'It's not illegal to be mentally ill' - East Valley Tribune: Health

'It's not illegal to be mentally ill'

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Posted: Sunday, January 14, 2007 5:15 am | Updated: 7:48 pm, Fri Oct 7, 2011.

Terry stayed still in the spotlight of the police car, one foot on a concrete bench that he had slept under minutes before. He lifted his eyes occasionally toward the Phoenix police officers who huddled close by, deciding what to do with him.

Officer Dave Beauchamp approached him, guarded and ready for a possible fight. His line of questioning wasn’t about broken laws, though.

“My preference is to get you the help you need,” Beauchamp said.

Terry, a lean man in his 20s with short cropped hair, kept his jaw tight between short statements. He had quit taking the medication for his mental illness, he explained, and he now used methamphetamines instead.

“You look exhausted,” Beauchamp said. “I’m ready to fall asleep just looking at you.”

Beauchamp’s partner, Nick Margiotta, made a late-night call to Terry’s case manager, who came and persuaded him to enter a detox program voluntarily.

“We’re not trying to solve his problem,” Margiotta said. “We’re just trying to get him to the people who will solve his problem.”

Beauchamp and Margiotta are cops with an “extra tool” on the streets: special training for interacting with mentally ill people and navigating the behavioralhealth system. That training is just one of several new approaches the criminal justice system has taken recently in Maricopa County to adjust to the long-held philosophy of integrating mentally ill people into society rather than institutionalizing them.

Maricopa County has poured millions of dollars into expanding courts and launching programs designed to get mentally ill people treatment and divert them from jail, which authorities say isn’t geared for their special needs.

Jail diversion efforts can backfire, though.

The care for indigent mentally ill people falls to state contractor Value Options, which is accused of negligence and medical malpractice in a rash of lawsuits stemming from the deaths of innocent people and police.

THE REVOLVING DOOR

A social worker, defense attorney, probation officer and court commissioner monitored the life of a 37-year-old Mesa man who had a history of domestic violence, sex offenses and bizarre behavior.

But they couldn’t be there at 3 a.m. as he called his probation officer 14 times over the next three hours to rant about his displeasure with her. He had quit taking his medication long before, he said, and stashed about 1,200 pills in his apartment.

“You have overstepped your boundaries,” the man said menacingly.

Five days later, his group of caretakers agreed he needed to be committed to a mental hospital and jailed for a while after his discharge.

“He’s going to explode in court today,” defense attorney Tammy Wray warned, an hour before his proceeding.

There was no fight in him though, only sobs, as two burly deputies stood nearby to arrest him.

Commissioner Michael Hintze of Maricopa County Superior Court warned him that a long prison term was in store for him if he didn’t cooperate with him and the other professionals.

“Hopefully, we can give you the tools for your success,” Hintze said.

The 37-year-old man is one of more than 18,000 people in Maricopa County who are considered “seriously mentally ill,” or SMI in government parlance. They receive state benefits because they have been diagnosed with one of a variety of mental illnesses and have been incapacitated for a certain period.

Although Hintze threw him in jail, that’s not where the commissioner or Maricopa County leaders would prefer him or most other SMI defendants to go.

“Public safety is always paramount, but there are certain populations that don’t need to be in the jail or can be better served outside of the jail,” said Amy Rex, the county’s Justice System coordinator. “We need to change the way we manage our jail population or we’re going to go bankrupt”

Deinstitutionalization dropped the population of the nation’s mental hospitals from 560,000 in 1955 to 100,000 in 1996, according to a U.S. Surgeon General report.

But the nation’s jails and prisons housed more than 283,000 people considered mentally ill in 1999, four times the number in state hospitals.

USING JAILS AS MENTAL HOSPITALS

According to a report this year by Barnes and Associates, there are 300 inmates in Maricopa County jails on any given day who are SMI.

Sheriff Joe Arpaio often boasts about how he keeps costs low in housing inmates — $62.29 per day per inmate, or about $22,700 per year.

But a mentally ill person’s incarceration costs more. The U.S. Department of Justice estimates it costs about $50,000 to hold a mentally ill person for a year.

The Maricopa County jail system has the largest psychiatric hospital in the state with 120 beds. The facility is run by Correctional Health Services, whose 2006 budget was $46 million.

Hintze, who presides over the SMI Probation Violation Court, where more than 600 SMI criminal defendants are monitored on probation at any time, gives the jail psychiatric unit credit for doing its best. But the facility is overburdened.

“Sometimes (SMI inmates) just do not receive the necessary mental health treatment for them to be functional,” Hintze said.

FINDING OPTIONS TO INCARCERATION

In the last 18 months, Maricopa County has implemented a number of jail diversion programs at the suggestion of the Commission of Justice System Intervention for the Seriously Mentally Ill, led by county Supervisor Don Stapley, R-Dist. 2 of Mesa and Scottsdale.

The County Board of Supervisors this fiscal year approved:

• $551,880 for the sheriff’s office to hire mental health professionals to assist deputies on the streets in determining whether suspects should go to jail or a mental hospital;

• $323,218 for a new commissioner and staff to hear cases involving SMI defendants and defendants deemed incompetent to stand trial;

• $104,000 for two workers to monitor defendants whose mental competency has been restored and to coordinate SMI cases between the various courts.

• $400,000 for a jail program to treat people who are diagnosed with substance abuse and mental-health problems.

Two projects in the planning stages for the county are to link lower courts into the Superior Court’s pool of information on SMI defendants and work with the state in building transitional housing for SMI people released from prison. The latter project is expected to require about $2 million from the state.

One of the biggest changes in recent years has been to establish the Comprehensive Mental Health Court, which has existed since 2005 and is the brainchild of Judge Barbara Rodriguez Mundell, the county’s lead judge.

Mundell said she saw the need for such a court when she was a probate judge. Her many duties included committing people into mental hospitals against their will.

Mentally ill people who are involved in probate court often also have cases in criminal court, where issues of mental competency must be resolved before trial or plea agreements can be reached.

Most of the time, there was no coordination between the psychiatrists, attorneys, social workers and judges assigned to a person’s cases in the various courts, leaving the person with fragmented care, Mundell said.

COORDINATING EFFORTS

“I would see a revolving door,” Mundell said. “Why do we want for these people to crash and burn before we find them help.”

Getting them that help is part of Hintze’s job. Under the Comprehensive Mental Health Court, Hintze presides over courts for people who have been declared incompetent to stand trial and another in which he monitors as many 600 SMI defendants who are on probation.

Hintze holds court each Wednesday for this latter group.

During the two hours before he raps his gavel, he meets with the defense attorney and prosecutor assigned to his court, as well as the various probation officers and social workers from the state’s behavioralhealth contractor, Value Options, who are assigned to the individual defendants.

Over bagels and juice, they discuss the progress of each defendant scheduled to appear before Hintze later.

These are some of the sickest of the sick, and dealing with the ones who function best is still challenging for the professionals who are gathered around Hintze’s conference table.

The objective is to keep them taking their medication, making their doctor appointments, meeting their social workers and probation officers — and most of all, keeping them out of jail.

Stapley said Hintze’s probation violation court is an example of how the justice and mental-health systems should work together.

Stapley is chairman of the Commission of Justice System Intervention for the Seriously Mentally Ill, which advises the Board of Supervisors on matters pertaining to the seriously mentally ill in the criminal justice system.

The criminal justice system historically has been ill-equipped to handle mental illness, mostly because there are so many adversarial parties, Stapley said.

Hintze’s court puts them all at the same table, where he says information is shared.

“They all have to deal with their piece of the problem,” Stapley said.

ON THE FRONT LINES

Phoenix police officer Nick Margiotta cackles when he laughs and he laughs a lot, but that is no indication of how serious he takes his job, just how much he loves it.

Margiotta’s niche is the mentally ill, developed from 11 years patrolling central Phoenix, where there is a large population of homeless, most of whom are mentally ill.

His job satisfaction is found in the very reason why many people join the police. “They want to help, they want to make a difference,” Margiotta, 40, said. Margiotta knows all of the cracks and shadows on the streets where the homeless seek shelter and he also knows how to navigate Maricopa County’s social services network. He imparts his expertise to fellow officers who take a 40-hour class called Crisis Intervention Team, where officers also learn about mental illness and what it is like to be mentally ill.

On the street, he and his partner of nine years, Dave Beauchamp, carry their handcuffs, handguns and traditional police training, but they spend more time trying to get help for those they come in contact with rather than reading them their rights. On an October night, they visited a 54-year-old developmentally disabled man who they found housing, furniture and utensils for after he spent 10 years on the street. The man, sitting in his austere apartment, flicked ashes into his palm as he spoke with them.

“I gotta’ get you an ashtray, mister,” Margiotta said. And they also said hello to a man in a wheelchair who lived beneath a highway overpass and kept his urine in jugs for some unknown reason. The people he works with leave Margiotta impressed because they still manage to get by despite their extreme barriers. “He’s a survivor,” Margiotta said, as he left the man in the wheelchair. “This guy will never die.”

Some people will cuss at Maricopa County Superior Court Commissioner Michael Hintze. Some will cry, while others will stare blankly at him. Most of these people are medicated with powerful, mindaltering drugs, and some might be under the influence of illegal drugs too.

But Hintze, who has presided over courts specially designed for the mentally ill since 2005, loves his job.

“I’m just absolutely fascinated with the mind,” said Hintze, who has spent much of his career working with the mentally ill.

The defendants he sees not only have the extra burden of mental illness to begin with, but, by the time Hintze sees them, they are usually angry at most of the people in the justice and mental health systems, he said.

“I welcome them to the court and try to redirect them,” Hintze said. “Having a mental illness doesn’t give you a right to be disrespectful or rude.”

He’s part of the Superior Court’s Comprehensive Mental-Health Court, and the courtrooms he presides over aren’t necessarily meant for dispensing justice. They specialize in keeping seriously mentally ill defendants who are on probation out of trouble and restoring defendants’ rights to stand trial who were previously considered mentally incompetent.

His case load is about 600 defendants, and they are some of the most difficult ones to work with. But the assignment has plenty of gratification.

“There’s nothing better than seeing someone reconstituted after a severe decompression get back to life,” he said.

Hintze’s boss, Judge Karen O’Connor, said he brings a boundless enthusiasm, a unique compassion for a person’s circumstances and immense patience — a requirement for that court.

“He’s very upbeat about an individual’s progress or even if they’re not making progress, he’s very optimistic about their outlook,” O’Connor said. “And I think that transcends into their perspective on their situation.”

The stigma of mental illness doesn’t stop Scottsdale resident Dick Robson from speaking about his. In fact, Robson trains a speakers bureau of mentally ill people known as “In Our Own Voice” to present their experiences to nursing students, new employees of the state’s behavioral health provider, state employees and police.

“It’s somewhat of a therapy itself talking about the symptoms and disease,” Robson said, explaining why he was so at ease talking about his mental illness.

At an August training seminar for police officers held in Mesa, Robson brought with him a man and woman who had both seen “dark days” of mental illness and had bad experiences with police.

The officers, captivated and curious, wanted to know how to better interact with them, what they found insulting and how to calm them down when they are in a crisis.

“If a police officer touched me, I wouldn’t appreciate it,” the woman said.

“I think asking about medication is a good thing,” the man said. “It brings you back to reality.”

Police officers are usually stoic at the beginning of the presentations, but they usually are shaking hands and sharing laughs by the end.

“We see we get through to these guys,” Robson said.

Robson’s authoritative knowledge comes not from just his own mental illness but from his father’s and grown son’s.

He said his family takes a matter-of-fact approach and tries to separate the person from the illness.

“You’ve got to accept it. It helps with dealing with it and helps your mental outlook on it,” he said. “Our family is much stronger now with mental illness than we were before.”

TOOLS FOR POLICE

Matt, a Scottsdale artist, tells a classroom of about 30 cops that he began hearing voices when he was 24.

Since then, he’s frequently been in and out of jail.

Medication has driven away his belief that spy satellites and an espionage team were watching him, waiting for a chance to beam pain into him.

He believed the police were part of the conspiracy whenever they arrested him.

The officers are curious to know more about the voices, so they ask questions respectfully and gently.

Matt tells them it was “torture” to hear “hostile and intimidating” voices nonstop coming from television sets, vents and car engines.

Much of the time, they made death threats or urged him to kill himself.

“Actually, the voices told me to kill a friend, and I told the friend,” Matt said. “He got scared.”

Matt laughs and the cops laugh with him.

Matt told his story at an August session of Crisis Intervention Team Training, a 40-hour class presented quarterly by Phoenix and Mesa police departments and Value Options. Officers learn about mental illness, how to interact with the mentally ill and how to navigate Maricopa County’s mental-health system.

DAILY ISSUE FOR POLICE

The class in August was filled with officers from various Valley law enforcement agencies whose experience ranged from a rookie to a 20-year veteran. They were all street cops — the ones who get the call when someone is in the throes of a psychotic episode.

“How many of you thought that when you joined law enforcement you’d be an integral part of the mental-health system,” asked Dick Robson, one of the guests who spoke about his personal experiences with mental illness.

Memphis, Tenn., police developed the training after they fatally shot a mentally ill person. The Phoenix Police Department began its own program five years ago. Mesa police became involved in 2004, a little more than a year after officers shot and killed a suicidal teenager in one incident and a woman with a record of mental instability in another case.

The Mesa shootings were within weeks of each other and sparked an outcry from the public and mental-health advocates for the city to improve its officer training.

Margiotta, who has patrolled central Phoenix for 10 years, and Tom Gussie, Mesa’s training coordinator, organize and lead the training. The first thing stressed to the officers who must face the dangers of someone who is wielding a knife and hallucinating is that officer safety is paramount and that the new training doesn’t replace their guns, radios or other tools they use for survival.

Lt. Anthony Vasquez, who oversaw the training for more than two years for Phoenix police, said an officer shooting is a “no-win situation,” but if necessary, they must put “two to the chest and one to the head.”

Although only a microfraction of all police encounters with mentally ill people turn deadly, the officers interact regularly with mentally ill people. These cases are usually misdemeanors and can frustrate an officer.

Joe Prawdzik, a Value Options trainer and a former police officer, said a common way police used to solve problems with the mentally ill was to simply drop them off in another jurisdiction.

Today, police can call Value Options to dispatch social workers to take over a call if it is more of a mental health matter than a police matter. Police also get preferential treatment from the behavioral health provider, so officers can drop off someone at a treatment center and be back on the street within minutes.

“This other side of the table is reaching over to us,” Margiotta said, pointing to Prawdzik.

DILEMMA FOR PATROL OFFICERS

But when people aren’t a danger to themselves or others, neither the state nor police can force them into treatment.

And if no crime is being committed, then officers can’t throw a mentally ill person in jail.

“It’s not illegal to be mentally ill,” Margiotta said.

Officers don’t just learn the ins and outs of Value Options and the law in the special training. They also learn about the various mental illnesses.

An officer who knows certain behaviors of someone in a psychotic state can mean the difference between jail or treatment.

For example, an officer interacting with someone exhibiting echolalia — behavior in which someone repeats someone else’s words — might believe that a person is simply being obnoxious and uncooperative, Margiotta said.

Most of Margiotta’s and Beauchamp’s work involves the homeless, most of whom are either mentally ill or developmentally disabled.

But many of the homeless don’t want help, so police must strike a balance between the public’s interest of cleanliness and order and the homeless populations’ living needs.

On a chilly October evening near the bright lights of the Arizona State Fairground, Margiotta and Beauchamp came across a homeless man who called himself “Mr. Smith” sleeping on private property. The doorway of the business and a shopping cart packed with his possessions served as shelter for the cot on which he lay.

Mr. Smith’s feet were left as stumps from some untreated ailment or injury, and his body odor was tangible.

Margiotta kneeled down to speak with the man and noticed his foot twitching, a mannerism he says people in a psychotic state will exhibit when scared.

“He’s having a real hard time even though we’re being gentle,” he said.

Mr. Smith declined their offers to get him social workers and doctors to see him. He wasn’t committing any crimes and there were no signs prohibiting trespassing, so they leave him.

“An officer could easily get frustrated with him,” Margiotta said. “But is that a guy you want to put in jail?”

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