by Ginger
The presiding judge’s goal is not only to divert people with mental illness and co-occurring disorders out of the prison system and to community-based care, but also to prevent people from languishing in jail or from being trapped in a revolving door of arrest cycles. Under Florida law, persons charged with a misdemeanor offense who have been found by a judge to be incompetent to proceed to trial are subject to case dismissal at twelve months from the date of the order after a hearing that finds that there has been no change in competency status.20
I anticipated that Roger’s case would ultimately be dismissed.
The marathon session continued and the public defender advised me that several of her clients wanted to challenge their charges by way of trial—that is, they wanted their cases to go to trial. After private consultations with the public defender, her clients decided to ask to opt out of participating in the mental health court. After all, the mental health court is voluntary and offers a problem-solving treatment, not a traditional trial. Many individuals are interested in participating in a therapeutic court in exchange for avoiding the risk of sanction, such as probation or jail. In this sense, the court offers a positive alternative to the traditional court process. On the other hand, those individuals who desire to exercise their constitutional rights to have their day in court may simply request to transfer out of the mental health court, and we let them know that the door remains open. I immediately signed a transfer order to have these individuals docketed in their regularly assigned criminal divisions.
Then I received the “all clear” from my deputy that Hayden was ready for release, which meant he could be released from the courtroom and did not need to return to jail for processing. I asked Hayden’s mother to return to the bench and reminded her about how important it is to follow up with Hayden’s discharge plan. I asked my judicial assistant to give his mother a written safety plan, which included important telephone numbers such as that of the Henderson Mobile Crisis Unit and other crisis hotlines of local community supports.
Currently, every court participant receives a mental health court safety plan including the telephone number for the National Suicide Prevention Lifeline and other contact information for crisis response and resiliency planning.21 These precautions are necessary in Florida, which ranks forty-ninth in mental health funding in the country.22 This is a deplorable circumstance, given that Florida is the third most populous state; hundreds of thousands of Floridians lack health insurance or Medicaid.23 In fact, the state of mental health across the United States is in shambles. The lack of sufficient funding and investment in statewide mental health care delivery systems that are accessible, affordable, and recovery-oriented has led to crisis for individuals and families across our nation. What policymakers fail to realize is that according to the data one in five Americans (adults and children) suffers from a mental illness at some time in their lives.24 The negative and collateral consequences of untreated mental illness, according to the National Alliance on Mental Illness, includes absenteeism, worsening health conditions, family erosion, homelessness, substance abuse and addiction, crime, incarceration, and suicide. From an economic perspective, untreated mental illness costs America $193.2 billion annually.25
In 1999, two years after the start of the Broward County’s Mental Health Court, US Surgeon General David Satcher released the landmark Surgeon General’s Report on Mental Health.26 Satcher described a mental health field “plagued by disparities in the availability of and access to its services.” He spoke of forty-four million Americans without health insurance and the fact that “we have allowed stigma and hopelessness to erect barriers to care—and [now we have] declared it is time to take them down.”
As I thought about Hayden and his mother, I’m reminded of the words and the vision of Dr. Satcher for our nation. For the entire session, Hayden, still shackled, had stood quietly before the court as we waited for his paperwork to be processed.
It took only minute, but to me, seeing what happened next always feels like a miracle. The shackles and handcuffs were removed, and Hayden, now free, wrapped his arms around his mother, embracing her. The vision of the end of criminalization of people with mental illness in America comes to life in this moment.
CHAPTER 3
Punishing Loss
In her early thirties, Kathryn Steeves was married with three children and lived in a spacious five-bedroom house in the western part of Broward County. She had purchased the house herself after working for fifteen years as a restaurant manager—an accomplishment that she took great pride in. But with the unexpected collapse of her marriage and mounting financial pressures, the stress Kathryn was under became unmanageable. At the time of the divorce, although both she and her husband were working, money was tight. As conflicts over child support intensified, Kathryn’s mental health rapidly declined.
Kathryn conceded, “I was an emotional mess.” Suffering from severe panic attacks and depression that doctors would later diagnose as symptoms of bipolar disorder, Kathryn’s perception of her life took a dark turn.
One night, in the middle of a psychological crisis, Kathryn walked out the door, down the street, and away from her home. She became a homeless person. “It just felt like the world caved in,” she said. “I never considered that I may have been suffering from a mental illness.”
For more than two and a half years, she struggled to adapt to life on the streets. Kathryn always strived to do her best. While homeless, she worked to build relationships and sought out people who could offer her food or a place to sleep. Kathryn still cannot explain why she never considered returning home, and she barely recalls the day she walked into a novelty shop in a South Florida mall and stuffed five harmonicas into her bag.
“I don’t get it,” she said. “I had never played a harmonica in my life. The only thing I remember is the day I appeared in mental health court.”
“Why is that?” I asked.
“Because it was the first time I realized I had lost everything,” she said.
According to a report written for the American College of Obstetricians and Gynecologists, “Women and families represent the fastest growing segment of the homeless population.”1 Studies reveal that 84 percent of homeless families are headed by women.2 These women often choose homelessness over domestic violence and sexual violence—in fact, 20 to 50 percent of all homeless women and children become homeless because they were fleeing a violent situation at home.3 African American families are disproportionately represented among the homeless population, making up 43 percent of homeless families.4
The committee’s report emphasizes that the lack of healthcare represents a major risk for women and families, with 73 percent of homeless individuals reporting at least one unmet health need. These needs often include medical, surgical, mental health, vision, or dental care or prescription needs.5 From an intersectional and criminal justice perspective, the committee found that substance abuse can be both a cause and a result of homelessness and can co-occur with mental illness.6 According to the data, 30 percent of individuals who are chronically homeless have mental health conditions and an estimated 50 percent have co-occurring substance abuse disorders.7
In the late 1990s, the number of justice-involved women had increased dramatically.8 By 2000, the figure had risen to more than one million.9 According to the National Resource Center on Justice Involved Women, “Women’s experiences within and outside the criminal justice system are markedly different from justice-involved men, and their needs are unique.” Women’s pathways into the criminal justice system, like Kathryn Steeves, are best understood in the context of relationships and are linked to past experiences of trauma and victimization, poverty, mental illness and substance abuse.10 During a mental health crisis, women are more unlikely than men to seek mental health care and thus place themselves at a higher risk for justice system involvement. This is why an estimated 31 percent of women who are arrested for low-level crime have a serious mental health condition.11 Fo
r many of the women who appear in the mental health court who have been exposed to trauma and victimization, the motivation to engage in mental health or substance abuse treatment is enhanced by the therapeutic approach, which is responsive and culturally sensitive to the unique needs of women.12
Lilly was a hard-working stay-at-home mom. Her husband was an accountant, and they seemed to have it all: a happy marriage, a beautiful home, and lovely children. Lilly had always lived a natural life; she did not believe in wearing makeup and was mindful of nutrition, adhering to a strict vegetarian diet. Or, this was true until Lilly’s postpartum depression hit and became increasingly debilitating.
Over time, her conduct became more bizarre and unpredictable. At the pinnacle of her odd behavior, Lilly was charged with a misdemeanor offense of violation of a restraining order and was not able to post bond. As I reviewed her court file, I discovered that a family judge had issued a “stay away” order, which prohibited Lilly from returning to her former home to see her children. Despite the order, she returned anyway.
According to her husband she was not making sense and was delusional. She would leave the home for extended periods of time without notifying her husband of her whereabouts, leaving the children alone. She was staying up all hours of the night. He indicated that he did not feel it was safe to leave the children in her care.
Her husband appeared in court on her behalf. He was soft-spoken and stoic, even when he said, “As Lilly got worse, I had no choice but to file for divorce and seek custody of the children.” Lilly was arrested and charged for the misdemeanor crime of violating an order of protection, as she was ordered to stay away from the family home where her children lived with her ex-husband. She was unable to post bond.
According to her husband, Lilly had refused to seek mental health treatment. He was concerned about the welfare of their children. He told Janis Blenden, a licensed clinical social worker who served as the in-court clinician, that Lilly had been hospitalized numerous times, only to be released within seventy-two hours because she refused medications. But it was her refusal to stay away from her own home that brought her case to the attention of the mental health court.
She had been referred to the mental health court by her division judge. Lilly’s public defender argued that the family home was the only one her client had ever known and she wanted to be with her children. As presiding judge, I have always maintained that every individual appearing in the mental health court be represented by a public defender if the individual could not afford to retain private counsel. Given the high prevalence of homelessness among adult inmates in jail, most people in the court (15.3 percent) cannot afford a lawyer and are represented by a public defender who is specially assigned to the mental health court.13 Lilly’s public defender also argued that given Lilly’s mental health condition, it was doubtful her client understood that there was a restraining order in place, and she had no intention of violating the restraining order.
I was shocked at Lilly’s appearance when she came before me in mental health court. She had been chronically homeless, and as a result, she was rail-thin and highly vulnerable. Janis screened Lilly. She had been hand-picked for this position because of her clinical experience, passion for recovery, and expertise in community resources. When the court was designed, I believed it was essential to have an experienced clinician embedded in the court process in order to effectively braid in psychosocial dialogues during criminal court hearings and to allow for spontaneous problem solving to expedite the diversionary process. As an excellent problem solver, Janis was highly skilled in service integration and creative treatment planning. I often joked that the more complex the problem, the better she performed. The court was also provided with a mental health court monitor, Bertha Smith, who was sought out for the position based on her expertise in housing for people with mental illness and cognitive disabilities. The court monitor is responsible for overseeing compliance of those individuals being followed by the court in the community. The monitor’s duties are to report any problems or concerns to the court and generally to track the status of each case. Unfortunately, this position was de-funded in 2008 as a result of budget cuts. The monitoring function was taken over by Janis, who has always maintained that our streamlined court staff works efficiently because of the strength of its relationships.
When Janis concluded her screening, she recommended that Lilly be sent to the hospital to be evaluated for psychiatric treatment and stabilization. I issued the emergency transportation order and hoped that Lilly would be admitted.
I did not realize it then, but there were obvious similarities between Lilly’s and Kathryn’s situations. Both women’s pathways to jail were largely due to homelessness and untreated mental illness and trauma, and both had lost custody of their children.
Each in her own way demonstrated that the challenges and individual needs of women are distinct and complex. Additionally, both Kathryn and Lilly faced a vexing problem unique to women in need of help: a lack of gender-specific services and housing for women who suffer from mental illness, substance abuse, and the residue of trauma.
Kathryn had been in custody, homeless, and unable to post the $25 bond (a customary amount imposed by a judge for a minor petty theft arrest) when she appeared in mental health court. Although the first appearance judge had agreed to release Kathryn on her own recognizance under pretrial supervision, Kathryn had nowhere to go—no place to live. Recognizing the impracticality of this order, Kathryn’s pretrial release officer referred her to the mental health court.
When Kathryn appeared in court, more than anything she wanted to regain legal custody of her children. She was highly motivated to engage in treatment and she enthusiastically embraced her mental health care in order to get well and rebuild her life. Her assigned pretrial release officer was well versed on the court, and she knew that a residential program had recently been dedicated to the court for defendants who were homeless. Located on the Howard Forman Campus in the City of Pembroke Pines, “the Cottages in the Pines” opened in 1998 as a twenty-four-bed transitional residential facility that answered the need for a dedicated housing resource for the mental health court. The program was intended for individuals who were homeless or at risk of homelessness and provided a needed resource in order to break arrest cycles and allow for treatment engagement and stabilization in the community.14
In Kathryn’s case, Bertha Smith, the court monitor, called the director of the Cottages to confirm that a bed for Kathryn was available. He told her they had available space. The court ordered Kathryn to the Cottages to begin her journey to recovery. Along with other residents at the Cottages, Kathryn was scheduled to return to court in a month so the court could monitor her progress.
The current state of gender-specific services has not gone unnoticed by researchers and advocates. In recent years, several universities and nonprofits have come together in an effort to address this glaring gap in services. One advocate in Florida is Lenore E. Walker, the pioneer researcher of battered-woman syndrome and coordinator of the concentration in forensic psychology at the College of Psychology at Nova Southeastern University, in Broward County.
In 1998, Dr. Walker stepped up to the podium in my courtroom and introduced herself. I had never met Dr. Walker before, but I certainly knew of her leadership in research on domestic violence and on gender and the cycle of violence.15 She told those in the courtroom that the president of Nova Southeastern University, Ray F. Ferraro Jr., had asked her to let me know that the university would provide any available resources I would need to support the court. I was overwhelmed; the court had no budget and had received no grants.
Within a few years, however, through the US Department of Justice, Dr. Walker and I applied for a Criminal Justice Mental Health and Community Collaborative Grant, a federal grant intended to promote jail diversion; our application was dedicated to gender-specific services for women. These grants are highly competitive because a wide range of institutions and
nonprofits are eligible to apply for them. Despite the large number of applicants, the grant was awarded to Nova Southeastern University in collaboration with the mental health court to serve women with serious mental illness and co-occurring disorders. The program targeted women who were arrested on nonviolent misdemeanor charges. Under the grant, we received an estimated $50,000 for one year; the grant was then extended for eighteen months. It was to be used to establish a comprehensive mental health and drug treatment day program for justice-involved women who were participants in Broward’s Mental Health Court.16
The university rented a 4,500-square-foot building within walking distance of the courthouse. It was a fitting space to occupy as its previous occupant had been Legal Aid Services of Broward County, dedicated to fighting for the legal rights of marginalized populations.
The grant allowed us to establish the South Florida Medical Corrections Options Program. Called Options for short, the program was hailed by the community as a needed resource to fill gaps in mental health services for women and their families.17 At the time, Broward County had one long-term housing program for women with mental illness and co-occurring substance disorders and one short-term treatment program. Over 30 percent of women involved in the criminal justice system have at least one serious mental illness, but they also have children at home. The goal of Options was to break arrest cycles and to promote healthy living and wellness, and it represented an important new resource not only for the court but for the women in need of services in Broward County.18