Chittenden County rethinks its approach to mentally ill offenders
District Judge Geoffrey Crawford is reviewing the morning's docket in a second-floor conference room at Burlington's Costello Courthouse. Seated at the table are the usual parties to a criminal court proceeding: the state's attorney, a defense counsel, a probation officer and a police officer. Also present are two mental-health experts. The topic of discussion: a client's guinea pig.
Lucy Joramo, a Chittenden County public defender, explains that her client, "Scott," has done well with the pet, and now wants a dog. However, his psychiatrist won't sign off on the idea unless Scott agrees to start taking his medication again.
"When he was in the hospital, they put him on a higher dose of Klonopin than [his doctor] would have prescribed," adds Terri Cameron, a probation officer with the Department of Corrections. "Sometimes there are creative things that'll work to get someone to try."
Bob Wolford, coordinator of offender services at the Howard Center for Human Services in Burlington, is a regular fixture at these weekly meetings. He knows Scott well and is familiar with his struggles coping with mental illness. "Scott went from this adamant position of 'No anti-psychotics!' to 'Maybe I'll think about it,'" says Wolford. "Two months to the day after starting his meds, he quit. But I think he'll do OK."
The judge asks about Scott's housing situation. Wolford says he's working with the Burlington Housing Authority to get him an apartment.
Judge Crawford seems convinced. "I don't think he would hurt a dog," he says, sounding more like a concerned uncle than legal arbiter. "He's taken very good care of his guinea pig. That thing's lived forever."
The judge scribbles some notes on a legal pad, and then turns to the next case on the docket. "Samuel. How's he doing?" Crawford asks.
Eric Leff, Samuel's case manager, explains that his client recently had a bad toothache, so his dentist gave him painkillers and referred him to an oral surgeon. Samuel took the pills and felt better, so he never returned for another visit.
"I've done that with dentists," the judge jokes.
But Leff raises a more serious concern. Apparently, Samuel's urine samples have been too dilute to get an accurate drug test. "I've spoken to him over and over again about not drinking too much water before he comes in," Leff says.
Crawford offers a suggestion. "Do you want him to write you an essay about it?" he asks. "I don't want to let this pass, but I'm wary of flying off the handle about it." After a brief discussion, the group decides not to hit Samuel with a legal sanction, such as community-service time.
Guinea pigs and toothaches aren't typical fodder for judges, prosecutors and public defenders, especially in one of Vermont's busiest criminal courthouses. But this isn't a typical court. One morning each week, Judge Crawford presides over the Chitten- den County Mental Health Treatment Court, a new and innovative approach to dealing with people who are mentally ill and break the law.
Launched in 2003 with a two-year, $150,000 grant from the U.S. Department of Justice, mental health court is Vermont's newest addition to the so-called "specialty" or "problem-solving" courts. Like drug court, family court and truancy court, it takes a more holistic and enlightened approach to addressing the root causes of criminal behavior.
The concept of mental health court is surprisingly simple - and remarkably effective. The premise is that it does little good, either for offenders or society as a whole, to lock people up for crimes they commit because of their disabilities. Instead, mental health court helps people modify their behavior by getting them into treatment and counseling. There, they learn the coping skills they need to manage their mental illness and, it's hoped, stay out of trouble.
The success of Vermont's first and only mental health court is due in large measure to the efforts of Wolford at the Howard Center. He wrote the initial DOJ grant and now supervises the court's two case managers. Wolford sums up the court's mission this way: "We want to reduce crime. We want to increase public safety. And we want to help these people take a look at ways of improving their own quality of life."
For the next 45 minutes, the mental health treatment team, as it's known, reviews 18 other cases and four new referrals. The topic of conversation ranges widely, from clients' drug and alcohol addictions to their employment status, to the ups and downs of their relationships with spouses, family members and co-workers. At one point, it's decided that one client will have to buy a cell phone so his case manager can remind him about his court appearances.
Strikingly, unless there's been a new offense, there's almost no mention of these people's crimes, most of which are minor. In fact, the people on this docket aren't even referred to as "offenders" or "defendants"; they're "clients." Also missing is the vocabulary normally heard in criminal court - references to bail, probation, plea bargains and jail time. Simply put, everyone in the room seems focused on a common purpose: the well-being of each client.
When it's time for court to begin, Crawford dons his black robe. "OK," he says, heading into the courtroom. "Let's go meet the troops."
Mental health court is designed for adult lawbreakers who have persistent mental health problems, such as schizophrenia, paranoia, clinical depression and borderline personality disorders, and who are deemed competent to stand trial. According to Wolford, about 90 percent of them also have substance-abuse problems.
Typically, their offenses are what are considered "nuisance" or "quality-of-life" crimes, such as disorderly conduct, unlawful trespass, drug possession, burglary and retail theft. Occasionally, the court will hear felonies, such as arson, DWI and low-intensity assault, though all cases must first be approved by the state's attorney's office. Certain crimes are automatically disqualified. For instance, the court won't take matters involving drug dealing or trafficking, significant bodily injury or death, sex crimes or other serious felonies that have a major impact on its victims.
Wolford emphasizes that mental health court doesn't let people off the hook for their behavior because they're mentally ill - far from it. In order to participate, an offender must first admit his or her guilt, and then sign a contract agreeing to the terms of the program. They include frequent - weekly or biweekly - court appearances, active participation in a treatment plan and random drug testing, when appropriate. The three-phase program lasts about a year.
Clients who follow the rules and stay out of trouble earn incentives for good behavior, including gift certificates, movie passes and trophies. Those who break the rules, use drugs or re-offend are sanctioned, often with community-service time, or else they're terminated from the program. Occasionally, a client will spend time behind bars.
Supporters of mental health court point to the scale of the problem they're trying to address. As the justice department reported last week, a record 7 million adults are now incarcerated in the United States, an increase of 35 percent in the last 10 years. That's 3 percent of the U.S. population, or one in every 32 Americans, behind bars, on probation or on parole.
A disproportionate number of those offenders are mentally ill. A 1999 study by the Center for Mental Health Services showed an estimated 16 percent of inmates suffering from "serious mental illness," compared to only 5 percent of the general population. Another survey, released in September by the justice department, found that 56 percent of all inmates have a "mental-health problem," such as major depression, delusions, hallucinations, psychotic disorders or symptoms of mania.
The figures for Vermont vary widely depending on how "mental illness" is defined. According to Susan Wehry with the Vermont Department of Corrections, only 5 percent of the state's prison population meets the statutory definition for a "serious mental illness." However, about 35 percent of state inmates receive some mental health services, and around 45 percent take psychotropic medications. That makes the state prison system Vermont's largest dispenser of psychotropic drugs.
The reasons for the prevalence of mental illness behind bars are evident to anyone who works in the criminal justice system. In recent decades, funding has been slashed for community mental health services, psychiatric facilities around the country have closed, and patients have been deinstitutionalized. Prisons and jails are now the de facto dumping ground for the mentally ill. Families who either can't afford psychiatric care for their loved ones or can't find adequate services in their own communities often have no other choice but to call the police when a family member is in crisis.
As a result, the nation's courts are now clogged with mentally ill offenders who have often committed trivial offenses. When they become repeat offenders, judges and prosecutors have no other option but to incarcerate, draining precious resources from the serious offenders who pose a true threat to public safety.
The justice department responded to the problem by funding about 150 mental health courts around the country. At a time when there's so little optimism about crime and punishment, mental health courts have earned ringing endorsements from prosecutors, public defenders, judges, cops and families.
T.J. Donovan, Chittenden County's newly elected state's attorney, says the criminal justice system must move in the direction of specialty courts such as this one. "We can't continue putting the problem on someone else," he says. "I have no problem sending people to jail. But the question is, is jail the right place for everybody? Clearly, for many people, it's not. I see this as a much more effective way of not only holding people accountable, but also addressing their underlying illness."
Richard Haesler, managing attorney for the Chittenden County public defenders' office, agrees. "Almost everyone who is incarcerated is coming out at some point," he says. "So the question is, when they come out, what have you gained by incarcerating them? With the mentally ill, almost invariably you've gained nothing."
To understand why mental health court works, it's worth seeing it in action. What's immediately obvious is how the prosecution and defense are able to move outside their traditional roles as adversaries. The due-process rights of the accused are clearly a priority. But as Judge Edward Cashman, one of the state's leading proponents of mental health court, is reported to have remarked, "This isn't about fact-finding. It's about problem-solving."
"Typically, prosecutors are trying to assign fault. So you have to step away from that, to some extent," notes Justin Jiron, a Chittenden County deputy state's attorney. "They have a lot of skepticism about any kind of event where there's a shifting of responsibility from the person to some other factor, like society or their medical history. That takes a while to get used to."
Judge Crawford takes his seat and calls the first client. There's no pounding of the gavel, and he speaks in a soothing, non-threatening tone. "Why don't we start with Scott?" he says. "Scott, you want to come up here?"
A 41-year-old unshaven man with long, black hair, an untucked flannel shirt, hunched shoulders and frightened eyes cautiously approaches the judge. He's flanked by his public defender and his case manager. Typically, most of the court's proceedings occur at the bench, often in subdued tones. Throughout the discussion that follows, the judge smiles often and never raises his voice.
Scott was first diagnosed with mental illness at 17, according to his mother. Since then, he's had repeated run-ins with the law, none very serious. Though he's never acted aggressively toward anyone, she says, he sometimes becomes angry, agitated and confused. In the past, he's been found wandering in traffic. Most recently, Scott was arrested for brandishing a sword in public.
"How are you?" Crawford asks. "Making any headway?"
"I'm trying to," Scott mumbles.
Crawford: "It's good to see you."
Scott: "Thank you."
Crawford: "I wrote a note and sent it to the Burlington Housing Authority for you, to see if we can support your application for an apartment there."
Scott: "I hope that goes through."
Crawford: "I hope it does, too. It'll be a great thing for you. And, I wrote to your doctor about the dog."
Judge: "I'm hoping that you two can work that out together . . . Any chance we can persuade you to take your medication?"
Scott: "Um, yeah, whatever you say. I just get upset sometimes. They said they may have to raise my diazepam."
Crawford: "How do you feel about that?"
Scott: "Well, I don't like the anti-psychotics or any of that stuff. They just cripple you. I like the drugs that make you feel better."
Crawford: "Do you think it's worth giving it a try with the new prescription?"
Scott: "Um, no. But I'll do it anyways."
Crawford: "That's fair . . . How's your guinea pig?
Crawford: "What's his name?"
Scott: "Tweet. For the sound he makes."
Crawford: "That's nice. Thanks for coming in."
Scott: "Take care, your honor."
The next case involves "Betty," a twentysomething woman. For a while, she and the judge chat about how she spent Thanksgiving. Then Crawford asks Betty about her job at a local store.
"Actually, they suspended me without pay unless the most recent charges are dropped," she says.
"Well, we'll put our heads together and see what we can figure out," Crawford replies.
Next, Betty asks for permission to spend the weekend in New Hampshire with her father. Crawford checks with her probation officer and the state's attorney, who nods his silent approval.
"It's fine with me. I'd like you to see your dad, so you're good to go." Crawford say tells her. "Come back next week to see us."
"OK! Thanks!" Betty says, like a teenager whose father just lent her the car.
Not everyone in this court is as relaxed as Betty. Some say little, if anything, during their hearings; others mumble only a word or two in response to questions. Others fail to show up at all. But, unlike in a traditional courtroom, clients here may have a family member and case worker by their side for emotional support. For individuals who find simply leaving the house a traumatic ordeal, these modest concessions can significantly improve their interactions with the system.
District Judge Jim Crucitti was Chittenden County's first mental health court judge three years ago. He admits he was initially "quite skeptical" about the idea. He recalls a case from his early days with the court, when a man came before him who had paranoid delusions that assassins were after him. The man was so terrified, he'd only stand at the back of the courtroom, his hair covering his face and his eyes glued to the floor. At first, Crucitti doubted he'd make any progress.
Two and a half months later, Crucitti says, the man was standing at the bench, his hair neatly trimmed, looking him in the eye and discussing his plans for the weekend.
"I found it to be incredibly successful," Crucitti says. "By far, it's the most positive thing you ever do in court. Once a judge does it, they're changed. They get a whole different mentality of how useful we can be."
Judge Crawford expresses a similar sentiment. "I really like it," he says. "Without overdoing it, it's more like being a parent than a judge.
"These people are trying as hard as they can. They're holding their lives out for you to see," he adds, cupping his hands to demonstrate, "and they're doing their absolute best."
Others who work with mentally ill offenders echo these views. "The work I did over there for the past three years was quite possibly the most rewarding and most meaningful work I've done," says Haesler in the public defenders' office. "I could see it working. I could see people whose lives were completely broken being reconfigured in a manner that allowed them to take ownership of their mental health and, more significantly, rebuild their lives."
Lieutenant Kathleen Stubbing is the Burlington Police Department's liaison with mental health court. She describes her role as "an ally" to its participants. Stubbing says she's noticed that many of the names she'd normally see "coming across my radar" are no longer creating problems for the police.
"We've seen some very serious and violent criminal acts just stop," Stubbing says. "Some of the folks in mental health court have a violent history, and now they're not re-offending. That's an impressive feat."
The statistics bear out Stubbing's anecdotal observations. According to Wolford, mental health court has significantly reduced recidivism rates among its participants. Mental-health workers have also documented graduates of mental health court needing fewer crisis interventions than before they entered the program.
Likewise, the Vermont State Hospital has seen a precipitous drop in its admissions of mental health court participants. A two-year study showed 70 admissions by such clients before they entered the system, and fewer than five afterwards.
Not surprisingly, mental health court is more time- and labor-intensive than is traditional court. But, as its supporters point out, the savings are reaped elsewhere in the criminal justice system. At a time when Vermonters pay $42,000 each year to incarcerate a male inmate and as much as $72,000 for a female inmate - more per year than the state now spends on higher education - the court's annual budget of $88,000 sounds like a bargain.
Beyond the financial benefits are the intangible human savings. Scott's mother recalls how heartbreaking it was for her to see her son brought into a criminal court shackled at the waist, his face contorted in fear and bewilderment. Mental health court, she says, has been an entirely different experience.
"I really feel positive about this mental health court," she says. "It's the one thing in the whole system I've seen in all these years that's positive. I just hope and pray it continues, for everyone involved."
Where would her son be now without this program? "I really feel that if Scott hadn't had this humane interaction, he'd probably be in jail," she says. "Or he'd be in the Waterbury asylum and never get out."
Detractors of mental health court are hard to find. Larry Lewack is the executive director of NAMI-Vermont - the National Alliance on Mental Illness. He admits that some advocates for the mentally ill - though not him - voice concerns that mental health court is a back-door means for coercing people into accepting treatment for mental illness, specifically, the use of psychotropic drugs.
Lewack dismisses that criticism. "My sense is that the civil rights concerns are overstated," he says. "If anyone is worried that they'll be ordered to participate in treatment, then the logical choice is, don't participate in mental health court. It's totally voluntary."
In fact, Lewack's biggest concern is that mental health court isn't available for all the Vermonters who need it. He'd like to see the legislature fund similar courts in Windsor and Bennington counties as well.
For his part, Wolford says there's no shortage of potential clients in Chittenden County. Currently, the court has 20 participants and at least four more on the waiting list. With an additional case manager, he says, the court could easily handle 30 people.
Perhaps the biggest testament to the court's success came from a man who'd gone through the program. It was Judge Cashman's last time on the bench, Stubbing recalls. "One individual who didn't need to be in court that day came in just to say good-bye to him. That's powerful," she adds. "It doesn't get any better than that."