Managing the Mentally Ill Offender in Washington, D.C.

“We Fix the Complexities of Life”

By Leonard A. Sipes, Jr. and Beverly Hill. Edited by Cedric Hendricks and Joyce McGinnis

See http://media.csosa.gov for “DC Public Safety” radio and television shows.

See www.csosa.gov for the web site of the federal Court Services and Offender Services Agency.

Walk down the streets of any major American city and you will likely encounter more than a few mentally ill individuals. Sometimes friendly, sometimes demanding and often scary, mentally ill people pose both a serious public health problem and a moral dilemma for our society. Both victimizer and victim, the mentally ill present especially unique challenges for those of us within the criminal justice system.

According to a Washington Post story filed by Rick Weiss on June 7, 2005, a recent National Institute of Mental Health study found that “One quarter of all Americans met the criteria for having a mental illness within the past year, and fully a quarter of those had a serious disorder that significantly disrupted their ability to function day to day.” Many criminologists suggest that rates of mental illness are even higher among the criminal offender population.

The vast majority of criminological concern for the mentally ill seems directed towards incarceration. Anyone working in our jails or prisons knows of the unique challenges mentally ill offenders offer to institutions attempting to balance security and treatment needs with the realities of budget. It’s difficult to operate within a purely medical model when a mentally ill offender becomes violent or disruptive and threatens the safety and security of the institution. Most correctional professionals have witnessed nurses and psychologists attempting to “talk down” an inmate after a verbal and near-physical encounter with staff or fellow inmates. Seething with emotion and ready to burst, the mentally ill inmate may sometimes stay in that agitated condition for hours at a time while the realities of prison continue to surround them.

Society justifiably calls for humane treatment. Correctional staff just try to keep the peace. But sooner or later, the mentally ill inmate is released back to the community, usually with the same mental health issues they went in with. What happens then?

In the Community

In the District of Columbia, they come to a unique federal, executive branch organization, the Court Services and Offender Supervision Agency (CSOSA). CSOSA supervises 15,500 offenders on parole, supervised release or probation every day. CSOSA assigns almost 50 percent of its caseload to its highest levels of supervision or to specialized caseloads, where each Community Supervision Officer (CSO – known elsewhere as a parole or probation officer) is responsible for only 25 or 30 offenders. Backed up by extensive drug testing, cooperative endeavors with police and prosecutors, a state-of-the-art information technology system, satellite tracking and 50 to 1 general supervision caseload ratios, CSOSA is well positioned to implement its community-based model of offender supervision. This research-based model combines the traditional elements of supervision with an equal emphasis on treatment, social services, and community involvement.

CSOSA’s specialized units offers counseling and special supervision techniques to offenders who are hard core substance abusers, involved in acts of violence, domestic violence, sex offenses and traffic-alcohol issues. Offenders with mental health issues may interact with any of these categories and are assigned to the Metal Health Unit. CSOSA currently supervises almost 800 offenders with confirmed mental health diagnoses Eighty-five percent are male. Some are assigned to mental health institutions and are monitored through regular correspondence with the facility.

CSOSA’s mental health teams have among the lowest caseload ratios in the country. At 30 offenders to each Community Supervision Officers, CSOs and their supervisors have contact with the offender an average of three to four times per week. All CSOs come to the job with a minimum of a bachelor’s degree and many hold master’s degrees as well. Most have a background in law or the criminological or social sciences. Most CSOs on the mental health teams volunteered for the assignment.

Thirty CSOs and supervisors staff the mental health teams. Mental health offenders are assigned to this specialized unit via a D.C. Superior Court or U.S. Parole Commission order; offenders assigned to another unit may also be referred by the CSO for evaluation. CSOSA contracts with psychologists who conduct an assessment of every referred offender. If the psychologist establishes a diagnosis of mental illness, retardation or a personality disorder, “gatekeepers” (licensed professional counselors with master’s degrees) then see the offender. It’s their job to represent the offender as he or she navigates through the District of Columbia’s mental health system to obtain counseling, therapy and medication services.

CSOSA’s gatekeepers have expert knowledge of the public and private resources available. In addition to the standard D.C. agencies, CSOSA explores alternative strategies, such as accessing services through Medicaid or the Department of Veterans’ Affairs. The focus is on developing a precise diagnosis and an appropriate intervention plan, so that psychologists and social workers can act as advocates to get each offender the best possible treatment.

Once the offender’s mental health condition is controlled, he or she can benefit from other CSOSA services, such as job training, drug treatment, anger management or a faith-based mentor.

Community Supervision Officers

But CSOSA contends that a vital ingredient in the success of the program is the dedication of the Community Supervision Officers who see the offenders on a regular basis. “We care about the public’s safety and the offender’s progress,” states 30-year veteran and supervisor Verna Young. “We are determined to achieve both.”

Ms. Young suggests that the CSOs who volunteer for the mental health team are some of the best in CSOSA, if not some of the best in the nation. “Think about it for a moment,” she urges. “These are highly educated individuals who deal with the toughest clients possible. These offenders bring an immense array of problems that would challenge the most dedicated professional. We are the lifeline between the mental health profession, their families and friends, their employers and everyone who interacts with them. We talk them down from negative encounters. We act as intermediaries with frustrated family members. They grow to depend on us for structure and guidance in a world that offers fear and resistance. We help them survive on their own without returning to the criminal justice or social services system. More importantly, we help them exist without doing harm to anyone else.”

DeAndro Baker, Verna’s supervisor and another seasoned veteran of the criminal justice system, explains that offenders with mental health, retardation issues and personality disorders offer an amazing array of problems.

Research for all criminal offenders (examples: Bureau of Justice Statistics-Prior Abuse Reported by Inmates and Probationers and the National Institute of Justice-Early Childhood Victimization Among Incarcerated Adult Male Felons) indicates that substantial social problems result from child abuse and neglect, sexual and physical violence, early age onset of alcohol and drug use and criminal activity. Couple all of this with poor school performance and limited employment histories and involvement in the criminal justice system, and the challenges seem insurmountable. To state that the average offender is a trial is an understatement. Add mental health or retardation or personality disorders, and the challenges are immense.

“But we do not shy from the task at hand,” states Mr. Baker. “The bottom line is protecting the public. We will not hesitate to go back to the courts or the U.S. Parole Commission and state that the individual cannot be safely supervised in the community. We will reincarcerate. But we do everything in our power, including day reporting, to make sure that offenders live a productive life without harm to themselves or others. We are the front line in the effort to serve the offender’s needs and protect society, and we do it every day.”

“The New Asylums”

All of this takes on greater importance as society grapples with the need for safety, balanced with a desire for humane treatment. This dilemma was explored in a “Frontline” episode entitled “The New Asylums” (www.pbs.org/wbgh/frontline) produced by WGBH in Boston and co-produced by Mead Street Films. The episode aired on PBS stations on May 10, 2005. The implications of the program are profound. There are no easy answers.

The New York Times reported on the episode: “An enormously disturbing Frontline report profiles the enormously disturbed.” Times reporter Ned Martin wrote that the documentary …. “explains that the mentally ill, in the decade after a mass release from mental hospitals, have often wound up in less forgiving confines.”

“The New Asylums asserts that 500,000 mentally ill patients, who in earlier decades would’ve been treated in hospitals, are now mistreated in prisons. The mental hospitals now house only a tenth of that number, the narrator says.”

Ultimately, after they leave the hospitals, or the prisons, the mentally ill return to the community.

According to the “Frontline” web site, “In 2004, some 630,000 prisoners were released back into their communities, many with mental illnesses and co-occurring disorders such as substance abuse. Studies have shown that 60 percent of released offenders are likely to be rearrested within 18 months, and that mentally ill offenders are likely to be rearrested at an even higher rate. Experts claim that a major cause for recidivism among the mentally ill is the “epidemic” shortfall in community-based mental health services (emphasis added). While offenders have a constitutional right to receive mental health treatment when they are incarcerated, they do not enjoy a similar right to treatment in the community…”

“I do not understand how everything began to unravel,” said a 52-year-old woman from northwest DC. She is on probation for drug distribution. Her years of cocaine abuse produced severe depression and an array of medical problems. She just got out of drug treatment, but recently tested positive for marijuana. She understands that CSOSA will mandate twice a week drug testing as a sanction for drug use. She believes that this level of scrutiny (and the possibility of returning to jail) will keep her from doing drugs.

“I need structure in my life, and my CSO provides that structure. My CSO comes to my home to check on me. It’s nice that I can talk to people who insist that I take care of myself.”

A 48-year-old parolee from southeast DC presents similar problems. He was incarcerated for assault and gun charges. He is a diagnosed paranoid schizophrenic. His drug use (cocaine) was a social event with friends until it became a demon that made his illness much worse. Structure is an essential element in his rehabilitation, and the requirements of supervision help him cope with life’s problems. “As long as I keep my job, I can stay away from drugs and take care of my family. CSOSA helps me cope with problems and keeps me on track.” He admits that drug testing is an essential element. “It’s nice that they care,” he states, “but I know that they will put me back in prison if I do not improve, so I know that I must stay on my medication and do what they want me to do.”

“Public safety is combined with a sincere desire to assist…”

It was because of concern for the community that CSOSA started its innovative mental health caseload. “Public safety is combined with a sincere desire to assist these offenders in meaningful ways,” states CSOSA’s director, Paul A Quander, Jr. “We can manage this caseload in a way that services both goals.”

Thomas H. Williams, CSOSA’s Associate Director of Community Supervision Services, states, “The Frontline report only confirms our experience with mentally ill offenders. Many of the recommendations of the report are already in place within the District of Columbia. The challenges are immense, but we are attempting to meet them with vigor and dedication.”

Tiffany Robinson is ready. “We fix the complexities of life,” she states. A CSO on the Mental Health Unit, she is ready to bring her education and enthusiasm to the challenges offered by this population. Ms. Robinson understands her caseload. “They often say, “˜Please help me,” she reflects. “They do not understand the world they inhabit. It’s my job to help them cope, to reassure, to make the world a less frightening place. That requires structure, and that’s what we and the mental health professionals offer. If that need for structure leads to incarceration or commitment to a mental health facility, then so be it. We will protect society.”

Ms. Robinson understands that CSOSA embraces both sides of the challenges posed by the mentally ill offender. “But we will also offer a humane and compassionate hand to those who need it,” she says. “Thousands have become productive citizens because of it.”

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