Police, courts grapple with the right approach to mentally ill offenders

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When Dustin Deshong was arrested in 2011 for touching a 7-year-old girl's belly at the Walmart in South Strabane, he faced the possibility of a long prison sentence because of a previous offense.

Washington County deputy district attorney Traci L. McDonald, who oversees the office's specialized victim investigation and prosecution unit, said she realized that severe mental illness was an underlying factor in Mr. Deshong's behavior and didn't believe that a lengthy incarceration would be an appropriate sentence.

At the same time, she said, the elimination of Mayview State Hospital in December 2008 left her with fewer options for placing, treating and monitoring such offenders.

So she returned Mr. Deshong, now 29, to a group home with a laundry list of restrictions on his behavior. It's the kind of creative, case-by-case approach Ms. McDonald said she often must take with defendants who have serious mental illness.

"He's not my only one," she said of Mr. Deshong.

People with mental illness are involved in a growing number of police calls, and for years, they've been filling jails and prisons. Managing the influx is a grave challenge in two fields -- mental health and corrections -- today.

PG graphic: Percentage of mental illness in prison and jails
(Click image for larger version)

In a 2010 report, a team led by psychiatrist E. Fuller Torrey concluded that three times as many people with serious mental illness were in state prisons than in state hospitals across the country. This is a trend the researchers attributed to the closing of state hospitals such as Mayview and a failure to adequately support former patients in the community.

Yet people with mental illness often don't get better during incarceration. Federal data show they're more likely in some cases to serve longer sentences -- and to get into trouble behind bars -- than other prisoners.

The justice system and mental-health professionals struggle to balance treatment, punishment and public safety. While so-called diversionary programs that emphasize treatment over incarceration are gaining favor as a way to deal with offenders charged with less-serious crimes, some law-enforcement officials and mental-health professionals believe there's still a need for a regional detention and treatment facility for offenders who are sexual predators or have other violent tendencies.

While it's possible to get an offender into Torrance State Hospital in Westmoreland County for certain kinds of treatment, some officials in the former Mayview service area -- Allegheny, Beaver, Greene, Lawrence and Washington counties -- said they often encounter a shortage of beds and waiting lists.

Ms. McDonald said she's spoken to Washington County officials and state lawmakers about the need for more detention and treatment programs for certain offenders with serious mental illness. County Commissioner Diana Irey Vaughan said she supports the idea, partly because sexual predators aren't welcome in communities.

"It's better for everyone if we can put them in a safer environment," she said.

Crisis training for police

With the closing of state hospitals, people with severe mental illness may live in personal-care homes, group homes or apartments, often with less supervision than before. They leave their homes to attend treatment programs, meet peers at drop-in centers, run errands and make use of free time.

Some police link the closure of state hospitals and decreased supervision to an uptick in calls involving people with mental illness. "All I know is, since the closing of places like that, they are out on their own," Homestead police Chief Jeff DeSimone said.

Beaver Falls police Chief Charles R. Jones Jr. said he believes state budget cuts have made it more difficult for social-service agencies to monitor clients with mental illness. At times, he said, these clients get into trouble, taxing the police and fire departments and other borough resources.

After Mayview

A special five-part series

Sunday, Sept. 22:

Overview and portrait of former Mayview State Hospital patients.
Monday, Sept. 23:
Community hospitals struggle with mental-health caseloads.
Tuesday. Sept. 24:
Police, courts improvise to manage ill offenders
Wednesday. Sept. 25:
Housing a weak link in mental-health system
Sunday, Sept. 29:
The future of mental-health treatment

To better manage calls with a mental-health component, some police departments have sent officers to 40 hours of crisis intervention team training, aimed at preventing people with mental illness from getting swept into the justice system for minor infractions or activity that falls short of a criminal offense.

When she took the training in 2009, Port Authority police Officer Danielle Hillgartner had to walk into a drug store and purchase a list of items while listening to a recording of voices screaming at her to do something else. The exercise was intended to acquaint her with the auditory hallucinations sometimes experienced by people with schizophrenia.

Officer Hillgartner also learned how to communicate with people having mental-health emergencies and about crisis programs that could serve as an alternative to confinement.

"Every situation is different. Not everyone needs to go to jail," she said.

Since 2009, Port Authority officers have taken at least 67 offenders to hospitals or crisis centers instead of jail.

Among the alternatives is Pittsburgh Mercy Health System's Central Recovery Center, a 12-bed unit on the South Side where officers may bring a person who's involved in disturbances or other minor crimes. City police, for example, recently brought in a man who twice tried to direct traffic on East Carson Street.

About 250 officers from Pittsburgh and 11 from the Port Authority are among those who have received CIT training in recent years. About 25 -- from the city and suburban departments -- completed the training last week at Pittsburgh Mercy Health System offices.

They're called "blue-pin cops" because they wear a pin often recognized on the street by people with mental illness, said city Detective Janine Davis, who oversees the CIT training. Officer Hillgartner said people with mental illness sometimes feel more comfortable speaking with officers who are knowledgeable about their conditions and the treatment system.

Sgt. Richard Manning, who oversees the county sheriff's transportation unit, said he took the training last week because of a plan to have deputies transport to and from court residents who have failed to comply with court-ordered treatment programs. Mt. Lebanon police Lt. Duane M. Fisher said he took the training, part of the department's core training regimen, in the hope of better serving residents by knowing where to send them for help.

Not everyone believes the training is as useful as supporters portray. State Rep. Joe Hackett, R-Delaware County, a Judiciary Committee member and former police officer who attended a hearing on diversionary programs in June, said he doubts that small or busy departments have extra time to spend on offenders with mental-health issues.

"Realistically, it's not happening," he said.

Jails inundated

Nationwide, about 56 percent of those in state prisons and 64 percent of those in local jails have mental illnesses, according to 2006 data from the U.S. Bureau of Justice Statistics.

Christine Martone, chief psychiatrist for Allegheny County's Behavior Assessment Unit, an arm of the court system, said she's seen an increase in the number of mentally ill inmates since Mayview's closing. Some of these inmates, she said, "never would have been out of Mayview" in past years.

Jails and prisons are struggling with the influx.

But as Thomas Insel, director of the National Institute of Mental Health, said during a July visit to Pittsburgh for an autism convention: "They didn't ask for this. ... They're doing what they can with what they've got."

In May, the U.S. Department of Justice said it would investigate the treatment of mentally ill prisoners in Pennsylvania prisons after revelations that inmates at one institution, Cresson, routinely were locked in their cells for 22 or 23 hours a day, in some cases for months or years at a stretch.

When jails and prisons do provide care, it isn't first-rate, partly because they use older, less costly versions of medications, said Laurence Miller, senior psychiatrist at the Arkansas Division of Medical Services, clinical professor of psychiatry at University of Arkansas and chairman of the American Psychiatric Association's Assembly Committee on Public and Community Psychiatry.

Citing a lack of communication between treatment providers and the court system, Dr. Martone called for better coordination of services -- perhaps through a "forensic mental health service" for offenders released on probation. If an offender fails to comply with a treatment regimen, she said, probation officers would be notified.

Like police officers with CIT training, county mental-health courts explore alternatives to incarceration for certain offenders with mental illnesses.

Cheswick resident Bill Grieco said Allegheny County's mental-health court helped to turn his life around. Twice since 2009, he was charged with assaulting police officers who went to his house when he threatened suicide. He also was charged with DUI.

Judge Beth Lazzara, who oversees mental-health court, ordered him to undergo treatment for depression and alcohol use. He "graduated" from mental-health court in June and works part time as an insurance broker, his mental illness and alcohol abuse in check.

He said he's not sure he could have found the proper treatment regimen -- or stuck with it -- without the court's oversight.

Despite a full docket in mental-health court every week, Judge Lazzara said she knows she isn't reaching everybody who could benefit from the program.

Sometimes, eligible offenders fall through the cracks and aren't referred to the court, the judge said, noting she's personally transferred cases from her regular criminal docket to mental-health court after picking up on signs of a defendant's illness.

In other cases, she said, defendants decline to participate because of the stigma surrounding mental illness. To combat that, she's thinking about renaming the court.

Because of funding limitations, she said, the court can't provide a full range of services to some groups, such as offenders with mental retardation or autism.

Also, Judge Lazzara said some inmates with mental illness are stuck in jail for months until beds in community treatment programs become available. The longer they're in jail, she said, the more she can see their mental health deteriorating.

"It's the saddest thing in the world," Judge Lazzara said.

Creative approaches

Mr. Deshong's case illustrates the difficulty in finding placements for those charged with major crimes or sexual offenses.

He was living with around-the-clock supervision in a group home when a caregiver took him to Walmart as a therapeutic activity, Ms. McDonald said.

When a female caregiver went to the restroom, Mr. Deshong was supposed to go to the restroom, too. Instead, he approached a 7-year-old girl, lifted her shirt and touched her belly -- a behavior reflecting his fascination with young midriff-baring pop stars, Ms. McDonald said.

Mr. Deshong already was a registered sexual offender for a Bedford County offense involving a child under 13, according to police records, and the Washington County charges violated his probation.

He pleaded guilty to indecent assault and stalking and was placed on probation and returned to the group home. Among other restrictions, he is barred from using the Internet, and two caregivers must accompany him whenever he leaves the home, Ms. McDonald said.

Ms. Irey Vaughan, the Washington County commissioner, said she's told state officials that they need to "step up" and create a mini-Mayview for offenders who may be too ill even to stand trial.

"It's an enormous, enormous problem," she said.

region - health - mayviewstories

Joe Smydo: jsmydo@post-gazette.com or 412-263-1548. First Published September 24, 2013 4:00 AM


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