By Sean Boone
Treatment Of The Mentally Ill In The Criminal Justice System
On the evening of May 14, 2008, Sheila D. Jackson, 49, reportedly threatened her neighbor with a kitchen knife. When two Pensacola Police officers arrived at her W. Jackson St. residence for questioning, she let them in and denied possessing the knife described in the report.
Instead of a knife, officers found a rock of crack and a broken crack pipe in the home that warranted her arrest.
Jackson went through several judicial hearings late last year for her drug charges before ultimately being ruled incompetent to stand trial by Circuit Court Judge Linda Nobles on Jan. 7.
Although she posted bail and was never prosecuted, she was incarcerated at the Escambia County Jail until she could be transported to the state mental hospital in Chattahoochee.
But Jackson never made it out of her cell.
On Jan. 21 she died from health complications. Her case files show she had a Project AIDS counselor, so AIDS may have been a factor.
There are several questions that surround her case: Was the medication that she received in the jail infirmary adequate for her health problems? Should she have been in a local hospital instead of the infirmary? Was she too much of a threat to herself and others to stay out on bond until she was admitted to the state mental hospital?
Her autopsy is scheduled to be released later this month, which could raise additional questions regarding the circumstances surrounding her death.
Two things are certain, however. She is not alone-and a jail cannot take the place of a mental hospital.
Jackson is just one of an estimated 15,000 detainees currently being held in county jails around the state on any given day who experience serious mental illness. She is also one of an estimated 1.3 million mentally ill that find themselves behind bars in the U.S. each year.
Because many counties like Escambia do not have a court system that focuses on those with mental conditions, many offenders-such as Jackson-find themselves back in police custody for petty crimes.
“My personal and professional opinion is that jails are the new mental health asylums,” says Escambia County Jail Detention Commander Fred Alford. “We should not be housing those with mental health issues and (Jackson) is a prime example of a person that would have done better in society than in a closed jail setting.”
Alford is a proponent of creating a mental health court in the county, which would give those who qualify a chance to avoid jail by allowing them to receive psychiatric visits in either a group home or their own homes for a period of time and then have their charges dropped once they complete the program.
Health courts have proved successful in other Florida counties, including Okaloosa, which is the only one in Northwest Florida.
Sarah Kilpatrick, a public defender and head of the mental health court in Okaloosa County, says the program she runs is now in its fifth year and is operating with two court dates per month and approximately 10-20 people enrolled at a time.
“They are referred to our mental health counselor by either someone from jail, me or their judge,” she says. “The counselor evaluates to see if the mental illness is causing the crime, then they are accepted into the program. Rarely is anyone turned away.”
Kilpatrick says the participants file a plea of no contest, and if they are able to complete the program, they can drop the plea and have a clean criminal record. If they have a felony, it is usually lowered to a misdemeanor.
“Our goal is to get them in a better shape so they won’t commit crimes again. Obviously programs like this help. If we could arrange them in circuit courts elsewhere it would really help.
“Recognizing the people in this situation is the key. You’ve got to be able to understand where they are coming from.”
EXPENSIVE TREATMENT
Understanding the situations of the mentally ill is one thing, but finding the money to treat them is another.
According to Alford, the Escambia County jail spends roughly $105 on each mentally ill inmate per day. If one of those persons is incarcerated for one year, the total cost equates to more than $38,000.
Alford says the state gave the Lakeview Center-the county’s main mental health facility-$2.5 million for a forensics program last year to help keep the mentally ill out of jail, but the money was not reoccurring.
“Sheila Jackson would have been a prime candidate for this, and it would have been at much lower cost to the jail system, not to mention that she could have been out in the community,” he says.
The grant money was for people with acute mental illness that have been in and out of the judicial system. The majority of the candidates were placed in a house at Lakeview and maintained in the community by caseworkers, who helped keep many from going back to jail or the state mental hospital by checking on their medication and appointments.
Programs such as the one at Lakeview cost less than sending a patient to the state mental hospital.
The Florida Department of Children and Families reported a $189.32 cost per day to treat a person at the state mental hospital. Overall, it cost approximately $134 million to run the facility during the 2008 fiscal year.
During the year, the state facility treated 62 patients from Escambia County, who cost the state nearly $4.3 million to treat-$1.8 million more than the Lakeview forensics grant.
But with a budget deficit and programs being cut nationally and at state levels, obtaining money for new and previously terminated mental health programs will not be easy.
According to the Florida Alcohol and Drug Abuse Association, $16.1 million in state money that has been used for crisis stabilization beds, alcohol detoxification beds and treatment beds, and slots for substance abuse and mental health emergency services and services to children and families has shifted from annual recurring to nonrecurring funding.
The association also reports a 22 percent reduction in community substance abuse beds statewide and predicts a cost of $2 million to the state if these offenders go to prison this year.
Some like Dr. Lawrence Gilgun believe a change in community attitudes might be the first step in addressing the growing financial problem.
“It’s not an ideal setting, but jails are forced (into taking care of the ill) because of our society,” he says. “The public doesn’t want to spend money on criminals because they don’t see the real face of the common criminal, who is not what is projected in the movies.”
Gilgun, a clinical psychologist with a specialization in forensics, evaluates roughly 30 patients in the state Dist. 1 Circuit Court each month.
He also says many people would never be a part of the system if there were more free mental health clinics available.
“If you don’t have insurance and you are mentally ill, then you are in a world of hurt,” he says. “It’s rough. Social benefits are being cut, which definitely means mentally ill people aren’t getting the services they need.
“There are a lot of folks that don’t have total control. We probably need to build fewer prisons and more psych facilities and drug facilities.”
Last year, the Florida Partners in Crisis (FPIC) organization was at the forefront of the creation of the Community Mental Health and Substance Abuse Treatment and Crime Reduction Act.
The $8 million dollar bill aimed to create more community forensic treatment facilities, mental health courts, crisis prevention and diversion programs. It was passed by the Florida House but was ultimately voted down in the senate.
The group, as well as several legislators, is pushing for it to be brought back up for the upcoming legislative session in the spring.
“If we can get that passed, that mental health act would give us everything we want to do for the next 10 years,” says Alford, who is a member of the FPIC. “What we’re looking at is just getting it passed. We’re not looking at funding until the economy gets better.”
DOUBLE JEOPARDY
Had Jackson been treated for her illness in Chattahoochee, she would have likely become a resident of the jail system for a second time while the court heard whether or not she could stand trial.
According to defense attorney Gene Mitchell, many of the mentally ill in Escambia County who go through the criminal justice system are jailed when they are initially arrested and incarcerated, and when they return from their mental treatment.
“Not only do you sit in jail for the first part of the process, but you are also (in jail) for the backside of the process.”
Mitchell says that because the judicial system often takes a good amount of time, many sit in jail for up to a month waiting for their new competency case to be heard. He questions whether the person could be placed back on bail instead of being held in the jail at the taxpayers’ expense.
“Imagine if you pay your bail and then you are found incompetent to stand trail,” he says. “What is the purpose of sitting in jail for a month?
“The whole role of the sheriff was to send Ms. Jackson to the state hospital.”
FRAGILE HEALTH
Before Jackson was found incompetent to stand trial, a letter from her Project AIDS counselor was faxed to public defender Paul John Hamlin: “Her health is fragile and I hope that her punishment will not be incarceration. If there is any alternative for her, please consider it.”
An e-mail was also sent to Hamlin expressing concern over Jackson’s “multiple health diagnoses, both physical and mental.”
While one can argue that a person with extreme mental health conditions would be better off under supervision, the idea of jailing a mentally and physically incapacitated individual who has not been prosecuted does not sit well with organizations such as the American Civil Liberties Union.
“This is not how you’d treat your family members,” says Northwest Florida ACLU Attorney Benjamin Stevenson. “Just because they have an illness doesn’t mean they should be treated differently.
“Why don’t we spend (the money it costs to hold her) on getting her help?”
Since 1996, the number of inmates in the state with mental illness has increased by 150 percent, according to the Department of Corrections. The department anticipates spending $3.6 billion over the next decade for mental health beds and services alone.
In 2006, there was an emergency bed crisis that cost taxpayers $16 million in emergency funding and $48 million in recurring annual funding.
But where do we point the finger for an epidemic that has spun out of control?
Stevenson says right at the top of the process.
“We are removing public funds for courts and public defenders,” he says. “The only thing (the government) isn’t cutting is funding for incarcerations.
“On top of that, we need to get serious about what these crimes are (that people are being arrested for).”
POSSIBLE SOLUTION
Tackling the problem directly with state funding or other help from Tallahassee is almost impossible, which is why most experts on the matter agree that implementing mental health courts in each county is the most effective solution.
One of the biggest and most successful mental health courts in the state is in Miami-Dade County. In the past few years the courts have branched out and created a Mental Health Task Force, which was formed after a 2005 county report showed how the criminal justice system was failing the mentally ill.
The report found that officers were not adequately trained to deal with those with mental conditions. The new task force trained more than 700 Community Intervention officers in the county.
Could a mental health court system be in Escambia County’s future?
According to Gregg Hall, the chief assistant for the District 1 Public Defender in Pensacola, it is.
“(Public Defender) James Owens and I were just talking about creating a mental health program (for Escambia) this past week,” he says. “James handed me a folder about it, and I’ll be working on something in the next few weeks.”
Commander Alford has also been in talks with officials about creating a new addition to our court system.
“Sheriff David Morgan and I met with Judge Kim Skievaski about the possibility of getting one started,” he says. “Skievaski gave Morgan the impression he wanted one, but there still is a monetary condition to get it started.”
Alford recommends using existing funds that are available and starting small.
“We could possibly start up small and wait for grants and funds,” he says.
While Escambia may be on the right path to achieving a mental health court, Gilgun cautions that the problem is certainly not skin deep.
“The whole process is fairly complicated and has become more so as things have gotten bigger and bigger,” he says. “The prisons and jails are loaded with mentally ill people, even though the vast majority of judges truly do pay attention to their evaluations.”
For Jackson and many other mentally ill who die in the hands of the criminal justice system, no evaluation seems valid.
“It just doesn’t make sense,” says Mitchell. “The process she went through is worse than some of those who have actually done something wrong in the jail.”
A Mental Sum
National statistics show that 1.2 million mentally ill are put behind bars each year.
In Florida, approximately 38,000 mentally ill are currently incarcerated in county jails
Escambia County Jail: The cost to provide food, medicine and housing to each mentally ill person is approximately $105 per day or $38,000 annually.
Miami-DadE County: The County spends $100,000 per day or $36.5 million per year on housing the mentally ill in prison.
Chattahoochie State
Mental Hospital : The annual cost to operate FSH, a 1, 042 bed facility covering 620 acres, is $133,912,116. From 7/1/07 to 6/30/08 1,915 individuals were treated, and from 7/1/08 to 12/31/08 1,434 have been treated. Cost per day is $189.32 per resident.