A Court of Refuge

by Ginger

  As I listened to Janis update the status of a defendant, a woman with blond hair entered the courtroom. The court deputy who monitored the door politely stopped her to inquire if she had a matter on the docket. As they spoke, a nagging sense that there was something familiar about her tugged at me. My mind flipped through the years as though they were index cards, flickering through courtroom scenes and life stories. After she finished speaking with the court deputy, she turned toward me.

  As I looked at her face, I recognized her. She stood where she had stood years before, when she had been a participant in the mental health court.

  Lilly. How could I ever forget Lilly?

  The power struggle between us had been extraordinary. If I only had a video playback of those hearings, where I was virtually pleading with her to let us help her. Lilly, like Kathryn, had been homeless. Unlike Kathryn, she had been unable to fully comprehend that her ex-husband had obtained a restraining order against her: Lilly was prohibited from returning to the family home or having contact with her children, even though she did return to the family home and did have contact with her children several times before her case was referred to the mental health court. Each time, I thought—hoped—that she would agree to the court’s offers of assistance. Instead, she would raise new obstacles to what had already been negotiated.

  Yet here she was. I hadn’t seen her for more than a decade. But the way she glided as she traversed the courtroom had not changed.

  As she approached the bench, I could see her more clearly. She had aged. But then, so had I.

  “Lilly,” I said. “Goodness! What brings you here? Is everything all right?”

  “Everything is fine,” she said. “I just wanted to say hello.”

  I felt like I had just been transported back in time. Everything seemed so familiar. Lilly was wearing a black and white flowing, bohemian dress with a sheer white shawl draped over her shoulders. Her blond hair was piled in a neat bun on top of her head. I was glad that she had not changed her style in all those years. It suited her too well.

  “Allen,” I said to my deputy clerk, “I am going to take a brief recess.”

  I escorted Lilly into the jury room to talk. We sat directly across from each other. “It is wonderful to see you,” I said. “What brings you to court?”

  “I wanted to come and thank you,” she said. “If it were not for you and the court, I don’t think I would be where I am in my life today. Actually, I’m not even sure I would be here.”

  She told me that she resided in a “delightful” assisted-living facility near the beach. “I spend time with my children. We’re close,” she said. Then she paused, taking a breath before saying with pride, “And can you believe it? I’m a grandmother.” She told me that one of her daughters lived in Thailand but telephones often.

  She told me about her hobbies—her plants and her garden—and how the white gardenia plant blooms on her private patio and its rich and sweet aroma. She told me about the bougainvillea plant that grew and twined around her living room window. She told me about watching sunrises and sunsets over the ocean, which was not far from her home. The ocean, she said, was big, but even so, it was unchanging and constant. That, she said, was a comfort.

  “I wanted you to know that I’m happy,” she said. We sat for a few minutes and spoke like two old friends who had known each other in another time.

  Then I told her about my life, or the court’s life. “The court is being considered for a prestigious award in the Netherlands,” I said.

  Lilly wished us luck.

  As the visit wound down, we looked at each other in silence and smiled.

  “Thank you for treating me so well,” she said. “My mother always taught me to treat people as you would want to be treated. I just don’t think I would be this far in my life if it wasn’t for you.”

  Her words meant a great deal to me, particularly since we had sparred so much in the beginning of her case. Who can know the impact we have on the lives of others? This was a voice from the past, an unexpected “hello” when the path of Lilly’s life crossed mine once again. I wondered, briefly, about the other lives with which mine had intersected as a result of my work in the mental health court. But as I gathered their names in my mind, I realized that there was really no way of knowing. Not unless they came to see me, as Lilly had done, or if by chance our paths crossed once again.

  Kathryn has been a constant fixture in the mental health court since she earned her degree in mental health counseling and achieved her goal to serve others, as a mental health community case manager. Fifteen years after she first appeared in Broward’s Mental Health Court, Kathryn and I once again worked together. Debbie Plotnick of Mental Health America invited me to participate in a webinar hosted by the Rosalynn Carter Fellowships for Mental Health Journalism.1 Along with her invitation, she also asked me whether I knew of a Broward County Mental Health Court participant who would also be interested in being on the panel. I knew that instant that I had to call Kathryn.

  I chose to do the webinar from my home as opposed to the courthouse because we needed quiet. There was no way to control the phones or the commotion in the corridor outside my chambers.

  I set up desk chairs directly in front of the computer screen, with two headsets, and I hung talking points on the wall next to the computer, in case we needed reminders. Kathryn and I took our seats in front of the computer screen to wait for the Skype call.

  The Rosalyn Carter Fellowship is highly competitive and attracts top journalists who have an interest in mental health. The goals of the fellowship are to increase accurate reporting on mental health issues, reduce stereotypical information, enhance the quality of the journalists reporting, and develop a network of informed professional journalists across the news, magazine, radio, film, television, and social media.

  The topic of this webinar was mental health, decriminalization, and jail diversion. As the webinar began, I started the presentation by describing the problems that Broward County had experienced in its criminal justice system, which had led to the development of the mental health court. These problems included a lack of access to mental health treatment and services in the community, jail overcrowding, several deaths by suicide in the jail, and other failures outlined in the grand jury investigation of Broward County’s mental health system.2

  Debbie Plotnick discussed the criminalization of people with mental illness and co-occurring substance disorders, as well as the failed deinstitutionalization policies that have left thousands of people with serious mental illness with nowhere to go.3 Katti Gray, the moderator, talked about community collaboration and then shifted the questioning to Kathryn.

  “Can you describe your experience as a mental health consumer and the challenges that you and—now that you work in the field—your clients face?” Katti asked.

  As Kathryn spoke, the webinar took on a deeper human focus. I am sure that the Rosalynn Carter fellows watching the webinar appreciated her perspective. On a personal level, I learned a great deal as I listened to Kathryn describe her experience in the court. She explained, “The court provided me with a pathway to transitional housing. That was a priority for me, since I was homeless. I doubt I would have been able to find housing for myself in the state that I was in back then.”

  Kathryn spoke from the heart and explained that the one of the greatest unmet social needs of her clients is housing. She stated that many of her clients reside in shoddy and unsanitary assisted-living facilities because they are dependent on Social Security disability payments and can only afford this poor-quality housing. After paying for even that, many of the clients do not have any money left to buy clothes, food, or necessities. Forget about going to a movie or buying an occasional treat. The level of poverty that her clients endure was “shameful,” Kathryn said. “I often feel guilty. I can’t do more for the people I serve, even if they deserve more,” she said.

  As the webinar came to a close, the moderator went around the
panel and asked each of us to share with the fellows what wish we would want to have granted for mental health and criminal justice. Without prior discussion, Kathryn and I interestingly expressed the same wish, but she articulated it more succinctly: “I wish that a new era of mental health would emerge where it was universally accepted that ‘recovery is real.’” In her voice one heard the years of exasperation with the fact that this was not yet the case. Her voice carried deep pain, I realized, as I listened to Kathryn speak. But it also carried great passion.

  When the moderator asked Kathryn why she decided on that wish, Kathryn replied, “I believe that access to qualitative, comprehensive mental health and substance abuse treatment should be available in our communities. People with mental health problems should not have to wait for crisis to get help.” After a pause, she added, “People were made to get better. Our bodies and minds have adapted to facing challenges and learning about them, and then we can overcome them. Recovery is not a myth. Recovery is a reality.”

  Days after the interview, I attended a luncheon meeting at one of Broward County’s leading civic organizations. At first, it was off to a positive start. The restaurant was elegant and had been closed to the public to accommodate the civic group. The organizer’s plan was to have a “working lunch.” The program was titled “Overcoming Stigma and Mental Health,” which I thought was a great topic for a civic group. I was especially looking forward to getting a better understanding of the views of people who are not part of the mental health community.

  The civic organization was diverse and included a mix of city officials, civic activists, and business leaders. Several panelists spoke eloquently about the impact of stigma from various perspectives. Unfortunately, by the time it was my turn to speak, most of the speakers had left after delivering their remarks.

  Since I was the only speaker left, I felt I should stay for the Q&A session.

  “Anyone have a question?” I asked. A man at the opposite end of the table nodded at me as he raised his hand.

  “Yes, sir?” I said.

  “Where do you put ’em?” He asked and leaned back in his chair.

  “What do you mean? Where do I put what?” I asked.

  “You know, the people that you see in your mental court,” he said.

  “I don’t put them anywhere, sir,” I said. “They are people.”

  I could feel the tension in the room growing. It was a derogatory comment, and several people looked confused. It was not so much what he said as how he said it, and I knew exactly what he intended to imply: his voice was cold and disdainful, as if he were asking where put excess plates in a kitchen cabinet that has run out of space.

  I remained composed and proceeded to spend the next several minutes discussing the prevalence of mental illness, the fact that everyone’s healthcare needs are different, and the reasons it is so important that policymakers at every level of government in Broward County prioritize mental health.

  Then, another hand shot up.

  “Judge, if Broward County spends more for mental health services, won’t that attract more homeless people?” this man asked. “You know, our community has a serious homeless problem.”

  I responded to this man’s question as best I could. It struck me that these views and attitudes about mental illness that were being expressed were more than likely how most people understood the issue of mental health. The perception that all people with mental illness are homeless is stereotypical and false. Yet this seems to be a common view. You don’t need research to tell you that not all mentally ill are homeless. The fact that several homeless people also have untreated mental illnesses would indicate a lack of services and resources to connect those individuals with care. The solution, therefore, is not one based on the issue of homelessness but on the amount of mental health resources and services available to serve our communities. That is why I work hard in the court to reinforce the message that treatment works. And this is why I rely on health literacy and the promotion of dignity to help level the playing field. I have tried to create a stigma-free environment where people can envision their dreams. But a courtroom is just one small space.

  I spent the last few minutes of the luncheon talking about recovery and humanizing the people I see in court. I hope I changed a few minds by the time the luncheon was over.

  Over the years, I have often thought about Roger, whose case was the first to be heard by the Broward County Mental Health Court, and wondered how he was doing. The memory of the opening day of the court—how it rapidly turned into a traumatic event—is forever etched in my mind. It was a harrowing experience for me as the presiding judge to have to order the courtroom cleared because Roger was too psychiatrically unstable to understand what was happening. He was so agitated, I feared he would pull the chair in the jury box out of the floor. The court’s first case led to its first order to divert a mental health defendant out of the jail, to be transported to a local receiving facility for psychiatric evaluation and treatment. I issued the order in the corridor outside the courtroom.

  Once Roger was connected to mental health treatment and care in the community, his case was dismissed. We never saw or heard from him again. But I will never forget the way he smiled as he stood in the courtroom, reunited with his parents who had lost him to untreated mental illness and the streets. Since the court heard Roger’s case, more than twenty thousand people have come through the Broward County Mental Health Court. We may not have been able to help everyone, but together with a mental health community collaborative, we have touched many lives.

  It was a bright spring morning when I left my house to drive to the courthouse. I took the same route that I have taken every morning for nearly twenty years, passing the same homes, and watched as parents walked their children to the elementary school nearby. On this particular day, I noticed a tall man walking toward the bus stop. It was a bus stop that I had passed countless times before, and I had never seen anyone waiting at that bus stop. But this man stopped there to wait for the bus. There was something familiar about him.

  It didn’t take me long to piece it together—it was Roger. He looked different than I recalled, but there was no doubt that it was him. Tall, with a clean-cut appearance, he was half smiling into the morning sun.

  I was so amazed to see him that I immediately lowered my window and shouted, “Hey, Roger! It’s Judge Lerner-Wren.”

  Roger turned to me in surprise. His look changed to a giant grin, and he pointed to the knapsack on his back. “Look, Judge, I’m in school,” he said and then gave me a wave.

  I waved back and wished him well. As I continued my drive to the courthouse, I shook my head in disbelief. And then, I cried.

  ACKNOWLEDGMENTS

  I want to thank the thousands of men, women, and their family members who have participated in the Broward County Mental Health Court and shared their personal stories of trauma and loss—and recovery. I am humbled by their courage and spirit of resilience, which rises to new heights when the vision of recovery and dignity is established through the court process. I am extremely grateful to Broward County public defender Howard Finkelstein. He listened with his heart to Jane Wynn, as she described her son Aaron’s descent into mental illness and incarceration. Howard’s realization that our community was ill-equipped to provide care compelled him to spearhead a response. This book reflects the capacity of communities to lead change.

  I am most grateful to the leadership of Howard and others, who led the assembly of a local task force seeking criminal justice solutions to those arrested who suffer from serious mental illnesses. This diverse coalition of high-powered and influential stakeholders was resolute in its mission to eliminate silos and integrate two independent and parallel systems of care and, most importantly, to find solutions for the mentally ill. After years of meeting, in spite of many frustrations, new and energized relationships formed to support the establishment of the nation’s first mental health court, in Broward County, Florida. I want to
acknowledge all those who participated in this process.

  I am extremely grateful to the academic scholars in the fields of therapeutic jurisprudence, disability rights, and forensic psychology who supported the court. Their contributions in research and scholarship from a perspective informed by human rights and the experience of trauma were profound, as the court was based on dignity and principles of procedural justice. The transformation of mental health care in America is the centerpiece of the work of the President George W. Bush’s New Freedom Commission on Mental Health. I am confident that the vision and promise of excellence in mental health care will be achieved. I wish to express my deep gratitude for the opportunity to serve on the commission.

  I am extremely grateful to Joanna Green, my extraordinary editor, for her insights and humanistic vision for this book. I am most appreciative of her guidance and for the privilege of working with Beacon Press. I am also deeply thankful to my agents, Phyllis Parsons and Dana Newman, for their unconditional support of this project.

  To my children, Erin and Matthew: you are my muses for the cause of justice and the touchstone of my life’s purpose. Finally, to my husband, Dr. Bent Nielsen, who traversed a world for me: your love and support are everything.

  NOTES

  Author’s Note

  1. Administrative Order No. VI-97-I-1A, “In re Creation of a Mental Health Court Subdivision within the County Criminal Division, 17th Cir. Ct., Broward., Fla.”

  2. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: IV-TR (Washington, DC: American Psychiatric Association, 2000).

  3. Carol Marbin Miller, “The Woman Who Changed How Disabled People Are Treated Has Died,” Miami Herald, June 5, 2016.

  Chapter 1: A Race for Justice

  1. Chapter 394 of the Florida Statutes governs mental health services, including involuntary examination (Section 394.463) and involuntary placement (Section 394.467). The Florida Mental Health Act of 1971, commonly known as the Baker Act (after Representative Maxine Baker, who sponsored the legislation in 1997), allows for involuntary examination of an individual if there is evidence that the person has a mental illness or is a harm to self or others as defined in the statute and is unable or unwilling to provide express informed consent for examination. (Florida Statutes, Section 394.467, as amended in 2016, added a “substantial harm” standard.)