My Turn: Stephen P. Erickson: Mental health woes swamp justice system
The Rhode Island mental health system is in crisis – a crisis caused by the failure of our courts to address behavioral health issues.
Unfortunately, the judiciary has approached this crisis in a piecemeal and haphazard fashion. Many mentally ill individuals are not identified. Many patients feel as though they are treated as criminals. Competency evaluations are being used as substitutes for planned treatment at tremendous cost to the state. The system is overwhelmed. The Adult Correctional Institutions have become the primary mental health treatment facility.
There is a solution: create a behavioral health court that can conduct civil commitment hearings, monitor competency restoration, and divert minor offenders into treatment, reducing recidivism and strengthening the health of our provider community.
This is not a new idea or a novel one. Many forward-looking court systems have been expanding such programs for decades. Unfortunately, Rhode Island has not been a leader in this movement.
Involuntary civil commitment is the last resort when an individual is an imminent risk of harm to self or others and is unwilling to accept treatment.
Our provider agencies spend tens of thousands of dollars in physician and transportation costs to cater to a centralized civil commitment calendar. Instead of judges going to the patients, agencies must transport clients (often by ambulance) to the court, wasting valuable (and unreimbursed) time and money. Treatment time is wasted when doctors have to wait hours to have a case heard.
A behavioral health court would strengthen the financial health of the system. It would maximize use of resources and, unlike the current process, would not discourage use of a valuable treatment option.
Meanwhile our inpatient facilities, especially Eleanor Slater Hospital, are being overwhelmed by court requests for competency evaluations. Creating outpatient competency evaluation systems, in conjunction with our existing agencies, could relieve this pressure. Unfortunately, too often the courts behave as if there is an unlimited pool of diagnostic time available for them to call on.
A network of agency-based court clinicians tied to existing programs could siphon seriously mentally ill individuals into treatment instead of simply ordering treatment as a condition of bail — a process that increases the stigma associated with mental illness.
Pre-trial services within the court should not be a shadow mental health agency operating under court jurisdiction. Such a network will decrease overall cost of treatment by ending duplication between the courts and the community agencies. People suffering from serious mental illness do not need a bail monitor – they need treatment in an established treatment program, and true diversion that gives them the opportunity for a fresh start.
Many are eligible for the highest level of treatment services, which strive not just to maintain a person, but to lead them on the road to recovery. These services are best provided in a community setting, by community agencies, using evidence-based practices.
There is, sadly, a broad consensus in the community of providers, advocates and professionals that make up the behavioral health system that the courts have failed to resolve these issues. I hear the frustration everywhere. Often there is real anger that our judiciary has not been more responsive.
The court need not cost any more than the present system, could work across existing boundaries, and be staffed by existing personnel. Active or retired judicial officers could staff the court. Most importantly, it could bring the judiciary’s approach to behavioral health into the 21st century.
Perhaps it takes a (retired) judge to tell the hard truth to my colleagues currently on the bench, but the time for action is now. Justice is not being done.
Stephen P. Erickson is a retired district court judge, adjunct professor of mental health law at Roger Williams Law School, and vice chair of Newport Mental Health.