By Robert Landauer – editorial columnist for The Oregonian, part of the series – “Rescuing the mentally ill,” March 22, 2000. Not available elsewhere online.
A new Multnomah County mental health court is in the offing as many more of the mentally ill populate local jails. Cautions are in order to protect ill individuals from harmful side effects of the state’s benevolence:
This specialty court is likely to stress voluntary diversion into treatment, preferably long before defendants enter pleas on misdemeanor crimes. To make informed rulings, judges will need defendants’ medical and mental health histories, records of alcohol/drug addictions and awareness of housing, jobs, skills-training, entitlement and language and cultural factors that affect treatment success.
This requires a far better cross-agency information system than now provided — one that emphasizes treatment results instead of billing practices.
Even if judges get all this information, they don’t know which treatments or sentences work best.
This is inefficient. It also is unacceptable for the special-needs population whose lawbreaking has more to do with illness than criminal intent.
There is a nation-leading opportunity — first in Multnomah County, then the rest of the state — to overcome these defects. It urgently requires continuing, top-level political, financial and interagency support to create a new information system:
Multnomah County Circuit Judge Michael Marcus leads a project to build a Criminal Sanctions Effectiveness Measurement.
The first goal is to find how different types of offenders respond to the various treatments and sentences.
Marcus recently took an early model of the measurement tool on what literally was a trial run:
“When I first ran the tool on the bench against real data on Jan. 26 — the first time such a technology was used anywhere in the known universe — I sent an e-mail to (several hundred) judges all over the world . . . analogizing the event to the Wright Brothers’ first flights at Kitty Hawk. On the one hand, I am confident that this step will have as much impact on criminal justice and its culture as Kitty Hawk had on transportation. On the other hand, we have about as far to go to a completely functional tool as the Wright Brothers had to go to a Boeing 737.”
This is the take-off stage. Incomplete data limit the sentencing-support tool’s useful range. But fuel is being added. Detailed information on a larger pool of offenders and available sentencing/treatment options is being collected, sorted and sifted in Multnomah County, and then compared with results.
Oregon’s Department of Corrections, with more than 9,000 inmates (18 percent with serious mental illnesses), no doubt will want to adapt this tool. It could be adjusted easily to assess effectiveness of programs in prison and to fine-tune others that Corrections workers are developing to help inmates succeed after release.
Information systems can and should help judges, medical staff and social workers choose the best matches of treatment programs or sentences for mentally ill defendants and clients as well as others.
It is critical, though, not to confuse output with outcomes. Turning data into intelligence will be futile if resources aren’t there to allow suitable referrals.
That is the deplorable situation now for the mentally ill in Multnomah County: Average funds available per client plunged from $440 in October 1995 to $244 in May 1999. Social workers and probation officers each are working with more than a hundred clients. Caseloads are two, three, even four times nationally recommended standards.
Overall, mental -health workers here are rushing from crisis to crisis. They have little time to devote to the early interventions and consistent support that keep patients stable in the community. Indeed, a woman movingly told a county task force recently that her mental illness hospitalizations, which used to occur once every 21/2 years, now come about every six months. The likely cause: Her breakdowns rose along with her social worker’s caseload; it is so high now that they only have occasional, cursory meetings, no time even to go out together for coffee.
So the mentally ill crowd our county jails. They get superior treatment there — it’s a progressive place — and their illness symptoms often improve greatly during their average three-week stay.
But jail shouldn’t be Multnomah County’s mental -health treatment center of choice because care that begins at the jailhouse entrance usually ends at the jailhouse exit.
Consistent, hands-on compassionate, care for people with treatable brain disorders will keep many from ever having to stand before a judge in mental -illness court.
It is important, though, that we know more about profiles of the mentally ill who do get arrested and jailed.
The sentencing-effectiveness tool will spotlight what best protects public safety and aids rehabilitation and recovery. Its development is an enlightened, urgent priority.
It would be wasteful and cruel to continue to sentence the mentally ill in the dark.