Criminal Justice Policy Coalition
After the keynote address, the first panel addressed “Current Realities and Costs: Setting the Stage for Discussion”. Moderated by Whitney Taylor, the panel began with a presentation by Paul Benedict of the Department of Mental Health (DMH). Mr. Benedict noted that in MA - for the past 50 years - courts have had access to mental health clinicians. However, in the late 1980s, the legislature gave a substantive infusion of funding to the courts to make mental health clinicians available on demand in every district and municipal court, and in the 1990s extended this to juvenile courts. These clinicians do evaluations in both civil and criminal cases to determine competency to stand trial and/or levels of criminal responsibility. In addition, they help courts make determinations of whether civil commitment under chapter 123, section 12 is appropriate.
In 2004, there were 200 sec.12 diversions from criminal courts in MA and 400 civil diversions to custody. In some of the former instances the diversions are sufficiently effective that criminal charges are dropped. Under sec.35 in the same period, there have been several thousands of evaluations within civil and/or criminal cases for possible commitment to treatment at either Bridgewater or one of several other facilities. The state is currently spending about 10 million dollars a year for mental health services for those incarcerated within state correctional facilities; resources within county facilities vary widely.
The Department of Correction recently has established two evaluation and stabilization units [under the supervision of the Hampden County Sheriff for the western part of the state, and Middlesex County Sheriff for the Eastern portion, according to the conference Keynote speaker Sheriff Ashe] , which handle inmates who are presenting signs of severe mental illness and instability. Formerly these individuals would be placed in isolation blocks, often in contact with extremely violent inmates. These evaluation units provide for up to 30 days evaluation to determine whether the individuals can be returned to the general inmate population or are better served through transfer to the state hospital at Bridgewater.
Since 1998, the DMH also has a Forensics Transition Team which annually works with up to 300 ex-offenders at the point of their release for the first three months to assist in assuring that they are connected with service providers within the community to which they return, and that the connection is working. (Statistics show that there is a 100% chance of recidivism if a released offender is homeless within the first 10 days after release. Those who have addiction or mental health issues are particularly susceptible to not finding housing.) And finally, those offenders who have no employment are eligible for state covered basic health services under the Mass Health Card program.
Finally Mr. Benedict noted that with the last several years’ pattern of closing down transitional housing, there has been a resulting “bleeding” into the criminal courts of those unable to find stable environments without assistance.
Judge Maurice Richardson, now of the UMass Medical Center for Mental Health Services Research, noted that the usual track is for police, when responding to calls about citizens exhibiting behavior which is disturbing to others, to make a quick decision about whether or not the individual should be taken into custody. Too often the response of the police has been to bring those individuals to the closest emergency room in a hospital and commit the citizen to the custody of the hospital, allowing the police to return to their normal police work. Judge Richardson noted the experimental programs of mental health clinicians working directly with police at the site in the community to help make decisions over whether many of those citizens can be more effectively treated where they are, rather than being taken into custody (see the paragraphs on Arrest Diversion Models). In 1992, the MA Supreme Judicial Court held a meeting for all judges to explore whether or not courts could provide assistance to those defendants who had addiction and mental health problems. At that point, law enforcement and the courts were, for the most part, wholly unfamiliar with the research around drug rehabilitation. Relapse wasn’t within the vocabulary of the criminal justice system, let alone the understanding that relapse could be seen as a part of the process towards recovery. Rather than understanding relapse as a symptom of some other unmet need, probation or parole officers saw relapse as a reason to revoke probation or parole and remand the client back to incarceration. Unfortunately that view of relapse is still in play in some areas of the commonwealth.
Judge Richardson spoke of the much more recent efforts to establish mental health courts, based on the success of drug courts, and that at this time, they are only in the planning stages. This is not to ignore those judges who have been working very informally to use diversion possibilities for the defendants before them, working where possible with both the prosecutor and the defense counsel.
Julie White, Suffolk County Sheriff’s Department administrator for Health Services Contracts and administrator of Women’s Programs and Services, suggested that at her county facility, it is common for those who are incarcerated with substance abuse issues have records which suggest that they have frequently been through diversion processes in the past. Often their records have lengthy arrest and conviction records with no incarceration attached.
Dana Moulton, of the MA Organization of Addiction Recovery, asserted that his experience while incarcerated was much at variance with the reports just given. Despite his having been tracked to treatment for substance abuse, Mr. Moulton stated that he received none while in prison. Further, the conditions of incarceration were counter productive to any treatment which would have been offered. His experience is that the community is extremely shortsighted in not investing in treatment before arrest occurs, while the disease of addiction is still in its infancy. Finally, he suggested that the refusal to make educational resources and housing available to those coming out of prison denies individuals the most basic tools needed to establish a productive life.
The panelists were asked what they considered to be the most pressing current problem in the way of effective response to the issues around addiction and mental illness, besides lack of money. Judge Richardson suggested the tendency of the treatment community to compartmentalize substance abuse from mental illness and the resultant inability to treat both problems simultaneously. Mr. Benedict felt that balancing the individual privacy rights of those coping with substance abuse and/or mental illness against the rights of victims and the rights of communities to assured public safety is a public policy dilemma which urgently needs to be sorted out. For Ms. White, the insensitivity of corrections officers and other staff to the realities of substance abuse and mental illness creates unnecessary problems for those clinicians who are working to alleviate those problems. Mr. Moulton clearly stated that the stigmatization of these two populations in the minds of the entire public makes recovery even more difficult. Ms. Cohen, a probation officer in the Boston Municipal Court Dept., agreed with the opinion that the difficulty of getting service providers to work together in addressing substance abuse and mental illness concurrently was the most pressing issue.
Finally, Mr. Moulton spoke at great length of the misunderstandings around methadone as a drug to enable heroin addicts to move beyond their addiction. From his personal experience, he found methadone the only treatment modality which was effective. Yet because of the public misconception that methadone is nothing more than another addictive drug, drug courts are not permitted to prescribe such treatment as a course of recovery. While methadone clinics appear to be populated with addicts who are clustered around with nothing to do, most on methadone are not visible because they are busy reconstructing their lives.