JEFF PORTER ARKANSAS DEMOCRAT-GAZETTE Arkansas will spend more than $3.5 million this
year to monitor potentially violent mental patients it has returned to
society, but it will ignore some of the most dangerous ones.
Until 1994, the state spent no money specifically
to track people who had committed criminal, even violent, acts but were
acquitted because of mental illness. Since then, the state has added programs,
spent millions of dollars and made plans to spend millions more to treat
and monitor a small number of people.
During the last fiscal year, the state spent about
$2.2 million on two programs to monitor the criminally mentally ill and
treat them for substance abuse. It plans to spend up to $3.56 million during
the current fiscal year on the same programs.
But for all that, the state does not necessarily
monitor the most dangerous mental patients.
For example, officials agree that the monitoring
program was begun at least in part because of two murders committed by
mentally ill people. But, had the new programs existed before those murders,
the men who committed them would not have been tracked.
The state Department of Human Services monitors
slightly more than 200 people who have been acquitted of crimes by reason
of mental disease or defect. Most of them have been released from the State
Hospital and are under the care of community mental health centers.
Operators of some community mental health centers
question the need for so much spending on so few. But Department of Human
Services officials say the programs are needed for public safety.
Arkansas is not the only state government that spends
money to monitor the mentally ill. Oregon, for instance, has a program
that can monitor some acquitted mental patients for life. Its system has
about 480 people under its jurisdiction and an annual budget of about $291,000.
Until 1994, community mental health centers were
responsible for monitoring in Arkansas. But some centers ignored monitoring
and reporting requirements or lost track of patients. And at the State
Hospital, doctors sometimes changed the commitment status of patients without
court approval.
"Nobody had been monitoring these people at all,"
said former state Rep. Bob Fairchild of Fayetteville, a sponsor of the
1989 legislation that established the reporting requirements. "They were
just acquitted and just dumped back on the street."
Why the burst of interest in the criminally mentally
ill? People involved with the process mention three names: mental patients
Michael Catlett and Tommy Allen Gentry, and Judge Mary McGowan.
Catlett and Gentry committed highly publicized murders.
Gentry was acquitted in Tennessee of a 1981 killing
and transferred to Arkansas in 1990. He was in a mental health outpatient
program in September 1993 when he killed Roslyn Reeves, 19, outside a North
Little Rock apartment complex. He told police he felt compelled to stab
the young woman because aliens were shooting moonbeams at him.
Catlett ran away from the Arkansas State Hospital
three times and was reclassified as "dismissed" before killing his former
fiancee in October 1993. He shot Stephanie Michelle Jungkind, 23, at a
west Little Rock intersection.
Gentry pleaded guilty and got an 80-year prison
sentence. A jury rejected Catlett's insanity defense. He was sentenced
to life in prison without parole.
But before those two murders, neither man had been
acquitted by reason of insanity in an Arkansas court, a prerequisite for
state monitoring.
The monitoring program is called the 911 Program
because it is based in part on Act 911 of 1989. Even though neither Gentry
not Catlett would have been monitored under the 911 Program, their cases
caused concern among mental health officials and legislators about tracking
potentially dangerous mental patients.
Most mentally ill people are not dangerous, said
Dr. E. Fuller Torrey, a psychiatric researcher at St. Elizabeth's Hospital
in Washington, D.C. Seriously mentally ill people off their medication
commit 4-5 percent of America's homicides, Torrey said.
Experts say that a criminal arrest background is
no real indicator of whether a patient is among the small minority of the
mentally ill who are potentially dangerous. Dr. Bill Peel, director of
the South Arkansas Regional Health Center of El Dorado, said his center's
911 Program participants are not the most dangerous people being treated.
"I can name a dozen people who are a lot more dangerous,"
he said.
McGowan, the Pulaski County circuit/chancery judge
who decides on the release of criminally mentally ill people from the State
Hospital, helped change the system when she pointed out in 1994 that she
wasn't receiving court-ordered reports on those acquitted because of their
mental illness. In part, that prompted establishment of the 911 Program.
She also pressured the Department of Human Services
to do something about criminally mentally ill people returned to the State
Hospital because they had failed court-ordered drug tests.
While McGowan's job includes considering requests
to release 911 Program participants from the State Hospital, she also considers
requests to revoke release if participants do not follow her orders.
Costly -- $300 a day -- State Hospital beds began
filling up with 911 Program participants ordered back to the State Hospital
because of drug problems. Human Services officials say they have nowhere
else to put them.
The department sought funds to build a $2 million
facility to house the Arkansas Partnership Program, which will take many
of the criminally mentally ill substance abusers out of the State Hospital.
McGowan said she didn't force the state to build
anything: "I was just doing what the statute said."
Tom Head, director of adult services for the Department
of Human Services Mental Health Division, said McGowan was a driving force
behind establishment of the new facility.
"She didn't have many options," Head recalled. "Her
actions speeded along the process."
The partnership program building is part of a series
of solutions to the problem of what to do with criminally mentally ill
people who can't function on their own.
The 911 Program spent about $411,000 in the last
fiscal year. This year, it has a budget of about $460,000.
The Arkansas Partnership Program could cost up to
$3.1 million. It's now housed in leased space in the State Hospital. Early
in 1997, the program will move to the facility being built on the State
Hospital grounds.
A nonprofit Little Rock mental health organization,
Greater Assistance to Individuals in Need, has a state contract to run
the program. The organization has hired Liberty Healthcare Corp., a Pennsylvania
company, to operate the in-patient part of the partnership program. The
organization also provides treatment for others who are in the 911 Program.
Organization Director Dennis Wells said demand for
the facility indicates that it's needed.
"That building can be filled up the day after it
opens," he said.
A computer database maintained by the 911 Program
shows about 40 percent of the program participants have some kind of drug
or alcohol abuse problem. That number is probably lower than reality, Wells
said. Nationally, 70-80 percent of people with serious mental illness also
have substance-abuse problems, he said.
Human services officials say the partnership program
could save the state $2 million a year.
Program literature estimates a cost of $178 per
day for clients in the 42-bed secure facility. That would make the cost
of treating 42 people for a year about $2.7 million. Dr. Laurence Miller,
State Hospital medical director, said the cost of keeping someone in the
State Hospital is about $300 a day. For 42 people, that would be $4.6 million
a year.
The partnership program will also have an outpatient
effort, which means that many more than 42 people can be in the program.
"It's taken quite a bit of money, but we have a
system in place," said John Selig, the director of the Department of Human
Services' Mental Health Services Division.
But not everyone in the mental health community
is satisfied. Officials with some of Arkansas' community mental health
centers -- nonprofit agencies that depend a great deal on state funding
--say they could do more good with the money.
"The monitoring program cost this center close to
$500,000 in resources," said Tom Grunden, director of the Little Rock Community
Mental Health Center. He said the center, on the grounds of the State Hospital,
lost about eight state employees when the monitoring program was established.
The money for continuing the program takes away from mental health centers
statewide, he said.
Peel -- who is also president of the Mental Health
Council of Arkansas, a trade association for community mental health centers
-- and Grunden say the centers could have done the monitoring work.
Others aren't so sure. As a group, the mental health
centers had a mixed record of following court orders, McGowan said.
The problems, McGowan said, developed mainly outside
Pulaski County. She said the system needed changing, because some mental
health centers just weren't monitoring and reporting as required by the
court.
Grunden said it's true that some mental health centers
didn't want to take part in monitoring or reporting. But, he said, the
state should have taken over monitoring only where necessary.
Selig said he would listen to proposals to improve
the monitoring system, including contracts with mental health centers to
monitor their own 911 participants.
Meanwhile, Selig said, the partnership program will
cut back on those costs and provide more appropriate treatment.
"It's expensive, but that is a very important population
to us and to communities out there," he said. "And I think it's essential
that they get good treatment and that we ensure communities that we're
watching them and taking care of them."
Monitoring turns some lives around
JEFF PORTER ARKANSAS DEMOCRAT-GAZETTE In 1988, a man walked into a Little Rock doughnut
shop and told a police officer there that he would lead the officer to
a felony arrest.
The officer followed the man to a nearby post office and
watched as he gave a clerk a note reading: "Assume the worst. Hand over
your money and rolls of stamps now."
The man then turned himself over to the officer. He was
unarmed.
He later told police that he believed the federal government
was conspiring against him. So he decided to commit a federal crime so
the government would have to support him in prison.
Instead, he was acquitted because of mental illness.
The man's story has a less comical earlier chapter, though.
Eight years before, he had used a shotgun to kill his father, according
to court records. He was acquitted by reason of insanity then as well.
He was discharged from the Arkansas State Hospital in
1982, when no state monitoring program existed. No one tracked his subsequent
mental health, and he was essentially on his own until the post office
robbery.
But now, he has completed a mental health program set
up under Act 911 and no longer is under state monitors. Underlying the
program is the goal of changing ingrained, in some cases decades-long,
patterns of behavior.
"The people released under this program are not psychopathic
killers," said Tucker Steinmetz, chief executive officer of Birch Tree
Communities, a Benton-based nonprofit mental health organization that treats
many released 911 Program participants.
"We would not take a Hannibal Lecter," he said, a reference
to apsychotic serial killer in the movie "The Silence of the Lambs."
Steinmetz points to the example of a man in Birch Tree's
care who had been charged with terroristic threatening after he telephoned
bomb threats to a radio station but who wasn't really dangerous.
"He could not blow up a paper cup," he said.
But many of the 911 Program participants were accused
of violent crimes. Battery is the most common charge, with 44 participants
accused of that crime. Frequently, records show more than one crime, such
as battery and terroristic threatening. Twenty-three were charged with
assault.
Generally, a person acquitted of a crime by reason of
mental illness is assigned to the State Hospital. But after treatment,
if the person is no longer mentally ill or dangerous, the law requires
his release.
A court sets conditions for release and can order the
person back to the State Hospital for violation of those conditions. Arkansas
limits post-release monitoring to five years.
Is that long enough?
"It would depend entirely on the person or the problem
or the diagnosis," said Dr. Bill Peel, president of the Mental Health Council
of Arkansas and director of the South Arkansas Regional Health Center in
El Dorado.
In some respects, it's too soon to tell. Act 911 is a
1989 law, and people acquitted and released under it have only recently
begun to be freed from monitoring.
While some 911 Program participants find themselves repeatedly
in trouble, the program also has its success stories.
* A woman charged with two counts of capital murder in
east Arkansas in 1988 now holds a job and lives on her own. In 1989, a
State Hospital doctor warned in a report on the woman that "rationally,
there exists a reasonable probability that similar harm could occur again."
After treatment, she was released to the care of Greater Assistance to
Individuals in Need, a Little Rock mental health program. She has attended
classes at the University of Arkansas at Little Rock, and, if all goes
well, will be released from the monitoring program next summer.
* Steinmetz recalled a client who went to Birch Tree after
a fight with police in which he was wounded in the eye. Steinmetz remembered
him as withdrawn and depressed. That's changed because of his participation
in the 911 Program, Steinmetz said. "He looks 10 years younger. ... It
probably turned his life around," Steinmetz said.
"We've had a lot of successes," said Dennis Wells, director
of Greater Assistance to Individuals in Need. "We've had three people successfully
complete their five years of conditional release. We've got people working
full time, in school full time, who've gotten off disability entitlements,
and are paying taxes and have returned to society and become productive
citizens. None of that would have happened without the forensic program,
without mental health centers stepping forward and being willing to treat
these people."
Nationally, people acquitted by reason of insanity eventually
commit later offenses at roughly the same rate as convicted felons, said
John Q. La Fond, a professor at the Seattle University School of Law and
author of the 1992 book, "Back to the Asylum: The Future of Mental Health
Law and Policy in the United States."
The Arkansas Department of Human Services is planning
statistical studies on success rates as more 911 participants complete
the program, said Billy Burris, assistant director for children's and forensic
services of the Mental Health Division of the state Department of Human
Services.
Waymon Coulter, coordinator of emergency services for
the Little Rock Community Mental Health Center, said five years isn't a
magic number, but it is enough to allow many of the participants to see
the value of continuing their treatment.
And it's easier than previously thought to predict dangerous
behavior by mental patients, said Dr. E. Fuller Torrey, a psychiatric researcher
at St. Elizabeth's Hospital in Washington, D.C. In a forthcoming book,
he outlines three factors important in predicting such violent behavior:
a history of violence, a history of alcohol or drug dependency, and a failure
to take medication as prescribed.
"The medication issue is the foremost one," Torrey said.
"That is the factor that distinguishes the seriously mentally ill" from
other people who tend to be violent.
These articles were published on Sunday, October 20, 1996
