My daughter sleeps in jail tonight, not because she is a criminal, but because the voices told her to do something that was. Instinctively, I stop at her bedroom door and look in at the stuffed animals left untouched on her pillowed bedspread, and I try to accept the fact that tonight, my precious baby girl will rest her head on a cold and dirty mattress in a jail.
In
Part I, introduced my daughter Trina and told of her diagnosis of
schizophrenia, of her
resistance to treatment, and of her eventual arrest for stealing a car she believed God had given her. Like many kids with a mental illness, Trina had a prescription for psychiatric medication but turned 18 and was legally able to refuse to take it. Her condition did not yet threaten immediate harm, so her mother and I were powerless to force treatment on her. Trying to talk to her was futile. She was convinced we just didn't have the faith to believe that God had chosen her to hear the voices nobody else could hear.
Below the break we'll pick up the story with the criminal court prosecution and the competency hearing process that was a recipe for disaster.
KosAbility is a Sunday 4pm(Pacific time) community series by volunteer diarists, as a gathering for people living with disabilities, who love someone with a disability, or who want to know more about the issues. Our use of "disability" includes temporary as well as permanent conditions, from small, gnawing problems to major, life-threatening health/medical problems. Our use of "love someone" extends to beloved members of other species.
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INEVITABLE PROSECUTION IN CRIMINAL COURT
It is a sad reality in the United States: sooner or later, all young people with untreated mental illness will end up in the criminal courts if they live long enough. In large part due to the gradual closing of state-run mental hospitals since the 1960s, jails (and E.R.s) have become the de facto treatment facilities for mental health patients in America.
(transcript and CC available on the YouTube site)
In one sense, we were relieved when Trina was arrested, because we knew that a court order would be the only way she would ever accept treatment. We also knew the system well enough (I a criminal defense lawyer and her mother, a public health nurse) to understand that under the current law there would be no other option until she hurt somebody.
There are two ways that police officers make sure the people they arrest show up in court. One is to issue a citation and have them sign a promise to appear in court. Called a "cite release," this allows the officer just to let the person go with the citation. Should they not show up in court, the judge issues a warrant for their failure to appear.
Trina's case was the other type, where she was arrested and booked into county jail. Booking is used for more serious crimes, and bail is set by the jail according to a published bail schedule for the crime allegedly committed.
If the person does not post bail immediately, the jail can usually keep them only for 48 hours without taking them to court for a hearing. At that first hearing, the judge has to make several decisions, among them whether or not there is probable cause to believe they committed the crime they're accused of and whether they should be released on their own recognizance pending trial.
Bail: To Post or Not to Post
As soon as Trina was arrested, we faced the same dilemma as countless family members across the country. Do we post bail to get her out of jail, or do we let her stay in jail until the court date? As horrible as was the thought of her staying in jail for two days, worse yet was the thought of her being released to the streets in the throes of this illness. And we didn't even know how bad the condition was until she went to court two days later.
First Court Date
After only two days in jail, Trina's condition had gotten much worse, as we learned when she arrived in court. I'll never forget seeing her in the orange jumpsuit, with her hands shackled in front of her and her ankles chained together. Her hair looked like it had not been combed in days. She looked at us in the courtroom as though she did not recognize us, and she muttered to herself throughout the hearing. Lawyer friends of mine (from almost two decades of practicing law with me in that courthouse) could not believe Trina was the same girl who won the
Mock Trial Competition six years earlier. When her case was called, she interrupted the judge and her lawyer to insist that they were violating her
First Amendment freedom of religion by prosecuting her for something God told her she could do.
At that point, her attorney told the judge he had questions about whether Trina were competent to stand trial. Under California law, if a defense attorney raises the question of competency, the judge must hold a "1368 Hearing" (named for Penal Code section 1368) to determine whether or not the case can even go forward. So the judge scheduled another hearing in four weeks--sufficient time to have Trina evaluated by court-appointed psychiatrists.
Four weeks? You mean Trina has to stay in jail for four weeks pending the evaluation? Well, there was certainly no way we were going to post bail at that point, and I doubt the judge would have allowed it had we wanted to. We did ask the judge to order her to take her medication while she was in jail, so that was some comfort.
Mistreatment in County Jail
It was to be cold comfort and short lived. During those four weeks, Trina was never treated by any medical personnel, though the court records clearly showed she was on a
1368 hold. Though she was court-ordered to have her medication (and we provided the jail with copies of her prescriptions for anti-psychotic drugs),
not once did they give her any meds while she was there. When we questioned the watch commander about it, we were told that
the jail doesn't give psych meds. Wait. What was that? You don't
give psych meds??
We learned that our county jail was one of a growing number to contract their health care to Corizon Health, which earns more than $1.4 billion dollars annually off of prison health care. That's billion with a B. According to the ACLU, Corizon has been sued more than 600 times for malpractice in the last five years. The most public of these suits involved Corizon simply refusing to give inmates their Hepatitis medication.
This prison profiteering will be the subject of a future diary, but for now suffice it to say that Trina's condition got progressively worse as she was isolated from everyone she knew and denied any medication for her condition. The voices made her condition so disruptive that she was put in solitary confinement for her own protection. In 96 hours Trina went from driving her own car around town to being locked in a solitary cell for 23 hours a day. Seriously, is this how a civilized nation provides health care to its youth?
THE COMPETENCY HEARING
Not surprisingly, the judge readily agreed that Trina was not competent to stand trial. At that point, it was his duty to send Trina somewhere for treatment so that she could become competent. In our county, competency defendants are sent to one of two places for treatment and return to answer the charges. Patients accused of misdemeanors are usually sent to a local Psychiatric Health Facility, or "PHF" (pronounced like the Magic Dragon). Felony defendants are usually sent to a California State Psychiatric Hospital.
Because Trina's lawyer had negotiated the grand theft auto down to a misdemeanor charge, the judge sent Trina to PHF. Her mother and I objected on the record because though the word "psychiatric" is in its name, the PHF is not a treatment facility. It is a locked-down unit designed to provide a safe place to house people temporarily during involuntary psych holds, providing little more than supervised room and board. Her mother and I knew Trina would not get the kind of treatment she needed to become competent, but we were up against the way "they always did things."
Four weeks later, we're back in court with the PHF liaison telling the judge Trina's condition was so bad that she would never be competent. In the opinion of this PHF director, Trina would never lead a normal life and should be committed to a psychiatric institution for the rest of her life. In my opinion, no licensed mental health provider could have plausibly believed this statement. I believe it was a bold-faced lie, designed to avoid having to admit that the PHF could not really help these patients (and lose the funding provided per patient referred).
Of course that was nonsense, and we were ready with the opinion of a psychiatrist and a clinical psychologist that Trina needed the State Hospital to have any chance of becoming competent to stand trial. It was the polite way to tell the judge, "We told you so." I wondered then how many other patients had been committed to mental institutions based on lies told by the PHF liaison.
When with these professional opinions, the judge then ordered her to Patton State Hospital in San Bernardino, California. I visited her every weekend for the three months she was there, and I watched her slowly get better. The combination of coerced psychiatric treatment and structured living environment made all the difference, and Trina never would have gotten that help if her mother and I had not advocated in court. Spoiler alert: finding a way to provide this combination of treatment and structured housing will be a major recommendation in Part III, and the failure of the current system to provide it is, in my opinion, the central problem in mental health treatment today.
After those three months, Trina returned to court and was proclaimed competent. Of course the judge gave her probation, and in Part III, I will tell you the story of a probation system that is set up to fail for mental health patients. I will also describe our painful decision to seek a conservatorship and will offer some thoughts on how we can improve the system for our sick kids.