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Articles Posted in Mental Health

The Cook County Jail in Chicago is one of the largest county jails in the United States, holding up to 9,000 inmates on any given day.  It is estimated that approximately one third of these inmates are mentally ill.  Indeed, Cook County officials have stated that the jail is, in effect, the largest mental health facility in Illinois.

Unfortunately, and as I have written in other posts, it is not unusual for a jail or prison facility to hold such a large number of mentally ill inmates.  What is unusual at Cook County, however, is the fact that the new director of the jail is a Clinical Psychologist, Dr. Nneka Jones Tapia.  Dr. Jones Tapia is apparently no stranger to the issues of mentally ill jail inmates or the situation in Cook County, having previously been in charge of the jail’s four divisions that house its large population of inmates with mental health issues.

Statistics show that the overall inmate population at the jail may be falling; however, the number of inmates with mental health issues either remains constant or increases.  These inmates suffer from the entire array of mental health problems including, without limitation, depression and bipolar disorder.  Some of them are floridly psychotic and require stabilization. Continue reading

Human Rights Watch (“HRW”) recently issued a new Report finding that mentally ill inmates in US prisons are frequently mistreated, neglected and abused.  The Report also contains a lot of information concerning the role of prisons in the mental health system in this country.

First, according to the HRW Report, prisons have become the primary mental health care facilities in the United States.  One in every six inmates is mentally ill.  In fact, there are three times as many mentally ill prison inmates as there are patients in mental health care facilities.  The rate of mental illness in our prison population is three times higher than in our general population.  Figures gathered by the US Justice Department buttress these findings.  According to a DOJ study, 75% of women and 50% of men in State prisons, and 75% of women and 63% of men in local jails, will have a mental health problem requiring services in any given year.

Mentally ill inmates experience mistreatment and abuse on two different fronts.  First, inmates who do not suffer from mental illness routinely exploit them.  Additionally, their mental illness frequently leads them to violate institutional rules (e.g., making excessive noise, failing to comply with orders, cursing, banging on cell doors), with the result that they are punished for displaying the symptoms of their respective illnesses.  Depending upon the facts and circumstances surrounding a given violation, an inmate can be punished with placement in administrative segregation (the “hole”).  A sufficiently long period of time in such an environment can cause their illness to worsen significantly.  Inmates have also been subjected to excessive force by corrections officers, and some have even died from asphyxiation because of the manner in which guards have tried to control them. Continue reading

New York’s Rikers Island is the second largest jail in the United States, housing between 11,000 and 12,500 inmates at a given time.  It is also one of the most violent jails in the country.

For many years, experts have acknowledged that placement in solitary confinement can negatively impact an inmate’s mental health.  Until recently, juvenile inmates at Rikers were routinely placed in solitary confinement even for minor offense including talking back, simple horseplay, possession of unauthorized amounts of clothing or art supplies, or ignoring a direct order.  Some of these juveniles sat in solitary confinement – locked alone in a cell for 23 hours a day – for up to 90 days.  Other juveniles sat in solitary confinement for up to one or even two years.

In August 2014, the United States Attorney’s Office in Manhattan issued a report that was highly critical of the New York City Correction Department’s treatment of teenage inmates at Rikers.  It noted that the atmosphere at the jail was permeated with a “deep-seated culture of violence”, and that the use of solitary confinement for juveniles (also known as “punitive segregation”) was “excessive and inappropriate”.  Forty percent of the teenage inmates were subjected to the use of force by guards at least once, and required medical assistance more than 450 times.  Teenage inmates were also instructed regularly to not report their injuries to other guards or the jail’s infirmary.  US Attorney Preet Bharara noted that “[t]here is a pattern and practice of conduct at Rikers that violates the constitutional rights of adolescent inmates … We are talking about a culture problem and a systemic problem – not an individualized issue …” Continue reading

A large part of my firm’s criminal practice focuses upon representing criminal defendants with substance abuse issues.  These defendants are typically addicted to cocaine or heroin.  Many of these clients are simultaneously addicted to numerous substances (typically referred to as poly-substances abusers).  These clients present special challenges that must be met if they are to obtain the best possible result in their cases.

It may sound overly simplistic, but attorneys representing drug-addicted defendants need to remember that their status as addicts goes hand-in-glove with their criminal charge(s), and their addiction issues will affect every aspect of the case.  For example, most addicts have great difficulty taking personal responsibility for their actions.  As far as they are concerned, few, if any, of the circumstances that led to their current criminal charges can be attributed to their conduct; rather, it is almost certainly the fault of someone or something else.  Further, addicts have a propensity to not tell the truth.  The defense attorney must be very careful in accepting as true anything that their client tells them about the facts and circumstances that led to the current criminal charges.  Additionally, these clients can also be very irresponsible.  They frequently miss court dates, as well as appointments with treatment providers or probation officers.  Such conduct can result in the denial of admission to a diversionary program, or a violation of probation.  Finally, most criminal judges – particularly those who sit in courts that see a significant number of drug addicted defendants will – almost as a knee-jerk reaction – refuse to view these defendants as credible in any way.  Getting a judge to believe your client about almost anything can be difficult without something to corroborate it.  However, the client can sometimes benefit from their attorney’s credibility with the court.

Many States, including New Jersey, have drug court programs.  These are diversionary programs which focus upon providing treatment in lieu of penal sanctions.  They are staffed by people who have special training and experience in working with addicts.  Generally speaking, a defendant has to have a serious addiction issue and a relatively minimal criminal background to be accepted into the program. (An offender with a record of violent offenses or sex offenses will have hard time finding an in-patient program that will accept them.)  The drug court program is, however, difficult to complete.  Clients have to be committed, focused, and willing to work hard in order to graduate successfully from drug court.  I have encountered drug addicted clients who would rather accept a county jail or State prison sentence rather than have their case diverted to drug court because they believe the former is easy while the latter is, relatively speaking, too difficult. Continue reading

National Public Radio recently ran stories concerning the off-label use of psychotropic medications to sedate nursing home residents to make them more pliable and easier for staff to control.  Unfortunately, this abuse does not occur only in nursing homes.  It happens in jails and prisons in the United States and other countries.

Several stories have recently appeared concerning the use of these mind-altering medications to control inmates in Canadian prisons.  This has, however, been a concern in US jails and prisons, as well.  I have spoke with mental health professionals who service prison populations, and they confirm that it happens here with increasing frequency.

One of the most routinely used drugs is known is quetiapine, more commonly known by the brand name Seroquel.  This medication is approved only for treating bi-polar disorder and schizophrenia; however, it is apparently given as a sedative to jail and prison inmates who do not have such disorders just to make them easier to control. Continue reading

Scott Panetti may be dead by the time you read this.  As of this moment, Texas is scheduled to execute him tonight, and his lawyers are probably doing handstands trying to get the US Supreme Court to review his case.

In 1992, Panetti, who has (had?) a long history of schizophrenia and other mental health issues, dressed himself up in camo and shot his in-laws in front of his wife and daughter.  He then changed into a suit and surrendered to the police.

The Texas criminal justice system, once again distinguishing itself as a model of fairness and decency, ruled that Panetti was competent not only to stand trial, but also to represent himself.  Panetti appeared at trial dressed as a cowboy.  He attempted to subpoena approximately 200 witnesses including, without limitation, John F. Kennedy, Jesus, and the Pope.  During jury selection, he asked prospective jurors if they had any Indian blood.  He referred to demons in his opening statement.  His argument to the jury was apparently premised on the “fact” that he became a character called “Sergeant Iron Horse” at the time of the homicides.  His defense was that he did not kill his in-laws – “Sarge” did. Continue reading

In Atkins v. Virginia, the US Supreme Court held that the federal Constitution barred the execution of defendants with intellectual disabilities.  Based upon Atkins, Freddie Lee Hall moved before the Florida courts for an order vacating his capital sentence because he had an IQ test score of 71.  By and through his Motion, Hall sought, among other things, to present evidence of his intellectual disability.  Florida law mandated, however, that capital defendants could not present such evidence unless they had an IQ test score not exceeding 70.  Hall was precluded from presenting his evidence because his IQ exceeded the 70-point cutoff, albeit by one point.  The Florida Supreme Court rejected his appeal, finding that the State’s 70-point threshold was constitutional.

The US Supreme Court found Florida’s 70-point cutoff to be unconstitutional.  The Court began by observing that justice must be tempered with humanity and decency, and that no legitimate penological purpose is served by executing someone who has an intellectual disability.  Although defendants with intellectual disabilities who meet the legal requirements for criminal responsibility can be tried and punished, they cannot, consistent with Atkins, receive the law’s most severe sentence.  Against this backdrop, the Court began by noting that “[t]he question this case presents is how intellectual disability must be defined in order to implement these principles and the holding of Atkins.”  The Court based its response to this question largely upon the work of experts in the field of IQ testing, and upon a survey of State laws addressing this issue.

A review of the available expert material revealed that Florida’s 70-point cutoff disregarded established practice in two ways.  First, it viewed an IQ score as final and conclusive evidence of a defendant’s intellectual capacity, while experts typically considered other evidence of the defendant’s abilities.  Further, the statutory cutoff relied upon the IQ score as a precise measurement, while the experts in the field viewed it as imprecise. Continue reading

During the same week in early April, 2014, the New York Times published two seemingly unrelated stories highlighting the increasing contacts that law enforcement personnel have with mentally ill individuals, and the problems that result from these encounters.  The fact that one of the Nation’s largest newspapers ran both of these stories within a relatively brief period of time suggests strongly that issues surrounding mentally ill criminal defendants are not being addressed adequately, and require more appropriate attention.

One story discussed James Boyd, who was homeless and camping in the Sandia Foothills near Albuquerque, New Mexico.  Boyd was not allowed to camp there, and police moved in to arrest him.  He had a history of mental illness, and told the officers that they better not try to arrest him because he was a federal agent.  The officers subsequently shot and killed him, saying later that he displayed two knives and threatened them.  The entire episode was captured on video taken by an officer’s helmet camera that was later released by the Albuquerque Police Department, and is available on Youtube.

Boyd, like so many others, are having more frequent encounters with the criminal justice system because of a lack of adequate mental health services.  State and local governments are slashing these services because of funding issues, with the result that the lack of available treatment is causing the mentally ill to engage increasingly in criminal conduct.  This, in turn, is forcing police to attempt to function as mental health professionals, and turning County jails and State prisons into mental hospitals.  Many of these defendants are arrested, sent to jail, then to a halfway house, and then back onto the street – only to repeat the cycle over and over again.

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In Newman v. Harrington, No. 12-3725 (7th Cir. 8/9/13), the Court affirmed a district court ruling on a habeas petition which found that the failure of defense counsel to investigate known deficiencies concerning his client’s mental capacity, and to raise the issue of defendant’s fitness to stand trial with the State trial court, constituted ineffective assistance.

Newman, a homicide defendant, was 16 when he shot and killed the victim.  Newman’s mother hired an attorney to defend her son and, at their first meeting, provided counsel with extensive material documenting her son’s long history of mental and cognitive deficits.  Further, Newman responded to the trial judge’s questions concerning his right to testify at trial with simple “yes” or “no” answers.  During this colloquy, Newman failed to display any meaningful understanding of the proceedings.  Thus, both defense counsel and the trial judge had reasons to question Newman’s fitness for trial, but there was no pre-trial fitness hearing.  Newman went to trial, was convicted, and received a custodial term of 47 years that was affirmed on appeal.

The following year, Newman sought State-court post-conviction relief.  His petition was supported by, among other things, an evaluation by a clinical psychologist which stated that Newman had cognitive deficits, was mildly to moderately retarded, was never fit to stand trial, and that his many mental health issues were obvious to anyone who attempted to speak with him.  Further, his IQ was 54, and his intellectual abilities were in the “extremely low” range.  His reading and math skills ranged from those of a child of 4 to one of 7.  Newman could not tell time, could not deal with abstract concepts, and had a poor memory.  Continue reading

The United States Supreme Court recently decided Kansas v. Cheever, 571 U.S. _____ (12/11/13), which discusses whether the Fifth Amendment prohibits the Government from introducing evidence from a criminal defendant’s court-ordered mental health evaluation to rebut the defendant’s presentation of expert testimony supporting a voluntary intoxication defense.

The defendant was charged initially in the Kansas state courts with capital murder.  In an unrelated case, the Kansas Supreme Court invalidated the State’s death penalty scheme.  The State then dismissed its charges and allowed federal authorities to prosecute the defendant under the Federal Death Penalty Act.  In the federal case, defendant sought to introduce evidence of his intoxication by methamphetamine at the time of the offense, asserting that this negated his ability to form the intent requisite to the offense.  The District Court ordered Defendant to submit to a psychiatric evaluation to assess this issue, and a psychiatrist interviewed Defendant for approximately five to six hours.

The federal case went to trial, but was subsequently suspended and dismissed without prejudice.  The U.S. Supreme Court also reversed the Kansas Supreme Court’s decision, finding that the State’s death penalty statute was constitutional.  Kansas then commenced a second prosecution against Defendant who, in turn, presented a voluntary intoxication defense supported by testimony by a professor of psychiatric pharmacy.  The State then sought to rebut this with testimony from the psychiatrist who previously interviewed Defendant in connection with the aborted federal prosecution.  This testimony apparently included statements Defendant made during the Court-ordered evaluation.  Defense counsel objected, arguing that such testimony would violate Defendant’s Fifth Amendment rights since Defendant had not voluntarily agreed to that examination.  The trial court agreed with the State, but the Kansas Supreme Court reversed.

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