On June 27, 2018 The California Legislation published amendments for Assembly Bill 1810 regarding Healthcare. It was signed into law by Governor Jerry Brown. Many California residents are outraged at the section specifically regarding Mental Health Disorders and are referring to it as the “get out of jail free card.” As an expert in the field, I felt this was the perfect platform to bring clarification to this topic.
If you review this bill online you will find that the details regarding mentally ill offenders are inserted, almost discretely, between descriptions of general funding of healthcare services and the Diabetes Prevention Program . Between those sections lies Section 29 Chapter 6.5: Diversion Funding for Individuals with Serious Mental Disorders. The objective of this, as per the view of the Governor, is to reduce incarceration of individuals with a serious mental illness who, after having undergone a psychological evaluation during criminal proceedings, was found to have a direct nexus between their mental illness and their crime. Rather than serving prison time, they will be placed in a State Department of State Hospital for two years to under go in-patient managed care in an effort to stabilize, educate, and rehabilitate.
California residents have responded to this new amended section with outrage. Individuals who have committed murder, rape, or other violent offenses could potentially be released within two years following treatment and have their records sealed. Without having a comprehensive understanding of a true severe mental illness and experience of current treatment of mentally disordered offenders makes it completely understandable why there is outrage following this change.
Let’s break down the specifics of this new amendment first.
- This new diversion program applies to first time offenders only. Therefore, recently paroled or ex-felons who hear about this assembly bill cannot suddenly report mental illness and think they can avoid prison time.
- The eligibility for this diversion program excludes many different mental disorders. Therefore someone who claims they have anxiety or depression does not qualify. This is for seriously mentally ill and incompetent to stand trial offenders only.
- Even if they are found to have a serious mental illness, a direct nexus between the crime and their mental disorder must be established.
- Even if they qualify for the diversion program, if there is evidence to suspect they cannot be rehabilitated, cannot establish competency, and will continue to pose a serious risk to the safety of society, they can be disqualified based on this and placed in a correctional facility for a sentence determined by State law.
- The details regarding this diversion program, including how many offenders are placed in it, how long they spend in the program, the contents of their crime, their confidential HIPPA or PHI information, their diagnosis, and treatment will all be sealed from public record.
- If placed in the diversion program and are non-compliant with the treatment and wraparound services offered, they can be placed in a correctional facility for the length of what would have been their prison term.
- The diversion programs will not only ensure restoration of competency, stabilization of their mental health condition, and treatment, but they will also offer continuation of care and wrap-around services upon release from the State Hospital to ensure they maintain stabilization. These services include community treatment teams and case management, crisis services, peer support, supportive housing, substance abuse treatment and vocational support to name a few.
What you need to know……
As a clinical psychologist who specializes in Forensics, I have done evaluations to determine serious mental illness daily. I have done forensic psychological assessment batteries for the courts to determine if a defendant is malingering or truly has a mental or cognitive impairment that should be considered upon sentencing.
In a correctional environment, when an inmate receives a disciplinary violation (known as a Rules Violation Report) and are a participant in the mental health program, they are (with some limitations) referred to the mental health department for an evaluation to determine a nexus between their mental health or developmental condition and the behaviors that led to their in-prison offense. In the four years I have been doing these evaluations, I have only found two cases in which a direct nexus was determined.
For emphasis, in four years of doing these evaluations at least 3-4 times per week, I’ve only found two cases where a severe mental illness exists and was directly related to the behavior that led to their infraction.
So what are my thoughts on this as someone in the trenches, doing this work, and seeing the limited resources for treatment in a correctional facility? Here they are….
- The majority of incarcerated offenders are not severely mentally ill. They have serious behavioral deficits, drug addition, and manipulation skills that far surpass the average joe. Many of them are personality disordered as a result of their upbringing, and the good news, these offenders don’t apply to this diversion program. Even better news? They are easy to identify!
- Many who are being treated for a mental illness are being treated for “medical necessity.” These are not severe mental illnesses. Aside from Axis II personality disorders, the majority of diagnoses I see are adjustment related disorders due to facing a life sentence, mood disorders, anxiety disorders, etc.
- For the inmates who truly are severely mentally ill and suffer from some form of psychotic disorder, we are not able to always fully stabilize them in a correctional environment because:
- Our resources are extremely limited.
- We have space issues for treatment space, group space, etc.
- We have trouble maintaining staff due to the seriousness of the work, the amount of work, and/or the location of State facilities requiring lengthy commutes.
- We have enhanced outpatient programming, similar to partial hospitalization, however even those programs are over crowded and understaffed.
- For those inmates with a true psychotic disorder (like Schizophrenia for example) we generally end up having to send them to an acute care facility or State hospital for stabilization at some point anyway.
- Due to various reasons (like alarms, inmate fights, etc) custody modifies the program and therefore limits the treatment available during these times (which are often) for safety and security of the institution.
- There have been many contracted companies popping up in the jail systems for the past 5 years to screen for competency and initiate restoration treatment. This is not anything new, but has already been taking place.
- Ensuring the privacy/confidentiality of their protected health information (like name, demographic, diagnosis, treatment, and other identifying information) is nothing new. This is federal law. For those referred to the diversion program, the reason they’re not allowing the details of the crime to be public record is because a direct nexus between their protected health information (mental illness) and their crime was established, thus protecting it under federal law.
The issues I see with this?
- I have worked with both Probation and Parole in the community. The access to wrap-around services is difficult THEN due to long wait lists for housing, rehabilitation programs, and vocation assistance. Without first insuring more supportive housing, community health centers, and case management services to accommodate this new initiative we will continue to have unstable individuals in the community who remain underserved. I have seen it with my very own eyes and it’s a travesty because serving the underserved means ensuring the safety of our communities.
- The State Hospitals are also overcrowded. When we have an inmate in the mental health crisis bed awaiting bed space in an acute care facility or State hospital, we have to move them to another institution just to free-up treatment space for new crisis patients. Then their new institution has to do the same, so they are bounced around until they can be placed. Nothing about this is clinically appropriate for a crisis patient and only serves to cause more distress and danger to self or others. But again, you work with what you have, and that’s not much in a correctional facility.
- The State or counties need to contract qualified and experienced psychologists (hi! RIGHT HERE!) to complete these evaluations to ensure that the malingerers aren’t slipping through the cracks. Diagnosing is not a science like it is in the medical field. Being an accurate diagnostician with a highly manipulative population means having the experience and exposure. After only four years in corrections, I have already learned many reasons why offenders feign mental illness and it’s not always just to reduce their sentence or get special treatment.
Overall, I agree with this new amendment provided only the truly ill are referred to the diversion program and more resources are made available by the State and county levels to accommodate this change.
Questions? Leave them below!
Have a beautiful weekend readers! Be the reason someone smiles today 🙂