Civil commitment leaves Hennepin County offenders languishing

Mentally ill inmates wait months for evaluation, treatment

In his appointment, Pawlenty remarked upon Quam's career as a successful litigator, with an impressive portfolio of volunteer work for low-income clients. "He will bring an incredible amount of intellect, energy, and compassion to the position," said Pawlenty. Fellow lawyers also comment on Quam's unusually personable attitude toward offenders in his courtroom—he has the "head and heart" for the job, says one attorney—but Quam is no pushover. He's the judge who boldly threw fallen-auto king Denny Hecker in jail over unpaid alimony to "motivate him."

After being assigned to civil commitment court, Quam quickly noticed the lag time for cases to reach his court. Many of the defendants were in desperate need of help, which Quam began to suspect was exacerbated by the long periods of time spent in jail waiting to move through the system.

"It's very apparent, when someone is symptomatic like that, that they need mental treatment," says Quam. "And these folks needed it and hadn't been getting it."

In the years prior to anti-psychotic medications, Minnesota's mental health system focused on long-term institutionalization
courtesy of the MN Dept. of Human Services
In the years prior to anti-psychotic medications, Minnesota's mental health system focused on long-term institutionalization
Judge Jay Quam believes that the civil commitment system needs to be reformed
Craig Lassig
Judge Jay Quam believes that the civil commitment system needs to be reformed

Quam was particularly galled with the burden this was putting on the jailers and the taxpayers.

"It's kind of everyone's fault," says Quam. "I think everyone would agree that it's bad to have people languishing in jail when they need mental health treatment. But the problem is, no one's really accountable for that."

Quam believes there is a better way. For starters, he thinks the two separate psychiatric evaluations could be condensed into one. This way, if the offender fits the criteria for commitment, the process would kick in right away. He also thinks jailers could be encouraged to file competency petitions, as they are the ones who see these inmates the most.

"I think you can tweak their personal responsibility to most effectively move the process along," says Quam. "Right now, it's kind of inefficient."

Others in the system have come to an almost identical conclusion. McGuire, who has been defending civil commitment cases since the '80s, has long believed that the system is too redundant.

"Right now, it's a sequential process," says McGuire. "They have to go through the criminal process until they get to a point where the criminal process says, 'We can't deal with you anymore'.... You end up with an individual that—if they end up refusing medications, which they can do very easily if they're not under commitment—they end up coming to the mental health court so psychiatrically decompensated that it takes a long time for them to get back."

But even if everyone agrees the system is broken, changing it is another matter. Quam has spent the last few months meeting with judges, trying to determine the logistics of instituting reform. Since it's never been done, Quam is venturing into uncharted territory.

And as a judge, his power is limited. If the system is truly to be overhauled, it will have to be done at the State Capitol.

"It could be addressed legislatively, no doubt about that," says Quam. "Whether anyone has the appetite to change or draft legislation to address the problem, I don't know."

In December 2010, Quam received a troubling letter from Al Poncin, an attorney on the mental health court's defense project. Eugene Gates had finally been committed that month. But several weeks later, Gates still hadn't been transferred to a hospital for treatment—he remained in jail.

Another of Poncin's clients, Ronald Brewer, was in a similar situation. In July 2010, Brewer was arrested outside the Country Bar, a karaoke dive in Uptown. The cops found a wadded-up napkin filled with 49 prescription Oxycodone pills in his pocket. The problem was that the prescription belonged to someone back at the bar, who told police Brewer had stolen the pills. Suffering from major depressive disorder, Brewer had threatened suicide from his jail cell, but it took months to commit him. And since his commitment, he had sat in jail for another month awaiting transfer.

By now, he had been wasting away in jail for more than five months for the low-level drug charge.

"If you've got a sick person and he's sitting in jail, the fact that he hasn't been committed doesn't make him any less sick," says Poncin. "If he's so sick he needs involuntary treatment, he probably needed that on July 1."

Not only does this violate the purpose of civil commitment, but it could also be illegal. The Minnesota civil commitment statute states that once someone is committed, the Department of Human Services is obligated to provide "proper care and treatment." The statute explicitly states that this means the patient can't be "confined in a jail or correctional institution."

Quam penned a notice to Cal Ludemen, then commissioner of Human Services, demanding the Department of Human Services come to his court and show cause for why Gates and Brewer continued to languish in jail.

"In no way can it be argued that jail or prison is an effective way to help a mentally ill person get better," wrote Quam. "In fact, the opposite is true."

On January 14, 2011, Quam held what would be the first of three hearings designed to make the Department of Human Services answer for why it was taking so long to transfer patients out of the jail.

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