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Connecticut's mentally ill need services, not prison, lawyers say

New Haven Register (CT) - 4/26/2015

April 26--Criminal defendants with mental illness who commit minor crimes are too often ending up behind bars, according to defense attorneys, who say there aren't enough mental health services or in-patient beds available for them.

Supervisory Assistant Public Defender Bevin Salmon, who works at Superior Court on Elm Street in New Haven, where less serious criminal cases are handled, said it is frustrating to see his mentally ill clients incarcerated because there aren't enough treatment spots for them.

"I've been doing this for about 13 years, and it has been a constant problem," Salmon said. "Having more treatment options in the community is a good thing, instead of warehousing them in jail."

According to Salmon, judges can be reluctant to release an individual with mental health issues without treatment, even if the charge is minor.

"What is so frustrating is, a lot of times, these cases are misdemeanors, where I don't think the prosecution's end goal is incarceration," Salmon said. "I wish there were a lot more beds, but it is hard to quantify how many more are needed."

Salmon said he also wishes there was more housing for defendants with mental illness, because now there is a waiting list, so people end up in prison if no relatives can take them.

"If we had more housing, it would alleviate it," Salmon said.

New Haven Public Defender Thomas Ullmann, who works at the Church Street courthouse, where more serious criminal cases are handled, said it is a "huge problem."

"There are not enough programs to treat and house (mentally ill) people to keep them out of the criminal justice system," Ullmann said. "There are not enough programs in the community, and there are hardly any inpatient programs."

In a related issue, mental health services providers and advocates also say they worry the $160 million in cuts in the budget now under discussion in the legislature will result in an increase in the arrest of people with mental illness.

In the mid-1990s, Fairfield Hills Hospital in Newtown and Norwich State Hospital closed, with patients transferred to Connecticut Valley Hospital in Middletown.

"They closed down these institutions and there was a big push for deinstitutionalization, but there was never the proper funding for other programs," Ullmann said. "The fall-back is the criminal justice system."

According to a report by the Virginia-based Treatment Advocacy Center, 95 percent of the public psychiatric beds available in 1955 in the country were no longer available by 2005.

It recommends a minimum of 50 beds per 100,000 people, a standard that no state meets. Connecticut has about 20 public psychiatric beds per 100,000 people, according to the center's website. The organization has recommended that Connecticut restore a sufficient number to create access to inpatient care for qualifying individuals in crisis.

Between 1995 and 2013, the number of inpatient psychiatric beds, at both public and private hospitals, decreased from 160,645 to 107,055 nationally, according to data from the American Hospital Association, based in Washington, D.C.

"There needs to be a greater commitment to treatment, more beds and more community programs," Ullmann said. "It is a terrible situation for a person with mental illness to be sitting in jail."

While there are organizations such as Continuum of Care Inc. of New Haven that provide services and housing to the mentally ill, Salmon said there needs to be more.

Out of the 16,154 inmates in state prisons, about 3,423 have a serious mental illness, 21 percent of the total prison population, according to Michael Lawlor, undersecretary for criminal justice policy and planning at the Office of Policy and Management.

About 15 percent of sentenced males and 25 percent of unsentenced men have a serious mental illness, Lawlor said. The rate is higher in the female prison population, though far fewer women are incarcerated. About two-thirds of incarcerated females, sentenced or unsentenced, have a serious mental illness, according to Lawlor.

Ullmann said the number of mentally ill inmates has gotten so high that Garner Correctional Institution in Newtown is a mostly psychiatric prison.

Karen Martucci, spokeswoman for the state Department of Correction, asserted the agency is "well equipped to handle the challenges associated with the treatment of the mental health offender population."

Chief State's Attorney Kevin Kane said a substantial percentage of the dockets at courthouses that handle less serious offenses include people with mental health issues.

Panhandlers are a common example of individuals who are chronic low-level offenders who often suffer from mental illness, according to Kane. They can prompt complaints to police from merchants, resulting in an arrest.

"They get out and do the same thing again, which ties up judicial resources," Kane said.

Kane said it would be beneficial for prosecutors to have more knowledge up front about the defendant and alternatives to incarceration available for them. Prosecutors may then decide not to prosecute them, or to release them and delay their court case until they have successfully been referred to a program.

"Prosecutors aren't social workers," Kane said. "We are dealing with a social and mental health problem. If it can be handled outside (the criminal justice system), we can devote our resources to prosecuting criminals."

The legislature is considering a bill that would establish a pilot program to serve courts in New Haven, New London and Norwich to identify and track the mentally ill, along with homeless and addicted individuals entering the criminal justice system. The idea behind it is to get these individuals treatment and help as an alternative to incarceration and to prevent future arrests. The initiative is already in place in New London, but the proposal builds on that and calls for a formal assessment of its effectiveness, according to the Division of Criminal Justice.

"The underlying issues in these cases often are better dealt with as social issues than criminal conduct, since it is the underlying condition that led the person to be arrested," the division wrote in written testimony for a public hearing on the bill.

Kane also noted that the state closed some of its mental hospitals years ago.

"Now, a lot are on the streets, getting arrested and going in and out of the court system," Kane said. "This pilot program might give us an ability to learn how things can be done better."

Kane said he would like prosecutors to be more aware of available community services and programs and how well they work.

"(Prosecutors) want to be confident they will get feedback from those agencies after they refer people to them," Kane said. "If there is an alternative we can have confidence in, maybe we don't have to prosecute."

Janel Davis, a social worker at Superior Court in New Haven, agreed with the attorneys' assessment.

"There is more of a demand than services available," Davis said. "They need housing and case management, so they stay steady on their medications."

If a defendant is schizophrenic, for example, they can't just be housed anywhere, she said. They need housing with a trained staff that understands that population.

"Those are few and far between," she said.

She also cited programs such as Continuum of Care and Gilead Community Services Inc., but she said beds are limited.

"It is hard to get people in them, because there aren't enough," Davis said.

According to Lawlor, there is an effort to reduce incarceration for low-risk, non-violent offenders, who tend to struggle with mental illness more than high-risk, violent offenders.

"Putting non-violent, low-risk people in prison will make it worse," Lawlor said. "The vast majority of these people are in jail for a short period of time, one to three months. It is expensive because of their health issues. It is a big demand on correctional staff. There is no real public safety value to it. They may be more of a nuisance than a danger. In this category, there are a lot of veterans with post-traumatic stress disorder who are homeless."

One of the goals, according to Lawlor, is to give police other options, rather than just arresting the individuals.

"There are not enough services" for police to refer people to, Lawlor said. "We are in a budget crisis. We are spending a lot of money providing healthcare to people in jail, and we could take the same money and provide more services in the community."

That is one of the themes of Gov. Dannel Malloy's "Second Chance Society," according to Lawlor.

"Non-violent, low-level people with mental illness don't need to be in prison," Lawlor said. "They need to be somewhere else. It is much more expensive to deal with the mentally ill in prison."

While the average inmate costs the state about $45,000 a year, an inmate with serious mental illness can cost double or triple that amount, according to Lawlor.

The governor would like to expand supportive housing for mentally ill offenders. Lawlor said this is aimed at individuals who get in trouble after not taking medication, for example, and end up arrested but never hurt anyone.

"You can interrupt the cycle by getting them in housing with services, and helping them get employed," Lawlor said.

Under the "Second Chance Society" plan, Malloy proposes to increase the number of people being served by the CT Collaborative on Re-entry, or CCR, program, from about 100 to 400 in the coming years.

The CCR program, formerly known as Frequent User Systems Engagement, or FUSE, offers services such as supportive housing and mental health services to individuals who repeatedly end up in state prisons. According to the governor's office, these individuals have complex unmet needs, including long-term homelessness and untreated mental illness.

Ullmann said police should refer individuals more often to mental health treatment instead of arresting them for a charge like breach of peace or disorderly conduct.

Some, but not all, police departments have officers undergo crisis intervention team training to learn how to deal with nonviolent mentally ill individuals. It is more common in the state's larger cities, Lawlor said.

"Some police are specially trained to deal with them," Lawlor said. "They have to have a network of community-based treatment centers to take them to, rather than arresting them, so police will be more likely to do that. One of the reasons the prison population is down is because police are taking more advantage of that option than they were before."

In New Haven, police Capt. Holly Wasilewski said the city Police Department has 116 officers who have undergone 40-hour crisis-intervention training, and the goal is to have all New Haven officers get it, she said. Participants learn about mental illness, the mental health system, suicide assessment and prevention, and how to de-escalate a situation.

"It expands on what the officers learn at the academy," Wasilewski said. "The more officers we have trained, the better. Sometimes people aren't oriented, and don't know where they are. We don't arrest them if they aren't harming anyone."

A clinician with the Connecticut Mental Health Center rides along with a trained officer each week to follow up on calls coded as "emotionally disturbed." According to Wasilewski, this has greatly decreased the number of repeat calls to a particular address. It helps individuals navigate through the mental health system, she said. A social worker from the center is also available for phone consultations with officers whenever needed.

"There are many resources in the community we can turn to," Wasilewski said. "Could there always be more? Sure."

New Haven police spokesman Officer David Hartman said if officers were to encounter someone screaming in the street who appears delusional or mentally ill, the person would be taken to the hospital, rather than arrested. But if the person commits a crime, such as larceny, he or she will be charged, he said.

"There are a lot of people with mental illness here, homeless people and those who need assistance," Hartman said.

Louise Pyers, criminal justice project director with the National Alliance on Mental Illness of Connecticut, based in Hartford, said one way to help prevent the mentally ill from getting into the criminal justice system is to have more police training and crisis-intervention teams.

"People with mental illness are ending up incarcerated instead of in mental health facilities or programs," Pyers said. "Many times, their behaviors get them in trouble, but if the behavior can be managed through treatment, it can help people stay out of the criminal justice system."

Pyers said there are some very good services available, but individuals can often end up in the criminal justice system if they don't know about them or lack transportation to them.

"People are left to their own devices to try to find services and get connected," Pyers said. "You need assistance and guidance to find what is out there."

Regarding the closure of some of the state's large mental health facilities years ago, Pyers said, "Deinstitutionalization is a good thing. Many people who were in institutions didn't need to be there."

"People often can manage themselves with the help of medication and services," Pyers said. "On the other hand, many inpatient beds have been slashed. At times, when there is a need for an inpatient bed, they are put on a waiting list or released from the emergency room and told to call a doctor."

Dr. Howard Zonana, a professor of psychiatry at Yale School of Medicine, said the problem is a national issue, not something unique to Connecticut.

"It is clear you do need more beds, though in Connecticut it is not as drastic" as in some other states, Zonana said.

"Finding housing is always a problem, because some people need a lot of external support and they need supervised housing," Zonana said.

Some individuals get into trouble when they don't take their medication, he said.

Mary Kate Mason, a spokeswoman for the state Department of Mental Health and Addiction Services, said the agency serves 110,000 people a year and provides services ranging from community-based, outpatient services to partial hospitalization to inpatient care.

"As hospitals closed, community services improved to help people live in the community," Mason said. "We have a huge range of services that are available that individuals can have access to if needed. The whole system has made a change -- we know we don't need to keep people hospitalized."

According to the state Department of Mental Health and Addiction Services' website, it operates four inpatient treatment facilities for individuals with psychiatric or severe addiction problems. These include CVH, the Connecticut Mental Health Center, Greater Bridgeport Community Mental Health Center, and Capitol Region Mental Health Center.

The department has a jail diversion program that is active in all Superior Courts, according to Mason. Program staff will evaluate individuals with mental illness and develop a recommended treatment program in lieu of incarceration for a judge's consideration, she said.

Kathryn Cohen, legislative and policy counsel and Connecticut advocate with the Treatment Advocacy Center, said community psychiatric care exists for fewer than half the patients who need it. According to Cohen, the number of individuals with serious mental illness in prisons and jails now exceeds the number in state psychiatric hospitals by tenfold.

"Prisons are becoming our de facto psychiatric hospitals," Cohen said. "Prison and jail officials are asked to assume responsibility for the nation's most serious mentally ill individuals, despite the fact that the officials did not sign up to do this job, are not trained to do it, face severe legal restrictions in their ability to provide treatment for such individuals, and yet are held responsible when things go wrong, as they inevitably do under such circumstances."

The solution, according to Cohen, is to maintain a functioning public mental health treatment system so that people suffering from severe mental illness do not end up in prison.

The organization also advocates for jail diversion programs and the use of court-ordered outpatient treatment to support at-risk individuals so they can live successfully in the community, Cohen said.

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