitentiaries, and an increase in the use of jails to house undocumented immigrants awaiting deportation, conference speakers said.

Authorities in cash-strapped regions across rural America initially welcomed the referrals as an additional source of revenues, but many are now rethinking the practice.

Kirk Taylor, Sheriff of Pueblo County, Co., said the population of his jail has almost doubled because of state referrals.

Kirk Taylor

Kirk Taylor, Sheriff, Pueblo County, Colorado

“The legislature is …absolutely killing the counties,” Taylor said. “I have a list of 50 legislative changes that have deferred inmates to the counties.”

Larry Amerson, retired Sheriff of Calhoun County, Al., and former president of the National Sheriffs Association, said that 250 of the 600 prisoners currently held in his county come from state prisons—yet the expected boost in revenue never materialized.

According to Amerson, his county receives just $1.75 per person to cover food costs.

“Legislators often have no empathy for the problems we face,” he said.

The pressure on county authorities to meet the burden of rising correctional costs is so high that they are often faced with the unpalatable choice of building a new jail at the cost of other crucial infrastructure like roads, schools and hospitals, the conference was told.

G. Larry Mays, Regents Professor Emeritus of Criminal Justice at New Mexico State University and author of “Trouble in the Heartland,” said the most common way to fund county jails is through property taxes, but because many smaller counties reassess property infrequently, it can be hard for them to keep up with costs.

“Jails in rural counties suffer from both political conservativism and fiscal conservativism,” said Mays.

Both sheriffs said more attention to pretrial services and risk assessment tools were important ways of reducing recidivism as well as helping individuals receive counseling or treatment for mental illness or substance abuse issues, particularly in the midst of an opioid epidemic which has hit rural areas the hardest.

For Amerson, the jail crisis is personal. Three people in his family died of opioid overdoses—a tragedy he said might have been avoided if they had taken advantage of pretrial services providing substance-abuse counseling or treatment after they were arrested.

“I begged the parents not to make bond, but they said it wasn’t fair,” he recalled.

“The purpose of pretrial services is not to decrease the amount of people in your jails—that is a byproduct, we hope—but that is not the primary purpose,” said Taylor.

“It’s designed to find the people who are supposed to be in jail through your assessments and identify those people who are a risk to public safety.”

Bail Reform

According to Burdeen of the Pretrial Justice Institute, reforming bail practices is one of the easier strategies to reduce jail populations.

She cited data indicating money bonds have no discernible impact in terms of improving outcomes and public safety.

“Money bonds only detain people who are too poor to post that bond, and they let bad guys who can afford to post bond get out without being assessed or having conditions that would improve public safety,” said Burdeen.

She pointed out that money bond is simply a condition of bail, and that there are other alternatives, such as providing access to public defenders at hearings, expanding the use of citations instead of arrest, and getting prosecutors to review cases to see if defendants are eligible for referral to specialty courts.

Burdeen also noted that many places set high bonds on high-risk individuals because they don’t have preventive detention protocols, which allow the courts to find dangerous individuals and detain them.

The Pretrial Justice Institute believes elimination of money bonds could reduce sharply reduce the numbers of individuals held in pretrial detention, noting that programs underway in Washington, D.C. and New Jersey have made important progress in that area.

But solutions to the larger issues driving jail growth, such as the failure to find alternative ways to deal with individuals with mental illness and addiction issues, continue to elude policymakers, the conference was told.

“There’s something wrong with a society that is willing to spend more to incarcerate people than to treat them,” said Judge Leifman.

Marianne Dodson and Dane Stallone are TCR News Interns. The conference on Rural (In)Justice was organized by the Center on Media, Crime and Justice at John Jay College, publisher of The Crime Report, and supported with grants from the Ford Foundation and the MacArthur Safety + Justice Challenge. Readers’ comments are welcome.

from https://thecrimereport.org

Thinking Outside the Cell: Software Cuts Recidivism Among Texas’ Mentally Ill

In Dallas County, the main outlet of psychiatric care for those with mental illness is no longer the corrections system. A five-year initiative using predictive technology is helping to divert justice-involved mentally ill individuals into effective treatment programs.

In Dallas County, Texas, the main outlet of psychiatric care for those with mental illness is no longer the corrections system.

A five-year initiative aimed at bridging the gap between the legal and medical communities is successfully diverting justice-involved mentally ill individuals to effective treatment programs.

The key to the program is technology. The initiative uses software created by HarrisLogic, a Missouri-based technology and clinical services company that allows information about mentally ill individuals who fall afoul of the law to be shared among law enforcement, courts and health care providers.

Experts say such a tech-based approach could be critical to reducing overcrowding in U.S. jails.

There are now nearly ten times the number of mentally ill patients behind bars than those residing in the remaining state hospitals, according to a 2014 report by the Treatment Advocacy Center, an Arlington, Va.-based national nonprofit focused on mental illness issues.

A prime example is the Dallas County Jail, whose jurisdiction stretches from the cities of Carrollton to Mesquite, to just outside of Arlington. Dallas County’s major detention center, the Lew Sterrett Justice Center, is the second largest mental health facility in Texas, according to the County Sheriff’s Office.

In 2014, the county received a $7 million grant from the W.W. Caruth, Jr. Foundation for a “Smart Justice Initiative” to provide alternatives to jail for individuals with mental health problems who come into contact with the justice system. The county partnered with the Meadows Mental Health Policy Institute (MMHPI), a research and development organization that helps Texans connect to mental health care.

Now in its fourth year, the jail diversion program has reduced recidivism from 31 percent in 2014 to 26 percent in 2017, according to the National Association of Counties.

It’s “an impressive example of how local jurisdictions can implement data-driven innovations that enhance public safety, reduce jail costs to taxpayers, and provide effective and humane interventions for people with mental illness,” said Marc Levin, vice president of criminal justice at the Texas Public Policy Foundation.

Alternatives to Punishment

Relieving jails of the burden of providing mental health services is only a first step towards the goal of developing alternative and non-punitive options for treatment. It doesn’t address the decisions that bring mentally ill individuals into the justice system in the first place, mental health advocates say.

The Dallas County initiative uses technology to assist in the decision-making by police, courts and health providers.

Following a 911 call, if it is determined that jail is an initially appropriate response to a troubled individual, data from the standard mental health and suicide screening tests (as per Texas standards) is automatically integrated with any other data related to the individual’s medical history contained in police or emergency response records as well as hospital data.

Traditionally, such data was kept in separate silos, but the software implemented through the Jail Diversion Platform, created by Harris Logic, integrates all the personal information critical to determining a defendant’s immediate needs and subsequent care.

That includes information such as previous arrests or incarcerations, previous mental health rehabilitation, and current medication, Hudson Harris, chief engagement officer of HarrisLogic, said in an interview with The Crime Report.

This data is entered in the County Adult Information System, a “master index,” which is used to share information in a manner that allows for access by court and jail authorities, clinicians, legal professionals, and pretrial staff.

Privacy Protection

No mental health assessment is conducted without the prior permission of a defendant’s attorney—likely a public defender. Further privacy protections require that each agency using the data can only view what is authorized to them through a data usage agreement.

By involving multiple agencies, the combined knowledge and expertise allows future treatment to be tailored to an individual’s needs─better than simply checking a box during a mandatory evaluation, authorities say.

This step is arguably the most crucial. Without accurate and swift identification, issues stemming from an individual’s illness can make it more difficult for persons to follow jail rules, increasing the likelihood they will face harsh disciplinary measures, or be subjected to violence from other inmates or from guards.

The second intercept in the initiative is through pretrial release, providing an escape from being trapped in the justice system.

“Mental health patients often spend more time in jail waiting for their case to be resolved than that of a mentally healthy convict,” observed Alisa Roth, author of Insane: America’s Criminal Treatment of Mental Illness, in a recent article.

This may be due to the requirement in many states that inmates with serious mental illness undergo additional evaluations or be restored to competency before standing trial.

According to a survey of 40 state hospital officials by the Treatment Advocacy Center, 78 percent of the respondents were wait-listing pretrial inmates for hospital services. Often, mentally ill inmates spend more time behind bars waiting for their case to be heard than they would serve if they were convicted of the offense.

To remedy this delay, the comprehensive technology utilized in the Smart Justice program increases the likelihood of a pretrial release by allowing officials to determine if the person is a flight risk, or a danger to the public.

Using this complete data, a judge is more likely to issue a pretrial release, but with conditions for connection to treatment.

An evaluation of the Smart Justice Initiative from April 2017 to January 2018 showed that of the individuals presented before the magistrate for a release decision, 89 percent were successful in being granted a pretrial release bond. Of those granted bond, 100 percent were “released, connected to treatment, and supervised on bond with monitored treatment for the Court,” reports Dallas County.

Need for Coordinated Care

So why are mentally ill offenders more prone to getting re-arrested and re-booked than the general population, even with increased treatment availability?

The main reason, explains Hudson Harris, is the lack of coordinated care. This refers to the absence of follow-up treatment or supervision of mentally ill persons after they have been released from jail, typically back to the same environment that caused them to get arrested in the first place.

It’s here that the third intercept comes into play.

The software directly assigns an individual to a treatment program based on the data provided. Normally it takes weeks to find a person eligible for mental health care programs, but with this technology it takes an estimated 15 minutes or less.

Inadequate coordination is not only a problem within the jail system, but also in an individual’s contact with hospitals.

When dealing with an individual with a mental health illness, a hospital’s main goal is only to focus on the individuals’ current state of health─stabilize them, get them locked down, and then out the door as quickly as possible—with little to no coordination of care, says Harris.

There is no link between simply going to the hospital and getting better when you have a psychiatric condition.

In fact, a 2018 study from the American Psychological Association found that hospitalization has an iatrogenic effect on mental health, meaning the treatment causes a worsening of the condition.

 Follow-up Care Crucial

Connecting mentally ill persons with the care and follow-up that they require will ensure they are less likely to become involved in the justice system, said Levin.

“The initiative has resulted in rapid screening and diversion to appropriate treatment programs for thousands of individuals arrested for conducted related to a serious mental illness,” he said.

Providing access to treatment and follow-up care can also help authorities save money on their corrections budgets.

When mentally ill inmates do not receive consistent treatment, they frequently cycle in and out of the jails, forcing the facility (and taxpayers) to spend additional money on health professional staff, medication needed for certain mental illnesses, and simply housing them behind bars for longer periods of time.

A 2003 study reports that in Texas prisons, “the average prisoner costs the state about $22,000 a year compared to the cost of prisoners with mental illness, which ranges from $30,000 to $50,000 a year.”

Also at a state level, Texas spends $1.4 billion in emergency room costs and $650 million in local justice system costs annually to address mental illness and substance use disorders that are not otherwise being adequately treated, according to MMHPI.

The operation of increased treatment may seem like a burden to the jail’s budget, but simply by providing individuals with the appropriate care that they need, the cost of doing so declines; breaking the high-utilizer cycle and reducing contact of the mentally ill with the corrections system.

According to HarrisLogic, the Smart Justice Initiative will be able to trim over $30 million in these expenses over the five-year implementation period.

While the initiative has resulted in significant savings to Dallas County on jail costs and indigent defense costs, and helped reduce overcrowding in the courts system, Levin notes the challenge is to replicate it in other jurisdictions.

Laura Binczewski

Laura Binczewski

While Dallas received a large grant, other jurisdictions would have to provide upfront funding or use a pay-for-performance model in order to get similar initiatives off the ground, which may prove difficult for less-fortunate counties, he said.

However, the prospects for similar programs elsewhere have brightened thanks to the increased interest of private funders, and a call to action by the Stepping Up Initiative, a national effort to divert people with mental illness from jails by asking state and local officials to pass mental health legislation.

Noting that 451 counties across the nation have already passed motions calling for reforms to the justice system’s treatment of mentally ill, the initiative organizers said a nationwide consensus for change was crucial.

“Without change, large numbers of people with mental illnesses will continue to cycle through the criminal justice system,” the organization declared on its website, “often resulting in tragic outcomes for these individuals and their families, missed opportunities for connections to treatment, inefficient use of funding, and a failure to improve public safety.”

Laura Binczewski is a TCR news intern. She welcomes comments from readers.

from https://thecrimereport.org

Thinking Outside the Cell: Software Cuts Recidivism Among Texas’ Mentally Ill

In Dallas County, the main outlet of psychiatric care for those with mental illness is no longer the corrections system. A five-year initiative using predictive technology is helping to divert justice-involved mentally ill individuals into effective treatment programs.

In Dallas County, Texas, the main outlet of psychiatric care for those with mental illness is no longer the corrections system.

A five-year initiative aimed at bridging the gap between the legal and medical communities is successfully diverting justice-involved mentally ill individuals to effective treatment programs.

The key to the program is technology. The initiative uses software created by HarrisLogic, a Missouri-based technology and clinical services company that allows information about mentally ill individuals who fall afoul of the law to be shared among law enforcement, courts and health care providers.

Experts say such a tech-based approach could be critical to reducing overcrowding in U.S. jails.

There are now nearly ten times the number of mentally ill patients behind bars than those residing in the remaining state hospitals, according to a 2014 report by the Treatment Advocacy Center, an Arlington, Va.-based national nonprofit focused on mental illness issues.

A prime example is the Dallas County Jail, whose jurisdiction stretches from the cities of Carrollton to Mesquite, to just outside of Arlington. Dallas County’s major detention center, the Lew Sterrett Justice Center, is the second largest mental health facility in Texas, according to the County Sheriff’s Office.

In 2014, the county received a $7 million grant from the W.W. Caruth, Jr. Foundation for a “Smart Justice Initiative” to provide alternatives to jail for individuals with mental health problems who come into contact with the justice system. The county partnered with the Meadows Mental Health Policy Institute (MMHPI), a research and development organization that helps Texans connect to mental health care.

Now in its fourth year, the jail diversion program has reduced recidivism from 31 percent in 2014 to 26 percent in 2017, according to the National Association of Counties.

It’s “an impressive example of how local jurisdictions can implement data-driven innovations that enhance public safety, reduce jail costs to taxpayers, and provide effective and humane interventions for people with mental illness,” said Marc Levin, vice president of criminal justice at the Texas Public Policy Foundation.

Alternatives to Punishment

Relieving jails of the burden of providing mental health services is only a first step towards the goal of developing alternative and non-punitive options for treatment. It doesn’t address the decisions that bring mentally ill individuals into the justice system in the first place, mental health advocates say.

The Dallas County initiative uses technology to assist in the decision-making by police, courts and health providers.

Following a 911 call, if it is determined that jail is an initially appropriate response to a troubled individual, data from the standard mental health and suicide screening tests (as per Texas standards) is automatically integrated with any other data related to the individual’s medical history contained in police or emergency response records as well as hospital data.

Traditionally, such data was kept in separate silos, but the software implemented through the Jail Diversion Platform, created by Harris Logic, integrates all the personal information critical to determining a defendant’s immediate needs and subsequent care.

That includes information such as previous arrests or incarcerations, previous mental health rehabilitation, and current medication, Hudson Harris, chief engagement officer of HarrisLogic, said in an interview with The Crime Report.

This data is entered in the County Adult Information System, a “master index,” which is used to share information in a manner that allows for access by court and jail authorities, clinicians, legal professionals, and pretrial staff.

Privacy Protection

No mental health assessment is conducted without the prior permission of a defendant’s attorney—likely a public defender. Further privacy protections require that each agency using the data can only view what is authorized to them through a data usage agreement.

By involving multiple agencies, the combined knowledge and expertise allows future treatment to be tailored to an individual’s needs─better than simply checking a box during a mandatory evaluation, authorities say.

This step is arguably the most crucial. Without accurate and swift identification, issues stemming from an individual’s illness can make it more difficult for persons to follow jail rules, increasing the likelihood they will face harsh disciplinary measures, or be subjected to violence from other inmates or from guards.

The second intercept in the initiative is through pretrial release, providing an escape from being trapped in the justice system.

“Mental health patients often spend more time in jail waiting for their case to be resolved than that of a mentally healthy convict,” observed Alisa Roth, author of Insane: America’s Criminal Treatment of Mental Illness, in a recent article.

This may be due to the requirement in many states that inmates with serious mental illness undergo additional evaluations or be restored to competency before standing trial.

According to a survey of 40 state hospital officials by the Treatment Advocacy Center, 78 percent of the respondents were wait-listing pretrial inmates for hospital services. Often, mentally ill inmates spend more time behind bars waiting for their case to be heard than they would serve if they were convicted of the offense.

To remedy this delay, the comprehensive technology utilized in the Smart Justice program increases the likelihood of a pretrial release by allowing officials to determine if the person is a flight risk, or a danger to the public.

Using this complete data, a judge is more likely to issue a pretrial release, but with conditions for connection to treatment.

An evaluation of the Smart Justice Initiative from April 2017 to January 2018 showed that of the individuals presented before the magistrate for a release decision, 89 percent were successful in being granted a pretrial release bond. Of those granted bond, 100 percent were “released, connected to treatment, and supervised on bond with monitored treatment for the Court,” reports Dallas County.

Need for Coordinated Care

So why are mentally ill offenders more prone to getting re-arrested and re-booked than the general population, even with increased treatment availability?

The main reason, explains Hudson Harris, is the lack of coordinated care. This refers to the absence of follow-up treatment or supervision of mentally ill persons after they have been released from jail, typically back to the same environment that caused them to get arrested in the first place.

It’s here that the third intercept comes into play.

The software directly assigns an individual to a treatment program based on the data provided. Normally it takes weeks to find a person eligible for mental health care programs, but with this technology it takes an estimated 15 minutes or less.

Inadequate coordination is not only a problem within the jail system, but also in an individual’s contact with hospitals.

When dealing with an individual with a mental health illness, a hospital’s main goal is only to focus on the individuals’ current state of health─stabilize them, get them locked down, and then out the door as quickly as possible—with little to no coordination of care, says Harris.

There is no link between simply going to the hospital and getting better when you have a psychiatric condition.

In fact, a 2018 study from the American Psychological Association found that hospitalization has an iatrogenic effect on mental health, meaning the treatment causes a worsening of the condition.

 Follow-up Care Crucial

Connecting mentally ill persons with the care and follow-up that they require will ensure they are less likely to become involved in the justice system, said Levin.

“The initiative has resulted in rapid screening and diversion to appropriate treatment programs for thousands of individuals arrested for conducted related to a serious mental illness,” he said.

Providing access to treatment and follow-up care can also help authorities save money on their corrections budgets.

When mentally ill inmates do not receive consistent treatment, they frequently cycle in and out of the jails, forcing the facility (and taxpayers) to spend additional money on health professional staff, medication needed for certain mental illnesses, and simply housing them behind bars for longer periods of time.

A 2003 study reports that in Texas prisons, “the average prisoner costs the state about $22,000 a year compared to the cost of prisoners with mental illness, which ranges from $30,000 to $50,000 a year.”

Also at a state level, Texas spends $1.4 billion in emergency room costs and $650 million in local justice system costs annually to address mental illness and substance use disorders that are not otherwise being adequately treated, according to MMHPI.

The operation of increased treatment may seem like a burden to the jail’s budget, but simply by providing individuals with the appropriate care that they need, the cost of doing so declines; breaking the high-utilizer cycle and reducing contact of the mentally ill with the corrections system.

According to HarrisLogic, the Smart Justice Initiative will be able to trim over $30 million in these expenses over the five-year implementation period.

While the initiative has resulted in significant savings to Dallas County on jail costs and indigent defense costs, and helped reduce overcrowding in the courts system, Levin notes the challenge is to replicate it in other jurisdictions.

Laura Binczewski

Laura Binczewski

While Dallas received a large grant, other jurisdictions would have to provide upfront funding or use a pay-for-performance model in order to get similar initiatives off the ground, which may prove difficult for less-fortunate counties, he said.

However, the prospects for similar programs elsewhere have brightened thanks to the increased interest of private funders, and a call to action by the Stepping Up Initiative, a national effort to divert people with mental illness from jails by asking state and local officials to pass mental health legislation.

Noting that 451 counties across the nation have already passed motions calling for reforms to the justice system’s treatment of mentally ill, the initiative organizers said a nationwide consensus for change was crucial.

“Without change, large numbers of people with mental illnesses will continue to cycle through the criminal justice system,” the organization declared on its website, “often resulting in tragic outcomes for these individuals and their families, missed opportunities for connections to treatment, inefficient use of funding, and a failure to improve public safety.”

Laura Binczewski is a TCR news intern. She welcomes comments from readers.

from https://thecrimereport.org

Why Didn’t Courts Act Against Annapolis Shooter?

Jarrod Ramos left a years-long trail of harassment, threats and contemptuous behavior. “You can’t lock someone up because you have an inner fear about what he might do,” said Richard Barajas of the National Organization for Victim Assistance. “The criminal justice system is not designed for it. “

Jarrod Ramos left a years-long trail of harassment, threats and contemptuous behavior. There were dozens of warning signs that he might turn violent – including repeated threats of killing a journalist, USA Today reports. Although none of that was seemingly taken seriously by authorities, Ramos’ words and online activity offer examples that in hindsight could have prompted a stronger response from his employers, police and the court system. Ramos is charged with killing five people at a Maryland newspaper last week. USA Today reviewed thousands of pages of court records and interviewed dozens of people who knew or interacted with Ramos. The record shows an angry man who became obsessed with the people he felt wronged him.

Experts say the attack at the Capital Gazette highlights the challenges of trying to balance the rights of people to speak freely against concerns that they could turn violent. In a court filing, Ramos said he had seen five mental health professionals for at least 75 visits before last week’s shooting. “You can’t lock someone up because you have an inner fear about what he might do,” said Richard Barajas of the National Organization for Victim Assistance and former chief judge of the Texas Court of Appeals. “The criminal justice system is not designed for it. And the mental health system is ill-equipped to do it.” Ramos had been engaged in a lengthy fight with the Capital Gazette over its coverage of a court case in 2011 which he pleaded guilty to harassing a former classmate. Attorney Brennan McCarthy, who represented the classmate, said in a court filing: “There exists a very real possibility that at some point in time, Mr. Ramos will take these violent fetishes as expressed in print, and will try to carry them out in person.”

from https://thecrimereport.org

Too Many Mentally Ill Are Jailed, TN Grand Jury Says

Nashville Sheriff Daron Hall is creating a facility to treat people who need mental health help instead of jailing them. A grand jury said that for many people needing treatment, “we seem to just throw them into the criminal justice system.”

Too many Tennesseans with mental illnesses are arrested and jailed instead of being referred for treatment, a Nashville grand jury determined, The Tennessean reports. There must be more societal awareness of what to do when someone is having a mental health crisis, jurors said. The vast majority of people who have a mental illness do not pose an immediate risk to the community, regardless of whether they own a firearm. The grand jury’s assessment comes as Nashville and other communities affected by mass shootings try to learn how to recognize and treat a mental health issue before a problem escalates into a tragedy. “Instead of solving the problem of why people keep getting in trouble, we seem to just throw them in to the criminal justice system. We treat too many affected individuals as criminals instead of getting them the treatment they need,” said the grand jury.

Nashville police say Travis Reinking, 29, shot and killed four people while injuring others in April when he fired an AR-15 style rifle at a Waffle House. Reinking is undergoing a mental evaluation. In previous interactions with law enforcement, he exhibited behaviors prompting requests for mental health evaluations. Dwight Lewis, a former Tennessean editor and the grand jury foreman from January to March, said the jury heard from officials like Davidson County Sheriff Daron Hall “who recognize the need for mental health care.” In conjunction with building a new downtown jail, the sheriff’s office is creating a facility intended to treat someone in the middle of a crisis instead of taking them to jail. The facility will have 64 beds, split evenly between men and women accused of misdemeanors. The facility, known as the Behavioral Care Center, is set to open in fall 2019.

from https://thecrimereport.org