Mental health court: Trading treatment for shot at forgiveness
URBANA — An open bag of potato chips was her undoing. Or her lifeline, depending on your perspective.
The 28-year-old Champaign woman went in a local grocery store last summer during a psychotic episode, opened a bag of chips and began eating them. Her arrest for misdemeanor theft was her ticket into Champaign County Mental Health Court.
Eleven months later, she's no longer under the watchful eye of the team of legal and social service specialists who comprise the county's latest foray into alternative justice modes.
"When she graduated, it was because she had been taking groups and had signed up for another session. She was lucky. She got her conviction dismissed," said Lori Kleppin, the Champaign County probation officer assigned to the mental health court team.
Although the woman's criminal case is a public record, The News-Gazette is not using her name because of medical privacy. Further, anonymity for the defendants allowed attorneys and counselors to discuss their cases candidly.
To date, only three of the 13 people are considered graduates.
But Judge Jeff Ford, who oversees the court, prefers not to use that term.
"We don't want them to think they're done," he said of the lifelong process that managing mental illness is.
"With mental health court, the final goal is to have them stabilized with services they need in the future," said Ford, who also oversees Champaign County's other alternative justice model, drug court.
Both aim to deliver as many services as possible in about a year in hopes that the client will improve. Of the 13 in mental health court, five have entered since March.
Although similar in concept to drug court, the courts have differences.
The main one is that a defendant in mental health court is not sentenced. The defendant pleads guilty to a crime with a promise from the prosecutor that if the defendant completes the conditions laid out for him, the charge will be reduced significantly or dismissed at sentencing.
The conditions are tailored to the person's needs. Participation is voluntary.
Urbana attorney Brett Olmstead represents a recent referral.
The man pleaded guilty in February to forgery for writing checks on a parent's account without permission. Despite the number of times it had happened, the parent didn't want the son prosecuted. He had previously been sentenced to standard probation for another forgery.
"He had an apartment. He was doing really well. Then he started using (drugs) and stopped taking his medication (for mental illness), stopped reporting, and forged a check on Dad's account," said Kleppin, who had supervised his standard probation.
State's Attorney Julia Rietz, who is her office's team member in mental health court, said the man had been admitted to Provena Covenant Medical Center's psychiatric unit more than a dozen times and has substance abuse issues, depression, and bipolar symptoms, all of which are common among the mentally ill people whose actions attract police attention.
She and Olmstead agreed that mental health court appears to be the best idea for him now.
"This is my first experience with mental health court. I think it is the best placement for my client," Olmstead said. Far from having to persuade the man to try it, Olmstead said, his client wanted to be in the program.
Rietz said a better label might help the court's marketability. "Other places call it 'recovery court,'" she said.
On the man's first day in mental health court, Ford spelled out the conditions: no alcohol, no drugs, no weapons, sign releases saying the state can check into all number of aspects of your life, cooperate with counseling, submit to random drug testing, and attend all appointments, including Monday afternoon mental health court sessions in Ford's courtroom.
"You understand this is a team? We're going to talk about you and what you're doing every week. If you withdraw, since you've already pled guilty, I can impose sentence. In this program, you can be sanctioned. If you do well, we will reward you," Ford said.
(Ford said that unlike drug court, where a harsh sanction usually involves jail time, a sanction in mental health court might be picking up litter from in front of Community Elements. A reward can be anything from praise in open court to a gift certificate to McDonald's.)
"This sentence is going to be held over your head. If you cooperate and do everything you're supposed to, this will be a misdemeanor and the felonies will be dismissed. If not, if you mess up, you come back here and be sentenced on this forgery case. It could be the penitentiary or probation and fines," Ford explained.
That felony-dismissal, carrot-and-stick approach is a big deal to some, said Becky Griffith, a specialty courts clinician with Community Elements and mental health court team member.
"It's all different for everyone. For some, it (a criminal conviction) doesn't matter. For others, it's a huge deal because of jobs, futures, careers. I see that a lot with drug courts. Felonies make it very difficult to get jobs," she said.
Griffith observed that many clients with mental illness receive disability payments from Social Security, so keeping a conviction off a resume is of little consequence to them.
Trying to keep them occupied in appropriate activities is part of Griffith's job.
"We're helping them find structured activities like volunteering, group sessions, social skill learning — doing something besides sitting at home and isolating," she said.
Griffith's colleague, Ed Hawkes, observed that with drug court clients, the goal is to keep them drug-free and crime-free for at least a year.
"With mental health court, it's more harm reduction. Preferably, we'd like to see clean drug tests or not dirty as often," he said. "We try to get people to the maximum level of recovery for them."
Hawkes said that can include attending group sessions to learn skills for how to manage their symptoms and to function in the community.
"We're talking social, communications, living skills — even as basic as diet and hygiene, the kind of stuff that a lot of us take for granted," he said. "We get up, wash our hair, brush our teeth. We have people who don't think about it. They're in their own world and they don't even know they smell."
For the potato chip consumer, that episode was her first that attracted police attention, thus getting her into the criminal justice system.
"I've known her for a while," Hawkes said. "She's had schizophrenia since her early 20s. She was compliant with medication for a while, then started thinking she doesn't need it."
"Typically, people think they're OK, don't take their medication and end up in the hospital," he said, observing that happened to that woman.
Rietz and Ford both described her as low-functioning and not very communicative when they first saw her.
"Previously, I had seen her walking around the mall talking to herself when we first started. Now she ... smiles and has a conversation. She's still low-functioning, but she's regularly attending groups," Rietz said.
"Probably one of the most important things they did for her was give her a schedule, things to do to keep herself occupied and make sure she's taking her medication," Rietz said.
Although she's but one member of the mental health court team — others are Public Defender Randy Rosenbaum, Ford, and representatives from probation, Prairie Center and Community Elements — Rietz holds most of the cards.
That's because the ultimate decision on whether to pursue prosecution lies with her.
Rosenbaum said he was initially concerned that the time in mental health court between guilty plea and sentence could go on too long, with the sentence being held over his client's head.
"A lot of my concerns have been taken care of," he said, adding that the outcomes for the three who are now done with the program have been positive.
"All have a good foothold for what they have to do to stay out of trouble, and that is the success of mental health court," Rosenbaum said.
The other two successful clients were a woman who had hoarding issues with pets in her home and a man who threatened to harm mental health workers who answered a crisis line. They were in court almost 10 months and nine months, respectively.
Rietz said she's trying to take her cues from Hawkes and the other mental health and substance abuse workers as to how clients are doing.
"I have really encouraged the mental health professionals to lead the way rather than the judge and the attorneys," Rietz said. "If they say there are still things that can be done, we'll keep going. Once they say we've exhausted all the tools, I'll move to find someone unsuccessful."
That has happened to at least five people since the program's inception, Ford said.
Hawkes admits there is no standard treatment formula for mental illness. For those who self-medicate with alcohol and drugs, they first have to get control of their substance abuse through Prairie Center before moving on to the mental health issues.
"We have to use our best judgment from our experience (about what might work for a person). Some people we've known for a long time, we know their history," Hawkes said of how treatment plans are designed.
Hawkes and Griffith spend most of their time linking the person to the correct social service or treatment provider.
"We have to make sure they get to their doctor appointments, refer them to other services, coordinate with Prairie Center," he said.
Can the work be frustrating? Yes. Is it worth it? Yes, say team members.
"These are people with significant long-term mental health issues. Many also have substance abuse issues in addition to their mental health issues. It would be unreasonable to expect a quick cure," Rietz said.
"I think it's working," Hawkes added. "You can't expect to be a success 100 percent. Anybody you can help is going to reduce the overall cost in the long run. The people we got in needed the help and appreciated the help they've received. They didn't want to get charged with a crime."
Added Rosenbaum: "Certainly there are some things we could do better. We've improved over time. We have progress goals like what do we want them to accomplish. We need to improve on setting realistic goals. Everybody understands the goal is to get these people in the best position for them."