Disorders in the Courts

If a federal grant comes through, Orleans Parish could launch one of the South's first 'mental-health courts.' It's one small way of dealing with a growing problem: mentally ill and troubled defendants.



They're brothers, about 18 or 19 years old. Their daddy was killed on the steps of their house; their brother shot in their own neighborhood.

Judge Calvin Johnson met these two young men when they came through his drug court in Orleans Parish Criminal District Court. For Johnson, cases like these clearly demonstrate the limitations of drug court. Because, for these defendants, a focus on addiction just isn't enough.

"Part of their drug issue is grief," says Johnson. He stops to make a distinction. "These kids are not mentally ill. But they need counseling."

That distinction is important because there is a system for the mentally ill within Orleans Parish criminal court. But it's reserved for the criminally insane -- people in such serious shape that they can't understand the court's proceedings.

In courts like the ones in Orleans Parish, there's long been a revolving door for mentally ill and troubled defendants -- people who are arrested, sentenced, released and then arrested again. The phenomenon is documented nationwide and is partly the result of the deinstitutionalization movement that took place in the mental-health system during the 1960s and 1970s. The movement diverted more people with serious mental illness into the community, where theoretically there would be a network of community mental-health providers. But the community system never really materialized.

"Deinstitutionalization sounded wonderful," says Dr. Lucille Perry, who oversees grants, counseling and victim services for the New Orleans Municipal Court. "But there are almost no services out there."

All across America, the courts, jails and justice system have become home, by default, for the nation's mentally ill. A Bureau of Justice Statistics survey estimated that in 1998, a significant proportion of inmates -- 16 percent of state and local inmates -- were mentally ill.

Yet, the same survey reports, only six out of 10 of those inmates actually received some form of mental-health treatment while they were incarcerated. Which means that, in reality, these inmates will be released only to end up, once again, in jail or in a courtroom. Some studies have found that more than 70 percent of mentally ill inmates will re-offend within a few years' time.

Johnson sees the results of this "revolving door" every day. He has long bemoaned the lack of mental-health resources available to his court. And so, when he heard about a new pot of federal money devoted to mental health initiatives, he immediately began holding meetings and writing a grant proposal in an effort to better link the court system here to mental-health services.

In mid-September, this city's municipal and criminal courts jointly submitted that grant to the Bureau of Justice Assistance, within the U.S. Department of Justice. Orleans Parish requested $150,000 to pay for a pilot mental-health-treatment court within Johnson's courtroom and a social worker within municipal court. If the grant is approved, New Orleans would be at the forefront of the nation, says Johnson. "There are only 12 mental-health treatment courts in America." Within the South, only Florida has one.

Of course, Johnson emphasizes, Orleans Parish can't hope to create an all-encompassing mental-health-court system with the little money they've requested. "This is a demonstration grant," he says, and he, basically, is the demonstration judge. "We're going to show how this can be done," he says confidently.

For several years now, Johnson has been overseeing a drug court, separate from his usual docket in Section E. It's one of five drug courts now established within the criminal courthouse at Tulane Avenue and Broad Street. Defendants must plead guilty, accept treatment, and agree to follow for several months a strict program that includes weekly drug tests, regular treatment sessions, and a curfew. If they successfully complete drug treatment, their jail sentences are put aside.

During weekly drug-court sessions, each "client" is called to the front of the court for a quick progress report. If someone is doing well and interviewing for a competitive job, Johnson is her biggest booster, saying things like "Terri baby, I'll keep my fingers crossed for you." Negative drug tests or missed curfews, on the other hand, bring out the fire-and-brimstone in the judge. The end result is usually jailtime, often accompanied by a lecture, a rant, a rap or a sermon.

At first, many judges were skeptical of "problem-solving courts" like drug court because they felt that the work more befitted a social worker than a judge. Today those concerns seem largely to have fallen by the wayside. There are now 500 drug courts across the United States and abroad. In Orleans Parish, where the first drug court began in 1997, only 12 percent of drug-court "graduates" re-offend.

Johnson sees the strengths of drug court first-hand. But, he says, he realized early on that his work with drug-court participants could be even more effective if drug-rehabilitation was coupled with mental-health treatment. "You can't deal with drugs unless you deal with mental health," explains Johnson. "In the lingo, they're 'co-occurring disorders."

Johnson wasn't the only one making these observations. In the mid-1990s, Florida's Broward County took the framework of drug court and from it created the nation's first mental-health court.

There are some differences. For instance, jail sentences as sanctions are inappropriate for certain defendants. And there are worries that some mentally ill defendants are volunteering for a process they might not understand. Johnson says that he also knows that his courtroom demeanor may have to be more subdued. "I have individuals in drug court who suffer such depression that if I look at them in an angry manner, they just fall apart," he says.

But, in the end, the basic goal is the same for drug court and for mental-health court, says Johnson. Both deal with the problem from "the front end" of the justice system, starting from the moment someone is arrested.

Randolph B. will be spending a year at the Bridge House dealing with his co-occurring disorders. He's bipolar and he had a "real serious chemical dependency problem, with cocaine," he says, sitting at a lunchroom table in the Bridge House dormitory. There are 120 people in the program. He belongs to a smaller subgroup of people with dual diagnoses -- addiction and mental illness.

Randolph is a 39-year-old house painter and contractor with slightly graying hair and a roundish face. He can accept both his addiction and his mental illness now because he better understands them, he says, patting the cover of his Alcoholics Anonymous blue book.

The mental illness was diagnosed six years ago, he says, after he -- in a fit of mania -- took a hammer to a big floor-model TV, shattered an entire set of dishes, and heaved landscaping rocks through two car windshields. "It was all over in five minutes," he recalls. His wife, from whom he's now separated, called the police and he ended up going to jail, then to a mental hospital. The doctors there prescribed lithium, he says, and "it helped me a whole lot."

Bipolar diagnoses generally run in families, and Randolph is pretty sure that his -- he's one of 10 siblings -- is no exception. "I'm just the only one who's diagnosed," he says. He looks at his dad, for instance. "He blew his brains out when I was five. He was very abusive to Mama. Had mood swings like Dr. Jekyll-Mr. Hyde. Mama and them don't realize it, but to me, when they describe him, they're describing a man suffering from mental illness."

But the diagnosis didn't mark the end of Randolph's troubles. The key with co-occurring disorders, he's now learned, is to deal with both things at that same time. Since Randolph hadn't confronted his cocaine and alcohol habits, he continued his downward slide, sometimes taking his lithium, sometimes not.

Then this past year, everything came to a head. He was arrested "about six times," on drug possession and paraphernalia charges, and -- after 20 years of marriage -- his wife and kids left him.

He checked into the Bridge House in June. "I say I came on my own," he says. "But that's a cop-out. I came because of my circumstances -- recovery by fear."

"That's where we have strength, the judge can mandate," says Dr. Lucille Perry. That strength, she says, is offset by municipal court's weakness: the overwhelming volume of cases they see -- about 70,000 annually.

In sheer numbers, municipal court sees the vast majority of mentally ill people within the local courts system. Some people are making leapfrogging appearances in both courts, for pending felony and misdemeanor cases. Others -- like the homeless people often picked up on quality-of-life, misdemeanor offenses -- are seen almost exclusively in municipal court.

Some younger people may be exhibiting early signs of mental illness. Municipal Court Judge Sean Early says that his court sees a lot of those defendants and their families. "They'll say, 'Will you hold this guy for a psychiatric evaluation? He's my brother and I think he's going nuts."

In some ways, those people are the fortunate ones, says Early's co-hort, Judge Paul Sens, sitting in his chambers after a three-hour court session during which he handled nearly 150 cases. Many of the mentally ill people he sees have no form of social support -- friends or family. Which makes it tough to deal with repeat cases, because no one is out there in the community, ensuring that the defendants keep their psychiatric appointments and take their medication. This is why, he explains, a few of the people in this afternoon's court were familiar faces.

"Some in the (Orleans Parish Prison) box today have been through this court more than 20 times." he says, mostly for nuisance, alcohol and marijuana charges.

Sens may suspect mental-health problems in those cases. And he's certainly able to order a psychiatric evaluation for those who entered his court babbling or delusional. But it's difficult for him, with 150 cases on each day's docket, to discern more subtle cases. "They don't have 'mentally ill' written on their foreheads," says Perry. People who are bipolar, she guesses, are the most "underdiagnosed."

For many, the most obvious sign of mental illness may be their alcohol or drug use, says Ciro Juarez, a psychiatrist who has worked on contract with municipal court for about six years. "Most of the mental patients I see (through municipal court) are dual diagnosis -- I would say 80 percent of them are. They're crackheads, heroin and cocaine users, alcoholics. But really they're mentally ill. They're making an unconscious effort to self-treat. Because the drugs dull their symptoms."

Perry says that municipal court contracts out for 30 to 50 full-blown psychiatric evaluations a month. "But then what do we do?" she asks.

"We're not able to really follow up," explains Sens. Municipal court's probation staff, along with Perry and her counseling staff -- many of them interns -- are devoting almost all of their resources to domestic-violence cases, which make up 20 percent of the total municipal docket.

"What we have now is an ad hoc, informal referral system," says Sens. "The only way we know anything is if they show up again."

Judge Early agrees. "If they're really off, I try to lead them in the right direction. I'll give them a referral and tell them to come back with proof." But that almost never happens, he says.

If the Department of Justice grant is approved, a licensed social worker will work in all four municipal courtrooms, connecting mentally ill defendants with services and then following up on each of those cases. Municipal court will be welcoming the new arrival with open arms, says Perry.

"But that one person, believe me, will be overburdened," he adds.

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