Improving Outcomes for Individuals with Co-occurring Disorders

At Reinvesting in Justice, Michael Young, chief public defender of Bexar County in Texas, talks about innovative programs to assist defendants with mental health challenges. The following is a transcript AVNI MAJITHIA-SEJPAL: Hello and welcome to the New Thinking podcast. This is Avni Majithia-Sejpal and I’m here in Dallas talking to Michael Young at the Reinvesting in Justice conference. Michael is the Chief Public Defender for Bexar County in Texas. Welcome Michael. MICHAEL YOUNG: Good afternoon Avni. MAJITHIA-SEJPAL: Can you talk about your panel today which just concluded and particularly your own contribution to it? YOUNG: This afternoon we participated in a panel for dealing with persons in the criminal justice system who have a co-occurring disorder. A co-occurring disorder means you’re charged with a crime, but at the same time you’re going through the criminal justice system, you’re suffering from a mental illness or an addiction or some other condition attendant to that criminal justice situation. Basically, the gist of the panel was myself, also Stephen Bush from Shelby, Tennessee, Shelby County, Tennessee, and Judge Marcia Hirsch out of New York. Each of them deal with the mentally ill in the criminal justice system through different programs. MAJITHIA-SEJPAL: What are some of the various challenges facing practitioners who are working with defendants who have co-occurring conditions? YOUNG: There are a lot of different considerations you have to think about. Obviously, if you’re dealing with someone who has a mental illness as a criminal defense attorney, one of your first considerations is: is this person competent to proceed? Do they understand the proceedings against them? Sometimes that’s a fine line when you have someone who’s suffering from a mental illness. Now, obviously, if you do have a mental illness, that doesn’t mean per se that you’re incompetent, but it’s certainly one thing that you have to be looking at. Another thing is I think you need to be prepared for a great deal of client contact because a lot of representing those who are mentally ill is developing trust. You will probably spend 10, 15 times the amount of time dealing with a client who has a mental illness over one who doesn’t because there are so many issues of trust, of explaining the process to them. It’s very time intensive. MAJITHIA-SEJPAL: I understand that you work specifically with indigent defendants dealing with mental illness. Is that correct? YOUNG: Yes. We have a mental illness defense team. They’re attorneys who represent persons who have a mental illness but are also charged with an offense. We’re also working at the jail during the initial booking process to represent those persons who have come into the criminal justice system but have a mental illness. MAJITHIA-SEJPAL: Can you tell us more about the program itself? YOUNG: It’s the first of its kind in the state of Texas. Right now, you are entitled to an attorney if you’re indigent, if you cannot afford to pay for one. The difference is: when do you get to see that attorney? It may be several days after your arrest before you actually are able to visit with your attorney. The program that we’ve initiated, we actually have public defenders at the jail, so immediately when you walk in the jail, if you’re identified as a person with mental illness, that public defender is your attorney from that moment forward. We determine if you have a mental illness through several different mechanisms. Law enforcement will talk to them and ask them questions about their mental health background. There’s also an ability to do what’s called a CCQ which is a Continuity of Care Query. There’s a database for people who’ve ever had a mental illness that’s maintained, and if we find that they have already a diagnosis for mental illness, we’ll begin representing them right then. That’s especially critical because these people are already in crisis. They’ve just been arrested. They’re going to see a judge. We want to make sure they don’t say anything that’s going to damage their case, and the primary focus of what we’re trying to do is find some type of community based treatment to send them to in lieu of them being booked into jail. It could be a homeless shelter if that’s their primary problem. It could be drug treatment if that’s a problem. It could be counseling. Basically, we try to connect that person with treatment in the community, and then we present it to the judge that, “Judge, if you give this person a bond, they are not going to go to jail, but they’re going to comply with this treatment that we’ve setup for them.” MAJITHIA-SEJPAL: You mentioned it’s the first such program in Texas. How long has it been up? YOUNG: The program was actually supported by the Texas Indigent Defense Commission. That’s the entity in Texas that was created as part of the Fair Defense Act which oversees indigent defense. They fund indigent defense through either discretionary spending or through grants if we have an innovative program, so we presented this as a grant proposal. It was funded effective October 1, so we’re very new into the program. MAJITHIA-SEJPAL: Wow. Was there a history there? Were you finding that in Bexar County there was a need specifically to work with defendants who are dealing with mental health issues? YOUNG: That’s a great question Avni. The Council of State Governments is really a national organization that’s focused on criminal justice reform. They did a study for Bexar County from April 2014 through February 2015. During that time period, there were 55,000 people who were booked into Bexar County Jail. They were able to determine that approximately 11,656 of those persons had a mental disorder attendant to their arrest, so that’s a large population that was not being diverted from the jail even though the county had setup programs, and there were a lot of community based programs available. During the time period of the study, only 125 of the approximately 11,000 were diverted from the jail. The goal of the program, obviously, is to increase the number of people we divert from the jail to these community based treatment. MAJITHIA-SEJPAL: Right. I know it’s early, but have you been seeing any preliminary results? YOUNG: Everything in criminal justice right now is being driven by evidence based methods. In other words, data collection is critical to whatever we’re doing, so we are collecting data to prove the viability of this program. Obviously, anecdotally we have a lot of stories. MAJITHIA-SEJPAL: I’d love to hear some. YOUNG: We have one young lady who came in, and when the judge evaluates someone for bond, generally, they only look at the criminal history and the current charge. The judge basically told us before we presented the case, “This person’s not a candidate. I’m not going to give them a PR bond” even though she was suffering from a major depressive disorder. Upon evaluation, we found out that the reason she had this depressive disorder is because she had been diagnosed with terminal cancer, only four months to live. After verifying that with her oncologist, presenting that to the judge, obviously, the judge changed their mind, and I think that was a great victory. This lady only had four months to live, and she was probably going to spend several months of those in jail if we hadn’t of gotten her out. Also, people actually come to court. That’s what we’ve been noticing. Before, if people got out on a commercial bond with no treatment, we had a big problem with them failing to appear. At least in the last 30 days, we’re seeing people show up. We’re seeing them complying with coming to court, and I think that has a lot to do with the arrestee feeling like they have an advocate. They have somebody who’s working for them, somebody that’s believing in them. Because a lot of the times what has happened, people at this point in their life have strained most of their relationships, and nobody really believes that they’re going to do what they say anymore. Our public defenders work hard to build a relationship with them there at the jail and say, “Now come on. You’re going to come to court. You’re going to go do this treatment.” I just think that connection really impacts them actually, ultimately showing up for court. MAJITHIA-SEJPAL: Speaking of community, do you find that linking defendants with community services has an impact on recidivism rates? YOUNG: We are going to be looking at that. We believe that if we treat the co-occurring disorder, if we get them into some kind of community based treatment facility, that it is going to have a great impact on recidivism. Again, anecdotally it’s easy to see. We’ve had a young man who is a serial criminal trespasser. He routinely trespasses at a bus stop, and every time he gets picked...