Super Vision

By keeping a constant eye on its mentally ill clients, an ACT team heads off all sorts of troubles

Off his meds, Chris was arrested four or five times over the course of a few weeks for minor crimes; once, he ate a steak dinner at a Montrose restaurant and was arrested when he couldn't pay for it. Sometimes Chris was picked up by police at his mother's behest -- she had seen him wandering the streets, and his behavior toward her was sometimes frightening. By the time Chris was arrested for aggravated assault, just before Christmas 1996, his mother decided jail might be the best place for her son -- for the time being, anyway.

"He didn't belong there," Patricia says, "but we weren't going to bond him out."

Chris's prior history of mental illness got him transferred to MHMRA's third-floor psychiatric unit, where he resumed taking his medication. In August 1997 a jury found Chris guilty of aggravated assault, but not guilty by reason of insanity. He spent the next 18 months at the maximum-security psychiatric lockup at Vernon State Hospital. He was released in March 1999 to the custody of the sentencing judge, Jan Krocker of the 184th District Court.

Chris: From a SWAT arrest to straight A's.
Deron Neblett
Chris: From a SWAT arrest to straight A's.

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Like criminal court judges across the nation, Krocker knew her docket was increasingly peopled by defendants with mental illness. Unlike many judges, she decided to do something about it. She had heard about Assertive Community Treatment and phoned the program's director, Tom Mitchell. It was a call, she says with a laugh, that changed her life.

"I was looking for someone in the mental health community to help me supervise people who are very dangerous when they are not taking their medications or getting treatment," she says. "I knew from the minute I met Tom that ACT was going to work."

Krocker has ordered about a half-dozen people into the ACT program, from young people trying to get a grip on life, like Chris, to people in prominent positions in the community. The judge receives a report on their progress every 90 days, although she doesn't have to wait that long if something goes wrong. Mitchell contacts her immediately when ACT clients from her courtroom stop taking their medication or start missing psychiatric appointments. On a few occasions, Krocker has charged ACT clients with contempt of court. After a few days in jail, they understand it's in their best interests to cooperate with the ACT team. Right now, they are all doing well, including Chris, who, Krocker is happy to report, is getting straight A's at HCC.

Krocker says judges who provide supervision to people with mental illness owe it to the community to make sure the person is not a danger to himself or others. That's not always easy; most judges are too busy, and no one has the staff. In Krocker's view, ACT "is really worthwhile, even though it's very expensive" -- program costs are between $7,500 and $10,000 annually per person.

"But if someone can lead a normal life and receive outpatient treatment, I think, as a judge, I have a duty to work with them on that," the judge says.

Unfortunately, says Mitchell, few judges look at mental illness the same way. Some don't want the trouble and attendant risk of being responsible for a mentally ill person who committed a violent crime and who eventually will be released from the state hospital. Other times, defendants are so deranged, the judge is afraid to release them.

"That's when we can help," Mitchell says. "But there are judges who won't let me in their court, or who obviously don't want me there. It's a matter of education, letting them know what we do, what we're about, so they feel comfortable with the program."

In one of two pilot programs of its kind in the country, the nonprofit Thresholds Psychiatric Rehabilitation Center has four ACT teams that operate from Chicago's Cook County Jail. The program was set up to help repeat offenders with severe and chronic mental illness get treatment and other social-welfare services. Their track record is impressive: Number of arrests, number of days incarcerated and number of hospital admissions are down 80 to 90 percent for Thresholds' clients, which has saved Cook County at least $500,000 in just the last two years.

Mitchell says he and Krocker have talked about putting together a grant for a similar program in Harris County. But, he says, the program won't work unless Harris County and the state mental health department pitch in to cover the long-term cost.

"I think that if we spent more money on mental health, we would be able to spend less in the criminal justice system," Krocker says.

If Chris's experience with ACT is any indication, it might be a good investment. Most days, Chris's caseworker, Karen Dorrier, picks him up and drives him to HCC classes. Every week, she gives him a ride to group sessions at ACT headquarters. And her constant presence serves to stiffen Chris's resolve to stay on his medication. "That's the key to treatment," he says confidently. Almost as important, though: "Mama loves her."

Dorrier says that at first she thought Chris would need to be constantly watched. She was also afraid that his behavior would put too much pressure on Patricia, and that he would have to find someplace else to live. None of that has been necessary. Chris is living peacefully at home with his mother and has been a model ACT client, Dorrier says.

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