We can cut out mental illness before it leads to crime

There was a case I handled during my career as a district attorney in Rusk County, in East Texas, that recurs every day in our state.

The patient, a woman in her late forties who we’ll call Jane Doe, was unable to live on her own. She moved in with her parents to help deal with her declining physical and mental health. Her resources were limited and her physical health was treated to the exclusion of her mental health, which, despite her parents’ efforts, continued to decline. She began to self-medicate, which only exacerbated her problems. Her parents dealt with this issue as best they could, but in the end their control over the situation was spent. In a rage caused by her mental health issues and excessive alcohol intake, this troubled woman assaulted her mother in front of so many witnesses that they had no choice but to call 911.

When officers arrived at the scene, Jane’s parents told them about her physical and mental health challenges. However, the officers could not ignore the clear evidence of domestic violence and arrested the woman.

But what if there was a way to get Jane the help she needed before she assaulted her mother?

there. It is an underutilized and misunderstood tool for dealing with the growing number of Texans dealing with mental illness, many of whom are homeless. It’s called an involuntary civil commitment.

Texas is severely under-resourced to deal with these individuals with severe mental illness. Often, the people who make the initial call to seek mental health treatment are their loved ones, who are reluctant to call the police for their family members. Problems that would benefit from early intervention slowly get worse until it boils over and the person commits a criminal act.

An involuntary civil commitment is one of the few real tools available at the state level to address this dynamic. These are cases of court-ordered hospitalization for the purposes of treating a mental illness so serious that there is a high risk of harm to that person or others. Here’s how it works.

These obligations usually begin with a 911 call from a loved one or concerned citizen. The resources available to deal with this initial encounter can vary widely. Some areas have crisis intervention and response teams that partner with specially trained law enforcement officers who specialize in mental health. Other regions may only have the closest officer on duty at that time. Whoever arrives at the scene of an accident must ultimately determine whether the person has a mental illness and whether, by reason of that mental illness, there is a significant risk of serious harm to that person or to a third party unless that person is immediately restrained.

If the patient meets the criteria of the Health and Safety Act, the officer will immediately detain the person, unless there is sufficient time to obtain a warrant beforehand. Unfortunately, the patient’s condition has usually deteriorated to such an extent by the time 911 is called that there is rarely enough time to get a warrant. Once the person has been taken into custody, the peace officer is required to immediately transport the person to the nearest appropriate mental health facility. A prison or other criminal detention facility is not permitted except in extreme emergencies.

There are clearly serious due process concerns in such a situation – the legal requirements to protect the rights of the patient.

When a peace officer makes an arrest without a warrant, he or she is required to file a Notice of Detention stating the specific facts that led to the detention to the mental health facility and notify the probate court with jurisdiction about the case by the next business day.

Once admitted to a mental health facility, the patient is evaluated by a physician. The physician must find that the person has a mental illness, that there is a real risk of harm to the patient or others, and that emergency detention is the least restrictive means by which the necessary treatment can be carried out. If the doctor does not provide these results, the person must be released.

If the doctor has reached the required results and the patient’s condition has improved so that one of the required results is no longer applicable, the patient should be released. Fortunately, a large number of those held under these emergency conditions were released shortly thereafter due to improved health.

If the patient’s condition does not improve, the local district or county attorney must file an application for court-ordered mental health services. Because the patient’s liberty interests are at stake in such proceedings, a hearing must be held within 72 hours of the patient’s detention to determine whether circumstances necessitate the patient’s hospitalization while the application is pending.

A hearing on the same application must be scheduled within 14 days of its submission. Before the hearing, two medical examination certificates must be submitted to the court. The doctors who provided the certificates must have examined the patient within the last 30 days and at least one doctor must be a psychiatrist.

The county or district attorney’s office bears the burden of proof at the hearing. If the judge decides that he has not proven his case, the patient is released. If the prosecutor’s office proves its case, there are two possible outcomes. If the patient is no longer a threat to themselves or others, they may be requested to outpatient services. Or a patient may be sent to inpatient treatment if, in rare cases, a judge or jury finds by clear and convincing evidence that the patient suffers from a mental illness, and as a result of that mental illness, that mental illness is likely to cause serious harm to the patient. himself or anyone else.

Throughout this process, from the initial encounter through to the final hearing, the goal is to get the patient the help they need with as little restriction as possible. The goal is not to incarcerate individuals whose mental illness amounts to disturbance or distress. Likewise, it should not be used as a means of restraining alleged criminal actors when the state lacks evidence. Each step in the process is aimed at obtaining the necessary treatment for individuals who are unable to obtain it themselves.

When applied appropriately, a law is capable of producing much public good when it is properly understood by local authorities and properly funded by state and local governments.

Our troubled neighbors, like Jane Doe, need our help. Involuntary civil obligations are one way to submit them.

Zack Wafrossa is an Associate Counsel in the Office of Inspector General of the Texas Health and Human Services Commission, and a former Assistant District Attorney for Rusk County. This column was written for the Dallas Morning News.

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