Civil commitment leaves Hennepin County offenders languishing

Mentally ill inmates wait months for evaluation, treatment

The emerging focus on civil liberties was a monumental step out of the Dark Ages of psychiatry, but it also created an innately more complicated system.

"Now, in Minnesota, you have a system that I think is very sensitive to the rights of individuals," says Dr. Lawrence Panciera, chief clinical psychologist for the Fourth Judicial District Court. "As good as that is—and I'm supportive of it—as soon as you put due process in the system, it slows things down."

On the heels of losing another Supreme Court case, the Legislature amended the Civil Commitment Act to include the "Jarvis petition." Named after Homer Jarvis, a Minnesota man who was committed to the St. Peter security hospital after killing his sister, the act established that a patient must be civilly committed before doctors can force neuroleptic medications.

Source: Hennepin County Mental Health and Probate Court

The focus on outpatient care also posed problems, particularly when treating the most severely mentally ill. New patients came in quicker than others were leaving, and there were not enough beds to accommodate everyone.

"I've been in the system since 1989; it's been an issue since 1989," says Dr. Alan Radke, chief medical officer for the State Operated Services. "We're chronically short of beds when we're talking about secure level of care. It's a back door problem, as well as a front door problem."

Currently, patients typically enter the civil commitment process in two ways: by being brought to the hospital for an evaluation, or through committing a crime.

The former is usually a speedy process; someone brought in for an evaluation by a concerned family members might be committed within days or a couple of weeks.

Going the jail route is another story. Once arrested, mentally ill offenders simply wait for someone to suspect they aren't competent. Once that happens, a judge will file what is known as a "Rule 20 petition," which refers the offender to a court-appointed psychiatrist to be evaluated for competency.

If found incompetent, the offender is transferred to the mental health court, where a judge will determine whether the person can be committed. After that, the offender becomes the state's problem. The Department of Human Services is tasked with transferring the offender to the appropriate hospital for treatment to return the patient to competency.

"The thing to do is to make sure that there's enough space at every point in the process, so it doesn't get clogged up," says Joel Fisher, an attorney with the defense project. "It seems to be that there are clogs almost at every place."

In Hennepin County, the civil commitment system can come to a screeching halt as soon as the offender is arrested.

The defense attorney, in most cases a court-appointed public defender, is usually the first member of the court system to notice if someone is mentally ill, and possibly unfit for trial. But today, public defenders are grossly overburdened with case loads. Recent years of budget cuts have made it common for public defenders in Hennepin County to take on twice the suggested work load, meaning they spend less face time with each client. And if competency isn't brought to a judge's attention, the Rule 20 petition is likely never filed.

"We can't do anything until we get the Rule 20 petition," says Carla Hagen, senior assistant Hennepin County attorney. "They're really not even on our radar, because we're not trolling for more clients."

But even more of a burden on the system has been a dramatic increase in mental health referrals. In 2001, there were a total of 52 Rule 20 petitions filed in Hennepin County in which the defendant was found incompetent in the criminal court and transferred to mental health commitment court, according to data provided by the court. In 2011, there were 92, an increase of 77 percent.

"I think it's true that the criminal system is somewhat becoming a funnel for people that are mentally ill who don't wind up getting services through the usual route," says Carolyn Peterson, another assistant Hennepin County attorney who handles civil commitment cases.

No one is absolutely sure what caused the increase. The working theory is that we're seeing a ripple effect from the economy. As budgets have tightened, community resources for the mentally ill have been cut. With a rise in unemployment, many have lost health insurance benefits, and can't afford treatment.

"We see some folks who cycle through because they fall through the cracks," says Peterson. "They may have been receiving treatment. They lose their insurance or lose their housing, and they have a history of criminal behavior in addition to their mental illness problem, and they wind up in our system."

Whatever the cause, it is the Hennepin County taxpayer who picks up the bill. On average, it costs the county about $120 a day to house an inmate. Accounting for the costs of security, mental health nurses, and other additional services, this price can be significantly higher for mentally ill inmates. The jail wouldn't provide figures for this story, but according to a 2005 article published in the Journal of Law and Criminology, "Prisons of the Mind," the cost of incarcerating a mentally ill inmate can be up to 75 percent higher than the non-mentally ill. By this math, someone like Eugene Gates could be costing Hennepin County more than $18,000 just sitting in jail waiting for the system to find him.

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