by Ginger
“Mrs. Harrison, please do not yell in the courtroom,” I said firmly. “That is not appropriate.”
The noise in the courtroom dropped to a murmur, then silence. Both Violet and her mother wore wounded expressions on their faces as though I’d taken something away from them. It was an expression I’ve seen in the court before—the expression of people who believe they have lost everything.
I wondered what this family had been through.
I called Violet’s case immediately so her mother wouldn’t have to wait and become more anxious. I introduced myself to everyone, appointed the public defender for Violet, and began to gather some basic information to find out why she had been referred to the court.
“Hello, Violet,” I said. “Before we begin our conversation, is it all right if I ask your mother a few questions?” This was a part of the court’s process—allowing defendants like Violet to maintain their constitutional rights. Anything a defendant says could be used against them in prosecution. If Violet’s case were to be transferred to a court in the criminal division, her legal rights must be protected. That is also why everyone who participates in the mental health court is appointed an attorney.
Violet nodded in response and said quietly: “Yes, you can talk to my mom.”
I turned my attention to Violet’s mother, who approached the bench. “Can you tell me anything about your daughter?” I asked.
“Judge,” Mrs. Harrison said, “my daughter is full of life and very talented. She used to dance and loves to cook. She has a heart of gold.” She took her other daughter’s hand, to compose herself.
“It’s just . . . that,” she said in a low whisper, “a very bad thing happened to Violet when she was in college.” Her words broke apart as she began to sob. She tried to control herself by taking deep breaths, but her body shook as tears rolled down her face. While I waited for Mrs. Harrison to regain her capacity to speak, I learned from Violet’s case file that Violet had been diagnosed with post-traumatic stress disorder and bulimia. After a few moments, Mrs. Harrison regained her composure and went on. “Violet rarely leaves the house anymore. She has a few girlfriends that she still sees, but they have been a bad influence on her.”
“Mom, that is not true!” Violet said forcefully, standing up.
“All right,” I said. “We all need to take it down a bit.” I turned my attention to the in-court clinician. “Janis,” I said, “I am interested in your thoughts.”
“I would rather not get into Violet’s trauma history other than to say that she is connected to a private therapist in the community who she likes very much. I am not sure what to suggest, given her insurance coverage and the fact that she has positive family support.”
“Violet,” I asked, “what are your goals? I understand you were in college. What degree were you pursuing? What was your vision?”
In a clear voice, Violet told the court that she had been studying to be an art therapist. “Once, I had a passion for art and children.” Her voice drifted as if she was talking about a different life. She had been enrolled in the school of education at a local community college but had dropped out after the traumatic event—Violet had been the victim of date rape. Since then, Violet had languished and was unable to engage in her life in any real way. She lacked the energy and the desire to return to school. For Violet, life had become a struggle to cope with mental health issues that were well beyond her capacity to understand, let alone control.
But after this pause, Violet pulled herself together and started speaking again. “It makes me feel bad to always have to rely on my mom for everything. I mean, I should be able to get out of bed in the morning without crying. I should be able to go to class without becoming so scared of what might happen to me there. I should be able to know when and how much to eat. But I can’t. . . . I just can’t do any of that.”
Violet’s mention of how disappointed she was that she had not overcome the problems in her life while she spoke about managing her mental health challenges inspired me. She acknowledged that she needed to learn how to manage her own care better and not rely on her mother to do so. In fact, this idea is very close to what social workers and therapists call health activation, which is an important idea buttressing what we attempt to do in the mental health court. I learned about health activation while attending the American Case Management Association’s Behavioral Health Leadership Conference in 2015.6
Health activation is a widely recognized concept of engagement for patients with chronic medical conditions such as diabetes, mental illness, obesity, and cardiac disease.7 Its goal is to teach self-care skill building that leads to lifelong engagement in personal wellness. The research indicates that the more a patient is engaged in his or her health, the better the health outcomes, and that to activate one’s health, one needs to shift one’s focus to positive lifestyle choices and healthy living. This can include any number of things, such as improving one’s physical fitness, following a healthy diet, getting adequate sleep, engaging in meaningful social activities, and spiritual pursuits. The higher the level of health activation, the more effective one’s healthcare management.8
What if I made health activation a priority in the Broward County Mental Health Court? I thought for a moment about the possibility before I decided I was ready to roll out a new court initiative to counter critical loss of mental health programs. Mental health court participants would need to step up in terms of taking responsibility for their own healthcare management and learn how to be advocates for themselves.
I asked Janis to explain health activation to Violet and her family. On the basis of the literature, Janis had prepared an example of a self-care management plan. In addition to making her therapeutic appointments each day, Violet would create her own structured wellness plan. It would include activities such as healthy living practices that she enjoyed doing and that would help her manage her PTSD symptoms and her eating disorder.
In addition to getting sufficient sleep, the plan would focus on eating nutritiously and engaging in physical activities and other pastimes that Violet had once enjoyed doing and would make her feel better. She would not be allowed to consume alcohol. To deal with her eating disorder, Janis suggested that Violet try an Overeaters Anonymous support group or a twelve-step women’s support group to help her manage the stress of facing the challenges of an eating disorder alone. Janis also suggested if Violet liked to paint, garden, or write, that time be set aside for such creative activities. Spiritual activities could also be part of Violet’s program—for example, meditation, yoga, or other spiritual or faith-based activities that would foster feelings of gratitude and of being a part of something greater than herself.
As Violet listened to Janis’s explanation, she seemed to become more alive, more vibrant. Color seemed to return to her skin, and she smiled when Janis finished her explanation. In fact, she was ecstatic.
“Judge,” she said, obviously excited, “I used to love tap dancing when I was a kid. And I used to love to try new recipes. I guess all of that just sort of stopped.” She paused as if collecting her thoughts. “Anyway, my mother has been suggesting that I eat more of a vegetarian diet. She has been reading about the benefits of diet and mental health. But I’ve always wanted to learn how to bake and decorate cakes. I think I might take a class on that.”
After Violet’s hearing, the court advocated for everyone to create their own wellness plan. Health activation became a core component of the court process. The celebration of health—of life—became, in some respects, the modality of the court. Perhaps it was no accident that I designated the mental health court a “Zero Suicide Initiative Court.”9 My decision came in part from reading about the recent surge in suicide rates across the country. To celebrate life was to keep it safe. And the court would do just that through its dedication to suicide prevention, which would now come under the court’s broadened health activation banner. Safety planning information would be distributed from the bench at every hearing,
including the numbers for local crisis hotlines and the National Suicide Prevention Lifeline.10
Each new court initiative built on the last. Life is sacred, and to guard it would require preventative and therapeutic measures to treat not only body but mind, heart, and soul.
Within a few weeks, Violet and her family returned to court for a follow-up hearing. They were pleased to be back in court, now that the family’s circumstances had improved. Violet was dressed in a floral dress with purple, red, and orange flowers. She, like the flowers on her dress, seemed vibrant and alive.
“Judge, I brought something to show you,” she said the moment she walked into the courtroom. It seemed that Violet had embraced health activation with both arms and soul. She had prepared an elaborate demonstration board that included a large multicolor diagram with illustrations linking her daily and weekly health activation activities to specific health goals. It was a work of art. Illustrated with tasteful images clipped from magazines and books and loose sketches in watercolor that she herself had made, the plan specified her scheduled activities: dance, journaling, meditation, spiritual reading, and a power nap.
For her evening activities, she was going to prepare dinner with her mother, bake, practice yoga, and watch a few favorite shows with her family until bedtime, which was at 10 p.m. Her chart included a separate section for therapeutic appointments, highlighted by positive life affirmations and therapeutic goals. It was all written carefully in vibrant ink in a script that looped pleasantly around itself in beautiful spiral flourishes. Drawings of flowers and musical notes floated to form a loose, organic frame as if holding the plan together. It was as though Violet was signing the document with who she was and who she wanted to become.
When Violet concluded her description of her “health activation project,” the entire courtroom applauded. I am not an expert in health activation, but by anyone’s standards, Violet’s efforts demonstrated something remarkable and beautiful.
Just when I thought Violet’s presentation had concluded, she had one more surprise up her sleeve. She shared with me that she had signed up for the Whole Health Action Management (WHAM) Peer Specialist Training, offered by the National Council for Behavioral Health.11 This program would allow Violet to take her lived experience in her own health management and integrate it into the WHAM program. It was a program developed by peers for peers.12
Health activation has been a positive addition to the court’s recovery toolbox, but it did not address the community’s lack of available residential treatment beds and housing options that were the result of a standardized level-of-care screening process and the bureaucratic allocation of available bed space. How do we provide for those who have no family or who do not have the support and backing of their family? How can the court find a way to help?
Just a few days before Violet’s presentation, I received a call from Fran L. Tetunic, a professor of law and the director of the Dispute Resolution and Restorative Justice Law Clinic at Nova Southeastern University’s Shepard Broad College of Law. She asked if we could meet to discuss how the clinic could serve the court. The clinic works across diverse areas of the law (juvenile justice, child welfare, family law, guardianship) to promote alternative dispute resolution and was interested in expansion of its scope. I scheduled a meeting immediately. My vision was to leverage the services of the clinic to expand the support network of the court and help people in mental health court find their way home.
CHAPTER 13
A Crying Shame
Derrick Brown and his father, Tyrone, stood before the bench at a status hearing to review Derrick’s community placement. At twenty-two years old, Derrick was intellectually disabled and had been diagnosed with attention deficit hyperactivity disorder (ADHD). He’d just been released from the Miami-Dade County jail, where he had been held after a series of elopements—running away—from residential treatment centers to which he had been ordered. I didn’t understand why the judge decided to release Derrick to his father’s care. Tyrone Brown had just been released from prison after serving twelve years for robbery and hadn’t seen his son for well over a decade. Perhaps the judge didn’t realize that Derrick would need specialized care for his condition, or perhaps he didn’t realize that Derrick’s father would be incapable of providing that level of care, given his limited resources and experience as a parent.
The last time Tyrone Brown had seen his son, Derrick was a ten-year-old boy who loved to play basketball and video games and do all the other sorts of things one would expect a young boy to do. To Derrick, his father was a stranger, a reminder of lost childhood memories, of holidays and birthdays. Perhaps Tyrone appreciated this—or perhaps not. Derrick, however, stood close to his father as if he were a lifeboat and the court, an endless ocean. For Derrick, his father was one of two adults he trusted, a trust that had formed through the father-son bond, as tenuous as that was.
“It is nice to meet you, Mr. Brown,” I said. “It was good of you to be here today.”
Tyrone Brown lowered his head and stood remorsefully before the court. Although he was not the subject of the hearing, one would have thought, seeing his body language and other nonverbal communication, that he was the one facing a tribunal for punishment.
“Judge,” Mr. Brown said, “I have failed my son, my family, and, most of all, myself. I have come to ask for the court’s forgiveness and help. The last time I saw my son . . . he was very different. I have been away in prison for so long. I feel like I am living on another planet. I don’t know how to operate a smartphone. I have no idea how to transact for basic services, and I do not have a steady job. How could I possibly take of my disabled son when I can barely take care of myself?”
“I understand, Mr. Brown,” I said. “I do not believe that the judge who released Derrick to your care had been properly informed about Derrick’s special needs.”
Derrick had been referred to the mental health court three years before on a charge of trespassing and possession of cannabis. Since that time, the court had made numerous attempts to secure an appropriate community placement for Derrick. So far, every placement had failed, and Derrick had often run away.
For the past six months, Janis had been monitoring Derrick at a group home in Miami-Dade. We had been told that everything was going well when, in truth, Derrick had been cycling in and out of jail in various locations in Florida. It took a great deal of effort, but we had finally gotten Derrick back to Broward County.
At this point, the court was at a loss. Derrick’s impulsive behaviors had proved too much for even the most experienced program administrators in Broward County, including Dr. Samuel Kelly of Dynamic Health Care. In the past, every time the court requested help to divert Derrick out of jail, Dr. Kelly had always stepped up to the plate. This time, however, he asked the court to allow him to step out. Ansom Phillips, the criminal justice liaison for Florida’s Agency for Persons with Disabilities, was also present at the hearing.
Dr. Kelly opened by saying, “Judge, I asked for this hearing because I am greatly concerned about the health and welfare of Derrick who has been placed in one of our therapeutic group homes.”
“Can you be more specific, Dr. Kelly?” I asked.
“Yes, Your Honor. We care about Derrick very much. At this point, I believe our program has exhausted every reasonable behavioral approach and strategy available to us. To sustain Derrick in our program, the state provided him a mental health technician to support him on a one-to-one basis. This means that this staff person’s sole responsibility is to support and assist Derrick. Yet this strategy has not been effective. Derrick has walked away from the program each day. As you know, this is not a locked facility. Staff cannot legally force him to stay or restrain him. Our case management team believes that he is more interested in walking around the neighborhood in search of drugs than he is on working on his rehabilitative goals.”
“Judge,” Ansom Phillips interjected, “in anticipation of this hearing, I have contacted
the director of the Agency for Persons with Disabilities for assistance in identifying a group home which is equipped to manage Derrick’s intellectual and behavioral challenges anywhere in the state of Florida.”
As Derrick listened to the discussion surrounding his fate, he became increasingly agitated.
“Miss Ginger, I want to stay with Dr. Kelly,” he said. “I’ll be good—please, Judge Ginger.”
As Derrick’s pleas become louder and more intense, I covered my face with my hands, as if that would shield me from the emotional intensity of the hearing. It was difficult to witness Derrick on the verge of tears, pleading for the only life he’d known. I wondered when—or if—a solution could be found. I told myself over again in a silent mantra, Every problem—no matter how vexing—has a solution.
I directed my attention to Mr. Phillips. “What do you propose?” I asked.
“In my view, the search for an appropriate residential placement for Derrick must be widened,” he said. “In the meantime, Derrick is at risk. His elopements have led to at least half a dozen arrests in two different counties. I cannot ask Dr. Kelly to continue to try to maintain Derrick in his program. We must consider the other clients who reside there, who are vulnerable. I also believe, based on Derrick’s behavioral pattern of elopement and substance use, that he is at significant risk of victimization by adults with criminogenic behavior. I believe he should be remanded to the jail for his safety and the agency should expand its search for community placement.”
“I am very concerned about this proposal, Mr. Phillips,” I replied. “This court is dedicated to decriminalization—putting Derrick in jail is not consistent with the values of the court. There must be some other alternative than jail.”
“If I may,” Janis said. “We need to be objective about how we respond to this dynamic. Derrick will not meet criteria for hospitalization. I know this is a terrible situation—but someone could get hurt or worse.” Janis paused and crossed her arms over her chest before releasing a deep sigh. “I don’t think I need to remind you about the recent shooting in North Miami, which involved a case manager of a young man with autism who walked away from his group home. When his case manager ran after him, the police received a call about a man with a gun. It was tragic! There was no gun—it was a toy truck. The case manager knew that his client loved trucks, and he carried one to help stop him from running. Somehow, the police mistook the toy truck for a gun and shot the case manager. Fortunately, he survived. But the young man with autism was traumatized and ended up institutionalized.1 This incident was devastating for everyone. We don’t want something like this to happen to Derrick or his caretakers.”