Lincoln officials seek solutions to keep people with mental illness out of jail, prison

June 28, 2018 GMT

The justice system is not known for being quick to change.

But, in Lincoln, key players -- public defenders, jailers and prosecutors -- have been working to counter a sad reality they’ve known for years: People suffering from mental illness and substance abuse often end up locked up in prisons and jails.

The county’s Mental Health Diversion program, for instance, started in August 2016 as a pilot program aimed at keeping people with serious mental illness from entering or returning to court for nonviolent, misdemeanor crimes.

Kim Etherton, director of Lancaster County Community Corrections, said both the Lancaster County Attorney’s Office and Lincoln City Attorney’s Office closely review cases before they’re selected.

So far, 27 people have been referred, she said.

Even before that, Community Corrections had been using mental health case management for anyone in their programs with identified mental health needs, Etherton said.

In 2016, state lawmakers cleared the way to allow for the creation of mental health courts.

They have yet to be a reality in Nebraska. But Lancaster County Public Defender Joe Nigro, whose office represents people in mental health commitment hearings and indigent people accused of crimes, is chair of the Nebraska Supreme Court Mental Health Committee, a subcommittee of the court’s Problem Solving Court Committee.

He said the committee is working to iron out standards for the probationary-like program for those with mental illness who have committed both misdemeanors and felonies.

Nigro said when he started hearing years ago about mental health courts starting elsewhere, he paid attention.

“These sorts of efforts are working,” he said. “And I think everybody sees the burden that having this population caught up in the system is causing.”

Throughout his career, he’s been concerned about the number of people with mental health issues caught up in the criminal justice system. Before he was elected public defender, Nigro worked in the office for years, handling cases that went before the Mental Health Board and insanity case reviews.

“The bigger problem is that 50 years ago we used to warehouse people in mental health hospitals,” he said.

The conditions were poor, and that was wrong, Nigro said. But, as the country moved to deinstitutionalize people there weren’t enough community programs created to help them, he said.

More than a decade after mental health reform began in Nebraska, availability of care an issue

“So all too often people with significant mental health problems don’t get adequate treatment in the community, and they wind up either getting hospitalized or they get arrested,” Nigro said. “And we’ve compounded the problem here in Nebraska by reducing the number of in-patient beds.”

The promise was that people would be taken care of in the community, he said, “and we haven’t done it.”

It used to be when people accused of a crime were found incompetent to stand trial they went to the regional center the same day for staff to start working with them so they could stand trial. Now, they might spend two or three months in jail waiting for a bed.

“So the court proceedings are on hold because they can’t even go start the restoration process because we don’t have adequate facilities,” he said. “Then you have more of these folks out in the community, and they get caught up in the criminal justice system.”

And it’s happening all over, Nigro said.

The largest mental health facility in the country, after all, is said to be the Cook County Jail in Chicago. Followed by the Los Angeles County Jail.

“And it’s really tragic because it’s really cruel to treat mental illness in our correctional facilities. And it’s really expensive,” he said.

In Lincoln, Nigro said he sees too many people in the criminal justice system because of mental health issues. And he’s seen what problem-solving courts, like Lincoln’s drug treatment court, can do. So he was an early advocate for mental health courts.

“It’s not the answer,” he said. “The big answer to all of this? As a society we need to put more resources into mental health treatment. Both in-patient and out-patient. Then we’d see a lot of these issues go away.”

But mental health courts could divert some of those who end up facing charges into mental health treatment and out of that revolving door of getting arrested and hospitalized, Nigro said.

He said for a variety of reasons it’s proven to be more complicated, and to take longer, than he had hoped. For instance, schizophrenics come with different issues than drug addicts.

After statewide standards get hammered out, they’ll still have to figure out funding, Nigro said. Ideally, it would come from the Legislature, he said.

It’s going to cost money, but the state already is spending money, he said.

Nebraska prisons playing major role in mental health care

“Housing people in jail is the most expensive thing we can do,” Nigro said.

Adding a social worker

It was that same thought that led him, a few years back, to go to the Lancaster County Board to get funding for a social worker to help connect clients to treatment and support.

He said the percentage of clients with mental health or substance abuse issues at the public defender’s office is huge. And attorneys don’t have the training or the time to get people connected to services.

Nigro thinks having someone in-house who can evaluate and assess people and help them navigate treatment has made his office more complete in its representation. And, with treatment, clients become better candidates for probation, he said.

It’s too early to see if it’s helping with recidivism. But, anecdotally, he said they’ve already started to see benefits.

On a recent afternoon, Rebecca Meinders, the social worker, and Kristi Egger, the deputy public defender who handles the mental-health docket, sat down to talk about what they see on a daily basis.

Meinders pointed to a Medicaid policy that says patients have to fail at every other level of treatment before they’re approved for in-patient care.

When people don’t get the level of care they need, she said, it leads to more police calls, more family issues and more police citations.

“It’s a tiny little pebble,” Meinders said. “But those ripples get so big that eventually you’re looking at law enforcement having 3,100 mental-health investigation calls in 2016.”

Egger called the number amazing.

“Just think of the time,” she said.

Criminal charges

Police officers have to go out on all those calls and deal with the people on the street, then potentially testify if there’s a mental health hearing.

The person taken into custody may end up facing charges, too -- felony offenses -- for things like assault on an officer or health care professional.

Egger said it doesn’t make sense to her that people with severe mental illness are charged criminally for what they did while in crisis if they have already gone before the Mental Health Board.

“It seems like it is penalizing people who suffer from a mental illness,” she said. “It doesn’t seem fair to me.”

Meinders said just because someone is sent to the regional center, it doesn’t mean the criminal case goes away.

She and Egger said others accused of misdemeanors may end up languishing in jail or at the regional center waiting longer for competency evaluations than judges could have sentenced them to for their crime.

Egger said it means defense attorneys have to think twice before filing competency motions in misdemeanor cases “because the time they spend waiting is awful.”

Lincoln Regional Center — where once people came to die

Meinders said it also leads to longer waits for regional center beds for those at the Crisis Center or area hospitals because competency cases take priority.

There are still others who are mentally ill who aren’t dangerous like one man who got in trouble for calling 911 thousands of times, she said.

“There isn’t enough evidence to (take him into emergency protective custody) but something has to be done,” Meinders said.

He’s gotten three tickets, but it hasn’t stopped him from calling.

Meinders, who started full-time in the office in December 2016, said she meets with clients, their families and support system to try to present a more whole picture to the court.

Like explaining, in one case, how a man in front of the court 100 times experienced childhood trauma as a Lost Boy of Sudan, she said.

Meinders describes it all as a kind of bull’s-eye. The middle is the legal charge that brought them to the office.

“And then everything outside of that legal charge is kind of on the table for me to deal with,” she said.

Nigro said finding a better way to try to help people with mental illness makes the community safer and is a more humane way to treat mental illness. It also may help shine a light on particular needs.

“We’re not going to go back to warehousing people in mental hospitals, but we can do better,” he said.