Virginia is NOT for Lovers of Mental Health Courts…

Virginia is for lovers

Virginia’s history of the implementation and maintenance of mental health courts (MHC), is as dismal as most other states. This isn’t to say that we should take comfort in our universal ineptness, but it should serve as a warning sign as to the abundance of hurdles, lack of oversight, and gap in funding for having truly effective mental health dockets.

Virginia currently has 32 general district courts which typically act as the primary entry point any person has with the judicial system due to it generally covering all traffic cases and other misdemeanor and civil cases involving amounts of under $25,000. Out of those 32 courts, only 2 have mental health dockets –  the cities of Richmond and Petersburg. As for circuit courts, Virginia currently has 120 courts that handle civil cases over $25,000, felony charges, and serve as an appellate jurisdiction for any cases originated in the General District Courts. Virginia has only one, Norfolk, which utilizes a mental health docket.

Court Flow Chart

Now let’s take a closer look at the history of Norfolk’s MHC. After over 2 years of trying to implement this specialized docket, it was officially established in 2008. Since that time, approximately 30 participants have been involved with the diversional program at any given time, and typically remain active for at least a year (obviously this number doesn’t even come close to addressing the disproportionate number of incarcerated individuals with serious mental illness, but its a start). With the Virginia Commission on Mental Health Law Reform  increasing focus on MHCs, Norfolk’s program became the prototype for all others in the sate to follow. This also put it under a high level of scrutiny from legislators and people within the judicial system. Old Dominion University was commissioned to completed a comprehensive study and issued a report on the MHC’s measurable outcomes. Due to this and other studies being conducted across the nation, the Commission was forced to acknowledge the substantially higher rate of access to services, less time spent incarcerated, better collaboration of services, improved mental health and engagement in treatment, and lower recidivism rates that came with the effective use of MHCs. Most important to legislators was the significant savings in jail costs, with $1.63 million being saved during the ODU study period of 18 months in Norfolk’s jurisdiction! One could assume that for this reason alone, more courts would quickly be following in step with Norfolk’s MHC.

money-grow

In 2005, both Richmond City and Petersburg City began to work towards the creation of a MHC through grants and subsidies from the federal government, yet it wasn’t until April/May 2011 that the dockets became active. Even after that long stretch of time to iron out the wrinkles, Richmond City’s docket was met with dissension from within its own judicial ranks. By November 2011, the Virginia Supreme Court issued a memo that stated the creation of any “problem-solving courts” was legislatively unauthorized. The memo sent by Chief Justice Cynthia D. Kinser to over 400 statewide judges, specifically warned that the creation of any specialized docket would need General Assembly approval before being implemented. This one memo created a level of fear in many judges across the state (even those who serve on other specialized dockets like “Drug-Courts”) to temporary suspend services until substantial research and collaboration with the General Assembly could be worked out (and we all know the speed at which the GA works!). Concurrently, Petersburg City was facing additional issues of their own. For example, they recognized that they were missing a critical factor: a position of a coordinator that could work with all of the necessary agencies since there was no precedent for inter-agency collaboration prior to the MHC creation. <Insert eyeroll> Luckily the Cameron Foundation provided funds for the position… for approximately 1 1/2 months! (Le sigh). It was after this rocky start that from a media standpoint, information on Richmond’s and Petersburg’s MHC dissolved into oblivion.

GA

With no general information available on the  interwebs, I was left cold-calling each General District Court for information. Both courts stated that their MH dockets are “active;” however, trying to get more specific information on its use, effectiveness, and evaluation proved almost impossible. After leaving numerous voice mail messages, I finally received a call back from Petersburg’s General District Court clerk’s office. Again, most of my specific questions were met with “Oh geez, I really don’t know,” but I was able to get some generic information. For instance, the process of a defendant’s inclusion on a mental health docket is a little different than in other jurisdictions. Petersburg police officers responding to a call can “fill out a form and report” to submit along with the other charge documents “if it appears that the defendant has a history of mental illness” (Leave it up to untrained and overworked police to fill out a form!?) From there, the paperwork is “routed” to the current Mental Health Docket Coordinator for review (The coordinator has evidently been in flux, because it took 4 attempts to find this person’s name and transfer me to their voice mail). A “through” case review is conducted and eligibility is determined based off of “prior police reports and additional information.” From there, District 19 conducts a mental health exam if one already hasn’t been completed to screen for Axis I diagnoses. (I’ll save my complete and utter disdain for District 19 and their unethical/ineffective services for a later post.)

I don’t think it takes a PhD in research to see the numerous shenanigans of Virginia’s Mental Health Courts. After a rocky start, contempt from naysayers, and general funding and logistical concerns, one can easily see where program access, effectiveness, and outcomes can be called into questions. Even with the totality of these chronic issues, it does not signify a need to scrape the whole idea of mental health courts – as research shows them to be overwhelmingly beneficial to consumers, the judicial system, communities, and tax payers. Instead I believe it shines a spotlight on the necessity to establish funding streams and subsidiaries to encourage the creation of specialized dockets, provide technical assistance  to negotiate inter-agency collaboration and fast-track MHC creation,  and have a regulatory body provide oversight and adherence to evidence-based practices that serve the consumer above all else.

From “Old Dominion State” to “New & Improved Dominion State”

Born and raised a proud Virginian, I’ve unfortunately come to know that my state has a checkered history of making legislative decisions that are most definitely not for the “common wealth” of it’s constituents.

While doing research on the state of mental health treatment in Virginia, I have come across numerous statistics that corroborate what we as social workers see all too often.

The National Alliance on Mental Illness (NAMI) currently gives Virginia a grade of “C” (on an A – F scale), in its treatment of the mentally ill. See the breakdown below:

NAMI Score Card VIRGINIA

On a good note, Virginia was able to improve from it’s 2006 rank of “D” and is currently offering more services to the mentally ill than many states with dismal numbers like Arkansas, Kentucky, Mississippi, South Dakota, Wyoming, and our dear ol’ neighbors, West Virginia.  Virginia now is on the positive side of the national average; however, there still is a great amount of room for improvement.

Currently Virginia’s urgent needs towards mental health include:

  • Expand community services, including case management and crisis services
  • More housing options
  • Health care coverage for uninsured persons that includes mental health care

In recent years, the Treatment Advocacy Center has also identified another crucial barrier to treatment of mental illness. They specifically looked at the disproportionate number of mentally ill incarcerated within each of the 50 states. Regarding the odds of a seriously mentally ill individual being in jail or prison compared to a hospital, the odds in Virginia was 3.6 to 1 that they would be incarcerated. This means that in 2004–2005, throughout the state, there were almost four times more individuals with serious mental illnesses in jails and prisons than in hospitals. Virginia was ranked #32! Ouch.

In 2008 a Virginia state mental health commission estimated that “15 percent of all inmates in states prisons and jails are seriously mentally ill.” Roanoke County Sheriff Gerald Holt said it was 25 to 30 percent in his jail. In Virginia Beach, Sheriff Paul Lanteigne “estimated that it typically takes at least six months to find an available bed for a deranged inmate at Eastern State Hospital or a nearby psychiatric center. Scores of people are sitting in his jail today, long after they would normally have been released on minor charges, because they are too sick to be freed.”

In summary, national surveys and state reports both suggest that at least 15–20 percent of jail and prison inmates are seriously mentally ill. We have thus effectively returned to conditions that last existed in the United States in the 1840s:

Mentally Ill Incarceration Over Time
It is imperative that we as dedicated Virginians, work to stop the “frequent flyer” cycle of mentally ill being incarcerated versus receiving necessary treatment. This will come from utilizing assisted outpatient treatment, implementing mental health courts, maintain critical assessments and evaluations of state and local policies and programs, shift state and federal funding to address current service gaps, and work on reliable prevention and intervention services to address mental health before an individual is deemed dangerous.

Kudzu, Kudzu Everywhere…

Maybe kudzu can patch that broken window?

Just about every law, invention, treaty, and large-scale action has unintended consequences, which often alter society as a whole through a butterfly effect – like the ripples after a rock is thrown into a calm body of water.

The 19th Century French economist, Frederic Bastiat, warned of the dangers of unintended consequences in his classic essay That Which is Seen, and That Which is Not Seen. He taught that, “in the department of economy, an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause – it is seen. The others unfold in succession – they are not seen: it is well for us, if they are foreseen.”

It wasn’t until the 20th Century that American sociologist Robert Merton popularized the concept of unintended consequences and provided several possible causes: ignorance in that not every possible outcome can be anticipated, error from incorrect analysis, immediate interest that take priority over long term goals, basic values that prohibits certain outcomes, and self-defeating prophecy where well-meaning worrywarts attempt to fix a problem before it even comes to fruition.

If we focus only on the visible effects of a proposed policy, we may not recognize the invisible effects until the harm is done. How is it our policy makers seem so oblivious to the latent effects of choices supposedly made for society’s benefit?

Just a few infamous examples:

Prohibitionnascar-pepsi-400

  • Prohibition brought us bootleggers/gangsters and NASCAR (lest we all forget that moonshine runners were the originators of stock car racing!)
  • Passing NAFTA decimated Mexico’s agriculture industry and crippled their economy, leading to the vast influx of illegal immigration to the US.
  • The failed 1990s “War on Drugs” only served to solidify and consolidate the profitability of drug cartels.
  • Rent controlled housing was meant to help secure housing for low-income tenants, but essentially created a drought of quality in housing for most major cities.
  • Creating antibiotics saved millions, but now our bodies are unable to fight of “superbugs” that are resistant to our greatly outdated antibiotics

After undergrad (and in a former life) I worked in government relations and public policy for a medical non-profit in the DC-area. Fresh from a small town, I was completely content traipsing around the Capital for hearings, meetings, and the typical “schmooze fest” where every move  made was well calculated and micromanaged in order to have the best odds at “winning.” Our goal was simple, pharmaceutical companies had long abandoned research and development on antibiotics (something you take for only a short period of time) for the more lucrative medical innovations like Viagra, breast implants, and medications that secure a life-time of use. Most antibiotics still used today were originally invented in the 40s and 50s, and for that reason the levels of antimicrobial resistance continues to skyrocket. The bill introduced to US Congress aimed to create a number of incentives for pharmaceutical companies, and urged them to abandon the bottom dollar in exchange for the common good. I organized lobby days, press briefings, trips to the CDC and pharmaceutical companies, and attended countless meetings with Congress and their limitless legislative assistants. Our initial support was huge – because you couldn’t deny the scientific evidence! Our thought was if you ran a facts-based campaign, how can anyone vote “nay”? As voting day arrived, I sat nervously waiting for the results. The bill was voted down. It didn’t just die… it was slaughtered, burned, tarred ‘n feathered! Over a year’s work was gone and I sat stunned, holding back tears. I started the job thinking that the opening theme of Mary Tyler Moore was my background music, yet here I sat with only a funeral dirge playing on repeat. My mentor, my boss, had been through this rodeo several times before. He merely shrugged and said, “Next time.” I stammered, “But why?” His response was simple, “Pharmaceutical companies are the top financial backers of the elections,” and re-elections were right around the corner. I was so disheartened and jaded by the process of our government; I left the job (perks and all) to find a new career path.

Let me go back for a second to Bastiat and the Broken Window Phallacy. The salient point is that destructive policies will  destroy prosperity, regardless of the amount of “spin” that someone puts on the visible consequences. This short video does a great job of summarizing a highly debated theory:

It was almost two years later that my former boss contacted me out of the blue.  A prominent congressman had lost a loved one to MRSA (the antimicrobial resistant strain of staphylococcus). He just so happened to be one of the early backers to our bill who appeared to thoroughly enjoy our lavish dinners and “legal donations,” yet ended up one of the turncoats that voted against us. He wrote my boss a cryptic letter that apologized for his “oversight.” He quoted Bastiat, and made sure to point out that he and many of his fellow senators had voted for their own immediate best interest. It wasn’t until that a “nasty little infection” affected his own life that he was able to say, “Oops, My bad.”

In some hypothetical alternate universe, our country would have an “Oops, My bad” list to save us from the bipartisan blame-game and come clean about negative unintended consequences. I’m pretty sure if the south has anything to say about this list… the US bringing Kudzu over from Japan would be near the top! This fast growing plant brought over to help with erosion has since created substantial environmental and fiscal consequences as the “Vine that ate the South.”

Kudzu3

We teach our kids that it’s okay to make mistakes because it’s just part of the “growing pains” of life and meaning-making towards lessons learned and self-preservation. I would not only trust, but respect, my own government if they would just admit their own mistake. As Winston Churchill stated, “those who fail to learn from history are doomed to repeat it.”