A Court of Refuge

by Ginger

  It was Rosemarie.

  Rosemarie had been a star. I remembered her on the stage of a national mental health conference years ago, when the court was still somewhat new, fielding questions from the audience in a style that modeled a TED talk. The ballroom of the downtown Miami hotel had been standing room only due to the number of mental health and criminal justice stakeholders who were eager to hear about her experience in the mental health court. The Broward County Mental Health Court was still in its infancy, but Congress had recently passed legislation to pilot mental health courts in other states across the nation.1 Broward County’s leap of faith to do something to take a stand against the criminalization of people with mental illness had surpassed our wildest dreams. When I was asked to lead the court, my immediate thought was “At least the court will treat the people it serves with dignity and respect.” The conveyance of dignity is so fundamental to the court process that even if all else failed, at least the people the court served would know they had been respected, treated with dignity, and cared for. Fortunately, the shared vision of the community mental health and substance treatment providers empowered the court to succeed. Within a year, the court had diverted an estimated one thousand people from Broward’s jail system, and this became an annual figure.

  In 1999, I was sitting at my desk when an aide to Congressman Ted Strickland of Ohio called. She explained that Congressman Strickland, who had been following the court, wanted to introduce legislation to expand mental health courts nationally. She asked whether I would be willing to support such legislation. She indicated that staff had been researching the four mental health court models that were currently in existence—Broward County, Seattle, Anchorage, and San Bernardino—and wanted to propose a national demonstration project. I offered my support.

  Congressman Strickland filed a bill in the House in 1999, and Senator Mike DeWine, also of Ohio, filed a companion bill in the Senate in the same year. Over the next year, I engaged in a national campaign to support mental health courts and CIT (crisis intervention training) diversionary strategies, along with Major Sam Cochran (ret.) of the Memphis Police Department.

  On November 13, 2000, President Bill Clinton signed the legislation into law, and mental health courts became a reality not for just four, but for many more communities.2

  Rosemarie had been so happy for the chance to tell her story to the conference attendees—how she had suffered from untreated mental illness and how the court had found her housing and treatment services at the Cottages. She had spoken vibrantly, proudly, about the friendships she formed with other residents and about the strides she had made in her own life. “I’m living my life in a way I never thought I could. I want to have a part-time job, and I want to start taking classes at the local community college. I love to garden and read. I couldn’t be happier,” she had told the conference, beaming.

  I couldn’t recall the last time I had seen Rosemarie. She had lived at the Cottages in the Pines for just over a year. She had formed close friendships with two other residents, Margaret and Sharon, who interviewed her frequently for the newsletter they had started there. And Rosemarie had joined me on stage that day at the conference. It had been an exuberant experience to share the stage with her—one I’ll always remember.

  As Rosemarie’s participation in mental health court wound down, her case was closed. As the years passed, I lost track of her as she moved on from the Cottages and forward with her life.

  There really is no way to keep track of the thousands of people—more than twenty thousand—who have been participants in the mental health court. Some have worked with the court longer than others, depending on the complexity of their treatment and social service needs and issues of risk and legal competency. My hope is that people who continue to make their mental health a priority will apply the many lessons learned about recovery, wellness, and the need to champion mental health in their families. It is OK that they move on with their lives. In fact, they are supposed to; that means the court is working. But some court participants fell by the wayside, and either we never found out about it, or we found out by accident—as with Rosemarie.

  “Stay in the car!” I said to my kids in the backseat. They looked at me with confused expressions but nodded. Then, I stepped out of the car and walked over to the sidewalk where the heated exchange was occurring.

  The legal voice in my head was screaming, Do not get arrested for interfering with the execution of a police investigation! I walked very slowly toward Rosemarie and the police officer. I made sure I stayed far enough away so as not to interfere. I barely recognized Rosemarie. This was not possible, I thought. The star of the Cottages who had presented to hundreds of people at a national mental health conference in crisp, professional attire now had an orange lightning bolt painted on each side of her face. She was filthy, and her wet clothing was tattered and hung heavily around her body. On feet that had once worn stylish high heels, she now had tied the tops of shoe boxes in place of shoes. Nothing about her was recognizable aside from some hint of the person I’d come to know in mental health court. Her words tripped over each other incoherently as she flung them at the officer in nonsensical waves. He continued to ask her what she was trying to say, and she spoke ever more rapidly. She was becoming highly agitated.

  How did this happen? She was doing so well!

  I stood in silence and observed the scene. The police officer, a very large man, loomed over her. As I approached, his tone changed, and he began to yell at Rosemarie, “Get in my car!”

  Rosemarie appeared not to understand his commands. She flung frenzied sounds at the officer, waving her arms wildly. The longer she stood there in the rain, the more aggravated the police officer became. The encounter was so intense that the police officer never turned to acknowledge my presence.

  “Excuse me, sir,” I said. “I’m Judge Lerner-Wren. I’m a mental health court judge, and this woman is in my court.” His eyes were so angry I thought they were burning holes through me, despite the cold rain. I wondered if I had made a mistake by interfering, but there was no going back now. So I continued: “I wanted to let you know that she is intellectually disabled and suffers from schizophrenia. . . . So, I . . . I thought this information might help you.”

  The police officer grew more angry and his face turned beet red. He looked me straight in the eye and snapped, “If you want her, you take her!”

  Then the officer, beyond exasperated, took advantage of the exit strategy I’d unintentionally presented him with, jumped into his police cruiser, and sped away. The police car disappeared in the traffic, leaving me alone with Rosemarie in the rain.

  I returned my gaze to Rosemarie. For a moment, her eyes met mine and flickered. I studied her face. This was not the person I had known. I tried to recall how long it had been since she was at the Cottages and participating in the court. Was it five, seven, or ten years? How long does it take for a life to go sideways?

  Up close, she looked frightening. The orange lightning bolts painted on her cheeks accentuated the wild, feral look of her entire body. I did not want her to be hurt or arrested, but I certainly had not expected this to happen. I had hoped the police officer would help me contact the mobile crisis team, who had the skills to de-escalate the situation. It was clear Rosemarie needed help, but I was certainly not capable of providing the kind of help she needed in this precise moment. The rain fell on both of us, each one afraid to move, for our own separate reasons.

  This had turned into a nightmare.

  Rosemarie broke the standstill moment first, assuming a posture that may have been what caught the police officer’s attention. “Give me money, give me money!” she demanded in a deep voice that was unfamiliar to me.

  I took a step back from her, suddenly afraid. I felt for the familiar bag around my shoulder and realized I didn’t have my purse. I had left it in the car, with the kids.

  Alone on a long stretch of sidewalk in the rain, I didn’t know what to do. At this poin
t, Rosemarie’s psychosis prevented me from engaging her in any kind of conversation. She was getting more aggressive. I didn’t attempt to reason with her because I didn’t believe she had the ability to understand me. The only thing I could do was try to appease her. “OK,” I said, “I’ll get you money. But you have to wait here.”

  The car was parked a few yards away. I could see the faces of my son and daughter in the backseat peering out the rear window.

  In calm voice, I explained to Rosemarie that I needed to walk past her to get my purse. I also needed to call Henderson’s mobile crisis team, but I felt that I should make sure the kids were safe before I did anything.

  Rosemarie allowed me to walk to the car, but did not heed my direction to wait on the sidewalk as I retrieved my purse. Instead, she followed a couple of paces behind me. I began to sweat as I approached my car door, hoping she would not force her way in.

  I motioned to the kids to sit still and stay quiet. I did not want to escalate an already tense situation. I opened the car door and saw a box of cereal that one of the kids had brought. I picked it up and handed it to Rosemarie, thinking she was hungry and that having something to eat would distract her until I found my wallet.

  I reached inside the car for my purse, grabbed a few dollar bills from my wallet, and quickly handed them to Rosemarie. “Here, why don’t you go to the store at the gas station and get some coffee or something to drink with your cereal,” I said as I pointed to the gas station on the corner.

  Rosemarie took the money and began to walk in the opposite direction, toward the gas station.

  I got into the car and breathed deeply. I realized I was shaking. I called Henderson and asked for the mobile crisis team to come to the gas station. Then I tried to reach Rosemarie’s former community case manager. I began to realize that I was soaked from standing in the rain for so long. The sound of the world, which had gone silent, returned: the swoosh of passing cars, the click of tires moving across the road, the distant discord of a car alarm.

  I tried to process what had just happened. It was surreal. How could this woman, who had been such a stellar success, have fallen so far?

  It was heartbreaking. I put my hands on the steering wheel and could not hold back my tears. I put the car in drive and slowly pointed us in the direction of the grocery store, our remaining errand. I held my breath as I silently cried. I cared about Rosemarie. What I had witnessed was a tragedy. I had no idea what was going to happen to her. And although I had given her money, something to eat, and had called the crisis team, I had a sinking feeling. She had been to the mental health court years before and that hadn’t led to a healthier life. Was there nothing I could do to help her?

  I had failed to note the name of the police officer who confronted Rosemarie that day. I did not blame him for his heavy-handed behavior. Everything had happened so fast. I speculated that he had worked all night or may have been under stress about something that had nothing to do with Rosemarie’s behavior. My friends and colleagues whom I told about the encounter were critical of my decision to intervene. “What were you thinking, Ginger? What if the police officer thought that you were trying to hinder his investigation—even if you believed you trying to help?” they asked.

  I did not have a good answer, other than I felt that the officer needed to know that the woman who had rankled him was mentally ill and needed help. I feared that she might be harmed.

  If the officer had been specially trained in responding to crisis and the detection and de-escalation of people with mental illness, perhaps the encounter would have gone better. I was more interested, however, in what had happened to Rosemarie since I last saw her. How had the system failed her when she left the Cottages? Clearly, she had not been properly transitioned to permanent housing or provided with the means to access the proper services. Given her strengths and her abilities, she could have lived independently with supports. She might have become interested in taking a part-time job or become engaged in mental health advocacy and peer support activities.

  All that investment in her mental health treatment and care for so many years, had it been for naught? This is the great unknown. What will happen to court participants once their case is over? Recovery is defined as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”3 What is essential is to understand that recovery isn’t a single occurrence. It is a process, one that requires consistency and attention. It is important to remember that recovery is hardly ever sequential or linear. Furthermore, each person’s journey to recovery is unique. Sometimes, as in the case of Rosemarie, there can be frightening setbacks.

  Yet, for people with strong support networks of family and friends, there are safety nets that prevent a mental illness from taking a person down too far. Without that safety net, however, there is absolutely nothing to keep a person’s life from slipping away, one moment at a time. It is heartbreaking to consider that Rosemarie fell through the cracks of a highly fragmented and underfunded system of mental health care to find herself in an ongoing nightmare where relationships, health, memories, and even her sense of self fade.

  Philip Reynaldo was fifty-two years old and homeless. He liked to hang around the Fort Lauderdale bus station, which is where many of the city’s homeless population congregate. Fort Lauderdale, like all major US cities, has a significant number of homeless people. Without access to affordable housing and jobs, most people are not able to get off the streets, even though there are several homeless shelters sprinkled throughout the county. Without housing resources, there is no effective way to move people off the streets. Instead, people continue to cycle in and out of jail, shelters, and hospital emergency rooms.

  Philip was a frequent participant in the court. He had never connected to mental health care, although the court staff always was intent on ensuring that he did not languish in jail and that he received acute psychiatric care, treatment, and stabilization at the nearest Baker Act receiving facility. His arrests were always for minor nuisances and quality-of-life offenses such as panhandling or urinating in public. He was a fixture in the court system.

  Philip was an intensive and frequent user of local services, with no end in sight. I was serious when I said, “It would be cheaper for Broward County to pay to house him.”

  Until one day, when we found it: a solution.

  “Mr. Reynaldo,” I asked when he returned to court from the Fort Lauderdale Hospital, “how are you doing?”

  “I feel good, Judge. Thank you.”

  “You know, Philip,” I said, “all of the court staff marvel at how well you do on your medication. We were thinking that perhaps this time, you may be interested in working with the court so we can help you break these cycles of arrest. They cannot be good for you. And you have so much to offer.”

  My sentiments were genuine. Even though we had gotten to know Philip, we still didn’t know much about his personal history except that he had suffered a traumatic brain injury from a car accident. We also knew that when he took his medication, his mood, demeanor, and capacity to make sound decisions improved considerably. He became a kind, witty, and personable man.

  Surprisingly, Philip said he would like to try working with the court. I smiled, hoping that this would be the decision that would change his life for the better.

  “I’m so glad you do,” I said.

  Philip appeared at his review hearings for several months, as we monitored how he was doing and whether he required additional services. His progress was remarkable. He began to transform before our eyes. Who knew that he had a keen interest in men’s fashion? One day he appeared in court dressed in dark blue jeans and a red, white, and black striped shirt. He topped his look off with a black-tweed newsboy cap. It was impressive.

  Within weeks, however, Philip was back in jail. He had been arrested for panhandling. The next time I saw him in court he was wearing a loose-fitting jail jumpsuit. He had st
opped taking his medication and needed to be transported to the hospital for psychiatric treatment and stabilization. He had returned to his former life, to the streets.

  It was heartbreaking.

  When Philip returned to court again following his discharge from the Fort Lauderdale Hospital, I asked him what had happened to get him back to this point again. He had been doing so well.

  He lifted his shoulders in an exasperated shrug. He had no answer. In a gesture of goodwill and to preserve his dignity, I suggested to him that perhaps he simply did not have enough positive support to pivot to a new life.

  “Perhaps,” I said, “your friends who were homeless did not want you to leave them.”

  I thought about Rosemarie and wondered whether her homelessness was by choice or whether the struggle for a new life was just too challenging without the support she had enjoyed at the Cottages.

  Philip shrugged again. Like the rest of us, he just didn’t have an answer.

  After years of serving on its bench, however, I did. For me, the greatest failing of the court stems from my idealism. I was confident that as media attention grew, so would the public’s outcry against what Ron Honberg, the senior policy adviser for the National Alliance on Mental Illness, and members of other mental health policy organizations labeled the “inappropriate criminalization of people with mental illness.”4 Clearly, serious crime warrants punishment. Yet I believed that when minor criminal acts were viewed through the therapeutic justice lens of a court of dignity, that the shame of injustice would be evident.

  It wasn’t—not yet.

  As these stories reveal, the vast majority of people who have participated in the court have never seen a mental health practitioner. In many cases their families knew “something was wrong,” but could not identify the problem as a serious mental health disorder. Or, when a mental health crisis occurred, individuals and families had no health insurance and could not navigate systems of care that are highly fragmented and underfunded. Further, disparities based upon race, ethnicity, class, and education make up the lion’s share of the justice-involved population. People who suffer from these disparities encounter barriers to care with regards to stigma and a mistrust of the mental health system that must be appreciated to understand how to enhance engagement in mental health care. These barriers to care are particularly challenging when hope for jail diversion and precise treatment matching is reliant on access to publicly funded community resources. Resources such as supported housing programs and an array of residential treatment programs, like affordable housing and residential treatment programs, are very limited if they are available at all.