Mental Health Court: trying to stop the revolving door

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November 10, 2003 // UPDATED 11:06 am - April 30, 2007
By: Robyn Repya
Robyn Repya

A person with a mental disability commits a crime. He/she serves some jail time, or, if there's room, stays in Hennepin County Medical Center or a workhouse. Once released, he/she is back on the street -- homeless or living on his/her own without support services. A person with a mental disability commits a crime . . .

Local experts often characterize the legal system's interactions with people with mental disabilities as a "revolving door." This system, they say, does a disservice to vulnerable adults who need care, while sticking taxpayers with a hefty bill.

To help break the cycle, Hennepin County District Court Judge Richard Hopper

initiated a sort of "mental health court" in May. Hopper presides over a docket of

cases reserved for suspects with a mental disability.

A case study Hopper said he had a case involving a person with a mental illness who refused medication, choosing instead to live on the street and "self-medicate" with alcohol or other drugs.

In addition to committing dozens of low-level crimes throughout the last three years, the defendant also suffered repeated beatings each time he returned to the street after a jail or hospital stay, Hopper said

The judge said the county booked the defendant for low-level offenses 38 times; he was in jail for 187 days and cost taxpayers $23,581. During this time, the defendant racked up $472,954 in direct care costs, also paid for by taxpayers.

Hopper said such extreme cases constitute 10-20 percent of the defendants with whom he deals, but the "treatment" cost is often this high.

Hopper said this individual refused treatment and would not stay in a group home; therapy didn't help. After the case made it into Hopper's "mental health court," he appointed a guardian and placed the individual in a locked nursing home, where he can only go out when supervised -- the person is safer and taxpayers pay less than the average $140,000 annual cost of the previous approach.

Hopper said everyone would have benefited if someone had intervened earlier.

"Despite the fact it's not a desirable way for these individuals to live, we're spending a lot of public money on them," Hopper said. "It could be better spent."

Hopper has been trying to establish a support service he feels could reduce recidivism, but he's come up against the same limited resources that helped create the revolving door problem in the first place.

Inside the revolving door Police Training Director Sgt. Ron Bellendier said Minneapolis police officers take 120-130 people in a mental health crisis per month to Hennepin County Medical Center (HCMC), 701 Park Ave. S. -- constituting more than one-tenth of HCMC's 1,000 crisis patients per month.

Bellendier said officers are often frustrated at the help people with mental disabilities receive. Bellendier said the facilities are "always full."

Joanne Hall, HCMC administrator for behavioral services, monitors the crisis center and admits the intake room is often overflowing with people awaiting treatment. In the crisis care ward, she said, many people admitted for inpatient treatment await placement in a longer-term community-based program. Hall also attributes some overflow to the demand for medications by people with mental disabilities who, she said, have nowhere else to get them.

Hall also said HCMC cannot admit or treat everyone who comes in experiencing a mental-health crisis. The hospital cannot force a patient to accept treatment, and some patients do not meet the criteria for longer-term inpatient care.

This often frustrates law enforcement officers, she said, who think some people in crisis should be kept longer. In Crisis Intervention Training, "We try to get police to understand what we can and cannot do for people legally, because of their civil rights," Hall said.

However, Hall also said mental health professionals recognize that these limitations may cause problems. HCMC does treat some people excluded from the crisis center in partial hospital care, wherein they receive six treatments five days a week, Hall said. She has been meeting with group healthcare providers and hospital administrators for the last six months to work on issues relating to people with mental disabilities.

"There's a lot of activity in the community analyzing resources," Hall said. "The state has made a decision that these people should live in the community -- we need to develop more resources in the community."

Mental health court In 2001, Hopper gathered professionals from criminal court and mental health advocacy programs to solve the cyclical nature of cases involving people with mental disabilities, he said.

After years on the bench, "I've developed an expertise on what to do with these people," Hopper said.

Hopper also said he studied courts nationwide and decided Hennepin County should start a small-scale docket within the county's Community Court system to focus intense efforts on people with mental disabilities.

Hopper said the county hired a case manager to screen possible mental health cases for what he refers to as the "mental health court" calendar. Hopper said he began holding the court in May, every morning at 11 a.m.

Instead of just looking at an offense, Hopper said, the new court's goal is to give those with mental disabilities more individual attention -- devising a way to stabilize them and creating an individualized plan to keep them from re-offending and receive needed care. "Each person that walks though the door has a different set of problems," he said.

So far, Hopper has handled about 60 defendants with mental disabilities in his court, all charged with misdemeanor offenses and low-level felonies.

Hopper said encouraging defendants to stay on medication and attend counseling throughout the sentencing process has yielded some success. However, a key ingredient to eliminating the revolving door has stalled due to county budget cuts.

Community supports needed Hopper said Minneapolis needs a sort of reporting center, similar to one in Milwaukee. He said it would not change Minnesota services currently offered but make them more accessible and effective -- helping keep people from falling through the cracks.

Hopper said the Milwaukee center, created in the 1970s, allows defendants with mental disabilities to live in the community as long as they report to the facility where they get their regular medication and social service care all in one place.

"Minnesota does a tremendous job of providing services, but there's a sincere lack of coordination," he said.

He said the Milwaukee center has expanded to include housing and employment offices, and that the regular check-ins and support help offenders with mental disabilities stay on their medication and function at a higher level. (Offenders with mental disabilities who do not live in supportive housing must go to the pharmacy or hospital on their own to receive his/her medications; if a person forgets to take his/her medication, however, a downward spiral can begin.)

Hopper said a Minneapolis reporting center providing only medication and social services (not shelter or residential services) was in the works for the former Hennepin County Detox Center, 1800 Chicago Ave.

Those plans were put on hold because of budget cuts, Hopper said.

Although the county does not have the funds to start the center, Hopper said the service change is desperately needed to save money in the long run -- not to mention improving the lives of people with mental disabilities trapped in the system.

Although the idea's been sidelined, Hopper said he would continue his efforts to start the reporting center and is applying for state grants.

"You have to keep on trying because what we're doing is not working," Hopper said.