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Group Therapy 

A local court was among the first in the nation to assemble its own treatment team to meet the needs of mentally ill defendants. But it hasn't been easy.

The defendant holds up his baggy shorts with one hand and walks to the front of the courtroom -- Section E in Orleans Parish Criminal District Court. Behind him, the room's wooden benches are filled with other defendants waiting their turn.

The judge looks up from his notes and his eyes stop at the sagging pants. "Eldridge, what's up with your clothing?" he says.

Eldridge shrugs. "My belt is gone -- a dog took my belt. Not my dog, a 'hood dog." He takes a breath and keeps talking, about how he had to take a paternity test last week and that's why he didn't make it to see his case manager or his counselor. He was going to bring the proof of that, but he left it on his dresser at home.

"Eldridge, you have certain things you have to do," says the judge. For instance, he -- and everyone in this room -- must visit his caseworker and follow his treatment plan. "Eldridge," says the judge, pausing. The man looks up, meets his gaze. "Eldridge, this is a conversation we're not going to have again. You miss nothing else, Eldridge."

The judge threatens possible sanctions, including jailtime, and then his eyes rest again on the baggy pants. "Eldridge," he says, "when you come into my house, don't come looking like that again." Eldridge says, "Yes, sir," grabs his pants and heads back to the benches.

The caseworker calls the next name. A woman with a red headband rises, moves to the edge of her bench and walks to the front. The judge sees her and immediately asks questions. Has she gotten housing yet? Can she stay where she is for a month? The answer is, evidently, no. The woman chokes up as she tries to respond. "It's hard sometimes," she says.

The judge sympathizes. "I know, baby, I know," he says, then gestures to some of the courtroom staff, who gather next to his bench for a few minutes in a "sidebar" conference with the woman with the headband.

Next comes a man who's on dialysis but hasn't been buying healthy food. Soon, after another sidebar huddle, someone is assigned to accompany him to the grocery store. "We ain't going to let you be hungry -- that's what we're here for," says the judge.

Yes, this is still a court, dealing with matters of law and order, with felony-level defendants. But all of the defendants have also been diagnosed as mentally ill; almost all struggle with "co-occurring disorders" -- mental illness and substance abuse. And every Friday morning, they enter the gothic Orleans Parish criminal courthouse to participate in Judge Calvin Johnson's mental-health court, which addresses the root cause of these defendants' criminal behavior -- mental illness.

Only about 100 such courts exist in the United States and most are fledgling, like this one in Orleans Parish, which celebrated its one-year anniversary in December. Mental-health courts began as a way to serve defendants who couldn't be effectively treated in drug courts. Some predict that, in coming years, the new courts may become as common as drug courts, which started in 1989 and are now a part of nearly every criminal-justice system in this country.

The reasoning is clear: If defendants don't get help through the courts, they might not get it at all. A Surgeon General's report in 1999 found that, nationwide, only about half of adults with serious mental illness receive treatment. The situation is even more dire in Louisiana, where a mere one in four people with serious mental illness are served by the state's Office of Mental Health.

In this atmosphere of limited services and scarce funding, the court has been praised for its ability "to marshal resources" by no less than the John D. and Catherine T. MacArthur Foundation. The foundation recently selected Orleans Parish as one of four courts nationwide to participate in a three-year study. Researchers will test the effectiveness of mental-health courts by comparing the outcomes of the courts' defendants with mentally ill people who simply do time in jails like Orleans Parish Prison.

Research about drug courts have found that judges' interactions with defendants are crucial. In Section E, Johnson's "benchside manner" is a textbook example of how this works. Within the last 15 minutes of his docket, the judge admires one man's new state ID, preaches to a red-haired woman who used cocaine last week, and praises a young lady in an apron who just landed a job. He has a stern face for the last defendant, a man in a tan blazer who spent the week in jail for failing a urine test.

"You can't use, Vernell," says Johnson. "You cannot use."

The man fiddles with the sleeve of his blazer and tries to explain why he slipped. "I told you I was suicidal," he says.

The judge nods. "Thank God it didn't happen," he says. "But everyone in these benches has issues. Our job is to get you to deal with those issues as best you can."

JUST AFTER THE USUAL FRIDAY mental-health court session, a woman in a blue probation-office jacket walks to the front with a familiar refrain. "Can you please take one more person?" she says, making a compelling case for her client. When she leaves, the mental-health court docket has grown by one, to 157.

At the beginning of that morning's session, 11 new people had stepped forward -- nine men, two women. Some less-urgent cases have been added to a waiting list, because the court is carrying well over its planned caseload of 100 defendants.

Johnson told the 11 newcomers what he expects from them. They have to see their probation officer and, on a weekly basis, submit to a drug test and visit case manager Kisha Lorio. Then, depending on their individual plans, they will receive treatment at the New Orleans Center for Additive Disorders, medication and group counseling at a Office of Mental Health clinic, and individual counseling at Family Service. There is also a curfew team that verifies that they're at home by 6 p.m. each night.

"I not only want you to complete this program," Johnson told the group, "but I want you to live your life in a way that ensures that you will not come back to this court."

In the rest of the courthouse, most defendants are male and many are young. Not so in mental-health court, where about one-third of the defendants are women and half are over the age of 36. Some experts suggest that older people with mental illness may show up in court in higher numbers because that's when they have burned all their bridges -- their ties to family, work, housing. Case manager Lorio says that half of the defendants are facing their first charge; others have rap sheets dating back to the 1970s.

Other observers predict that, as the court develops, those with the rap sheets would be diagnosed earlier, at a younger age. The court's older demographic, they say, reflects the fact that mental-health court is new and just now diagnosing people who have been cycling through the justice system for years.

No one can say for sure. At this point, mental-health courts are so new that there's no consistent model, says Fred Osher, a national expert on co-occurring disorders in the criminal-justice system. The courts themselves are also evolving. For instance, the Orleans Parish court started out with defendants from other sections of court who had already pleaded guilty. Johnson and his team plan to eventually include only pre-trial defendants, who can be treated before they have another strike against them -- a criminal record.

Osher, who heads up the Center for Behavioral Health, Justice and Public Policy at the University of Maryland, says that he's visited enough mental-health courts to make this statement: "You've seen one mental-health court and you've seen one mental-health court." How they're organized and run varies widely from city to city, he says.

But all the courts are addressing the same basic problem. "At every step of the criminal-justice system," Osher explains, "there's an over-representation of folk with mental illness." One reason is that drug and alcohol use is higher among mentally ill people, so they are more frequently arrested for drug crimes. Homeless populations also contain disproportionate numbers of people with mental illness who often get caught up in police sweeps.

Once arrested, people with mental illness serve more time for the same sentences and charges as people without mental illness. That longer jailtime helps to explain why, at any given time, 15 to 20 percent of inmates nationwide need psychiatric medication. In Orleans Parish Prison, according to the sheriff's office, 13 percent are taking psychiatric meds.

Upon release, the mentally ill aren't funneled into the public mental-health system, according to Dr. Anthony Johnson, who diagnoses all of the defendants for mental-health court through his role as medical director for the Central City mental-health clinic. "A significant number of these people -- the mental-health court defendants -- have never been in the mental-health system before," says Johnson.

The very existence of mental-health courts is a sign that something isn't working, says Tammy Seltzer, who's studied the courts for the Washington, D.C.-based Bazelon Center for Mental Health Law. "Mental-health courts have become an end-run for public-health systems that are not delivering," she says.

IT TOOK 3 YEARS OF PLANNING to get the Orleans Parish mental-health court up and running. Judge Johnson's first step was gathering people from every branch of the alphabet soup that is the public mental-health system, including OMH (Office of Mental Health), NOCAD (New Orleans Center for Addictive Disorders) and OCDD (Office for Citizens with Developmental Disabilities). The situation is even more complicated because all of these agencies used to fall under DHH (the state Department of Health and Hospitals); they now are under the umbrella of a regional entity called MHSD (Metropolitan Human Services District).

Putting it together wasn't simple, says Judge Johnson. "Because, in all honesty, these entities had no real working relationship with each other. OMH had never sat in the same room with OCDD." Plus, they had no set plans to work together on the same clients.

The Section E team started with case manager Kisha Lorio and her supervisor, Andree Mattix, along with representatives from the probation and parole departments. It then expanded to include a team of mental-health professionals from all across town, including Alozia St. Julien from the Metropolitan Human Services District, and Janice Bolin, who provides individual counseling through the nonprofit Family Service of Greater New Orleans.

Because mental-health court defendants are often people who have fallen through the cracks, the court needed to operate differently -- it needed to close some of the gaps within the existing mental-health system. For instance, says Johnson, the agencies needed to come to the clients instead of waiting for the clients to come to them. "We told them, 'That system has failed -- the clients who should have been getting those resources aren't getting them.'"

It's a common problem, says the Bazelon Center's Tammy Seltzer. "What we really need is for mental-health providers to get out from behind their desks and meet their clients where they are," she says. That very idea is built into the court, says Lorio. "We go to their houses and look for them."

But that task shouldn't be shouldered by the justice system, says Seltzer. "Because there are some important negative consequences that come from subjecting people to a criminal-court system instead of a mental-health system," she says. "If police aren't properly trained, people with mental illness can be shot. They're handcuffed in front of neighbors, can lose jobs and housing -- especially public housing." In the long term, a far better solution would be a fully funded, much more effective mental-health system.

In many other cities, for example, mental-health systems hire staff to visit more complicated clients, checking on them at home daily, if necessary, to make sure that they're doing well and taking medications. The local system has nothing like that, and can't even begin to wish for it, says Dr. Anthony Johnson from the Central City clinic.

Instead, the doctor's No. 1 wish is enough funding for up-to-date psychiatric medications. "The new anti-psychotics Rispidal and Zyprexa and the Prozacs, Paxils, and Zolofts of the world are great and they have less side effects. But boy, they are costly," he says. So he ends up prescribing older, now-generic medications, simply because they cost less. "We're always practicing with medicine that's at least 20 to 30 years old for most of our indigent patients," he says.

Kisha Lorio says that for her, the most elusive resource is housing for defendants. They also are scrambling to address something they didn't expect -- the startling number of defendants who suffer from acute medical conditions like heart problems, diabetes, high blood pressure, tuberculosis, HIV-AIDs, you name it, she says.

It's much more than one small court can tackle. And so, as Judge Johnson walks into court each Friday, he hopes that his team's work will have effects far beyond the 150 or so defendants waiting for him in those benches. "By what we're doing, we are educating the entire system, the entire community, about issues that involve the mentally ill," he says.

STEVEN, WHO'S NOW IN HIS 40s, was a biology major with an English minor when he was first arrested for a hit-and-run back in 1997. He was given probation, but got behind on his court payments and ended up in a state prison, where, he believes, his problems with mental illness began.

Today, he's a success story in mental-health court, taking a mixture of prescription meds and receiving individual counseling for post-traumatic stress and severe depression. To Steven, one sign of his success is that he's again writing songs and reading poetry. "My biggest inspiration is a female who you may or may not have heard of, Emily Dickinson, a 20th century poet," he says, reciting a stanza of one of his favorite Dickinson poems: "I felt a Funeral in my Brain." He quotes: "Like a Drum-- / Kept beating--beating--till I thought / My Mind was going numb."

Steven began using drugs, he says, during his prison sentence, when he used heroin and crack and whatever he could get his hands on. He did catch a heroin possession charge in 2003, a dime bag planted by cops, he says. Since he's been in mental-health court, he's only had dirty urine once, about five months ago. "They said I had one positive test for cocaine, so I spent from Saturday to Wednesday in jail," he says.

Like everyone else, Steven started out in the initial section of mental-health court, called Phase I, which requires certain activities every week. He has now graduated into Phase II, which requires less frequent court appearances and counseling sessions. His goal is to graduate after one year, the minimum time anyone can spend in the mental-health court program, no matter what the sentence.

At first, Steven says that he initially noticed signs of mental illness and substance abuse during his prison stint. But he amends that explanation in small pieces as he begins to describe his past. "Panic attacks and anxiety run in my family," he says at one point. A few minutes later, he mentions that he had had a good job, making dentures, and could have been bringing home good money, if he hadn't been giving $1,000 a week to "the pill-man" for painkillers.

Sometimes the descriptions seem to be embellished. As a child, he says, he spent a lot of his time riding a skateboard, planning to be a professional baseball player, making videos for MTV. And everything was fine. "I was so active and funny," he says a few times.

There was seventh grade, which he repeated three times. And his parents' divorce, in late elementary school, which at first meant weekend visits from his dad, then -- as the child support dwindled -- no contact at all. "That kind of really hurt me," he says. When he thinks about it, it probably had a lot to do with him dropping out of high school in 10th grade.

Steven speaks slowly, with great calculation. He just got a computer that he's been using lately to write lyrics for songs like "Waterfront From My Face." ("Can you feel the waterfront from my face, the tears falling from my eyes? Can you feel the pain you put me through, the waterfront from my face, out of my soul, from my eyes?")

Again this week, when Steven walks to the front of mental-health court, he follows his custom of thanking the judge and the treatment team for their compassion and empathy.

"I appreciate that," Judge Johson says. "Continue to allow us to help."

click to enlarge When Judge Calvin Johnson walks into court each Friday, - he hopes that his team's work will have effects far - beyond the 150 or so defendants waiting for him in the - benches. 'By what we're doing, we are educating the - entire system, the entire community, about issues that - involve the mentally ill,' he says. - TRACIE MORRIS/DONN YOUNG STUDIO
  • Tracie Morris/Donn Young Studio
  • When Judge Calvin Johnson walks into court each Friday, he hopes that his team's work will have effects far beyond the 150 or so defendants waiting for him in the benches. 'By what we're doing, we are educating the entire system, the entire community, about issues that involve the mentally ill,' he says.
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