Super Vision

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

Chris doesn't recall much of what happened that day in December 1996, when he was arrested for aggravated assault with a deadly weapon.

"I can't say it happened, or it didn't happen," he says. "I think I'd had a 12-pack of beer and a bottle of wine."

Apparently Chris had viciously cursed and threatened a neighbor at his Pasadena apartment complex. Forewarned and frightened, the man called police. When officers came to his door, Chris vaguely remembers, he told them to get a warrant or go to hell. Then he went to bed.

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

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The apartment manager notified Chris's mother that trouble was brewing. She arrived to find a dozen or more officers, some outfitted for riot-control duty, setting up a command post in the parking lot. Helicopters buzzed overhead. Television news crews were on the scene, reporting the story that an armed madman had barricaded himself in his apartment.

"The police knew he had mental problems, but I could have got him out of there. His sister could have got him out of there," says Chris's mother. "They didn't need to go to all the trouble they did."

A small battalion of officers eventually stormed the apartment. They arrested Chris and took him to Harris County Jail in his boxer shorts. In the kitchen, police found a small knife that Chris apparently had brandished at his neighbor.

In person, it's hard to reconcile Chris with the image of a man so dangerous it took half the police force to bring him in. Well-mannered and eager to please, he's 27 years old now, stocky, with a round, fair-skinned babyface and short strawberry-blond hair. He's taking computer courses at Houston Community College and doing well. He seems happy, and so does his mother, Patricia, a fact they both attribute to Chris's involvement with Harris County's Assertive Community Treatment program.

"If this hadn't happened," Patricia says of ACT, "I'd have buried him or he'd be in the penitentiary for life."

More than 283,000 mentally ill people were incarcerated in the nation's prisons and local jails in 1998, according to the latest figures compiled by the Department of Justice. Another 550,000 were on probation that year. At any one time, between 600 and 800 people are receiving "forensic" psychiatric care in Harris County Jail or have been referred to community clinics, according to the Mental Health and Mental Retardation Authority, which operates the jail's third-floor psychiatric unit. Some seek help while they're incarcerated; others have been identified through the pretrial screening process.

Sometimes a defendant's illness is brought to the court's attention before trial by an attorney. Defendants thought to have a mental illness are evaluated for fitness to stand trial, as well as to determine their state of mind when they allegedly committed their crimes. It's not a daily occurrence in Harris County to have someone found incompetent or not guilty by reason of insanity. But it happens often enough to present "many logistical problems," says George Godwin, the administrative judge for Harris County's criminal courts.

For one thing, MHMRA's third floor is perpetually backed up; the agency is supposed to evaluate an inmate within five days, but that rarely happens. Not long ago Baylor College of Medicine offered to help Godwin and the courts with the evaluations but wanted the sheriff's department to transport defendants to and from the Medical Center.

"Of course, we disabused him of that notion real quick," Godwin says. "I said, 'You just tripled or quadrupled the cost of that right there.' "

Defendants found incompetent or not guilty by reason of insanity typically go to a state hospital for treatment and then are released to be supervised by the sentencing judge. Some judges order the person to outpatient services at MHMRA. However, many don't. Apparently the agency has no mechanism in place to keep track of the former defendant's compliance with the court order, and many of them fall through the cracks until they show up in the criminal justice system again.

The bottom line is "there are probably people who do not need to be there, if we can give them a viable community alternative," Godwin says. "You don't have to be a trained psychiatrist or a psychologist to recognize that."

Sometimes it takes a while, though. After Chris's arrest, he was incarcerated with the county jail's general population. He immediately started brawling with other inmates and was removed to protective custody. Meanwhile, Chris's mother and his lawyer pressed the sheriff's office to have Chris looked at by MHMRA's jail-based clinicians.

Chris was a hyperactive child who started taking Ritalin at age 11. His father, who had divorced his mother, suffered from a mental illness, and by the time Chris was a teenager, he had been admitted to psychiatric hospitals numerous times. In 1987, while at Austin State Hospital, Chris was diagnosed with bipolar disease and schizoaffective disorder, the symptoms of which caused him to spin out of control with mania or withdraw into an almost catatonic daze.

Chris's illness usually was kept in check with medication. But in the fall of 1996, a doctor told him to throw his pills away. "He didn't lower [the dosage] or nothing," Chris recalls. "When I told him I was feeling 'manicky,' he said I was just young and excited. He didn't think I was bipolar."

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.

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.

Most clients -- especially those with a criminal past -- will need ACT's help to walk the straight and narrow for the rest of their lives. But Dorrier thinks Chris might be an exception to the rule.

"I can see Chris getting married and having a family one day," she says.

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