We can interrupt mental illness before it leads to crime

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There was a case I handled during my career as a prosecutor in Rusk County, in East Texas, which gets repeated every day in our state.The patient, a woman in her late 40s who we’ll call Jane Doe, wasn’t able to live on her own. She had 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 the efforts of her parents, continued to decline. She began to self-medicate, which only exacerbated her problems. Her parents dealt with the issue as best they could, but eventually their control over the situation was spent. In a rage brought on by her mental health issues and excessive alcohol consumption, this troubled woman assaulted her mother in front of several witnesses who were left with no choice but to call 911.When officers arrived on the scene, Jane’s parents told them about her physical and mental health challenges. However, the officers could not ignore the obvious evidence of family violence and placed the woman under arrest.But what if there had been a way to get Jane the help she needed before she assaulted her mother?There is. It’s an underutilized and misunderstood tool for dealing with the growing number of Texans dealing with mental illness, many of them homeless. It’s called involuntary civil commitment.Texas is painfully short on resources to deal with those individuals suffering from severe mental illness. Many times, the people who would make the initial call to get someone mental health treatment are loved ones, who are reluctant to call police on their own family members. Problems that might benefit from early intervention slowly worsen until the kettle boils over and the person commits a criminal act.Involuntary civil commitment is one of the few real, statewide tools available to address this dynamic. These are court-ordered hospitalizations for purposes of treating a mental illness that is so severe that there is a substantial risk of harm to that person or others. Here’s how it works.Typically, these commitments begin with a 911 call from a loved one or a concerned citizen. The resources available to deal with this initial encounter can vary dramatically. Some areas have crisis intervention and response teams that partner with specially trained law enforcement officers and mental health professionals. Other areas may only have the nearest officer on duty at the time. Whoever arrives at the scene will ultimately have to decide if the person has a mental illness and whether, because of that mental illness, there is a substantial risk of serious harm to that person or a third party unless that person is immediately restrained.If the patient meets the criteria of the Health and Safety Code, the officer will take the person into custody immediately, unless there is enough time to obtain a warrant beforehand. Unfortunately, the patient’s condition has usually deteriorated to such a degree by the time 911 is called that there is rarely enough time to obtain a warrant. Once a person has been taken into custody, the peace officer is required to immediately transport the person to the nearest appropriate mental health facility. A jail or other criminal detention facility is only permissible in the most extreme emergencies.Obviously, there are serious due process concerns at play in a situation like this — legal requirements for protecting the patient’s rights.When a peace officer makes a warrantless apprehension, he or she is required to file a notification of detention that lays out the specific facts giving rise to the detention to the mental health facility and notify the probate court with jurisdiction over the issue by the next business day.Once admitted into the 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 substantial risk of harm to the patient or others, and that the emergency detention is the least restrictive means by which the necessary treatment can be accomplished. If the physician does not make these findings, the person must be released.If the physician makes the required findings and the patient’s condition improves such that one of these required findings is no longer applicable, the patient must be released. Fortunately, a large number of those detained under these kinds of emergency circumstances are released shortly thereafter because there is improvement in their health.If a patient’s condition doesn’t improve, the local county or district attorney must file an application for court-ordered mental health services. Because of the liberty interests of the patient that are at stake in such a proceeding, a hearing must be held within 72 hours of the patient being taken into custody to determine whether circumstances exist which necessitate the patient to remain in the hospital while the application is pending.A hearing on the application itself must be set within 14 days of its filing. Before the hearing, two certificates of medical examination have to be filed with the court. The physicians filing the certificates have to have examined the patient within the past 30 days and at least one of the physicians must be a psychiatrist.The district or county attorney’s office bears the burden of proof at the hearing. If the judge decides they haven’t proven their case, the patient is released. If the prosecutor’s office does prove its case, there are two possible outcomes. If the patient is no longer a threat to themselves or others, they may be ordered to out-patient services. Or the patient may be sent to inpatient treatment if the judge or, in rare instances a jury, finds by clear and convincing evidence that the patient has a mental illness and as a result of that mental illness the patient is likely to cause serious harm to himself or someone else.Throughout this process, from initial encounter to final hearing, the goal is to get the patient the help they need in the least restrictive manner possible. The goal is not to lock up individuals whose mental illness amounts to inconvenience or annoyance. Likewise, it should not be used as a means to confine alleged criminal actors when the state’s evidence is lacking. Each step in the process is aimed at getting needed treatment to individuals who aren’t able to get it for themselves.When applied appropriately, the law is capable of producing a lot of public good when properly understood by local authorities and properly funded by the state and local governments.Our troubled neighbors, like Jane Doe, need our help. Involuntary civil commitments are one way to offer it.Zack Wavrusa is associate counsel in the Office of Inspector General for the Texas Health and Human Services Commission, and a former assistant district attorney in Rusk County. He wrote this column for The Dallas Morning News.We welcome your thoughts in a letter to the editor. See the guidelines and submit your letter here.



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