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The criminal justice and mental health systems strive toward two common goals — protecting the community while assisting the ill — and all too frequently fail at both. That was the consensus yesterday of speakers at a forum in Albany, N.Y., on the criminalization of mental illness. Speaker after speaker emphasized the need to integrate objectives and services. The speeches painted a picture of a situation where the mentally ill are increasingly ending up in a criminal justice system that is ill-prepared to address, and sometimes even recognize, the frequently treatable root problem. The forum, sponsored primarily by the Mental Health Association in New York State Inc., brought together a former judge, a former corrections commissioner and two mental health professionals. They addressed the problems that have resulted since the deinstitutionalization of the 1960s released tens of thousands of New Yorkers from mental institutions and seemingly resulted in a corresponding increase in prison populations. Joseph A. Glazer, president of the Mental Health Association, cited what he termed the problem of “trans-institutionalization,” or the shifting of a population from one institutional setting to another. In 1959, Glazer said, there were 550,000 people living in state psychiatric institutions across the country, representing .3 percent of the population of the nation. In 1998, there were 830,000 people with mental illnesses in prison or jail or on probation or parole — .3 percent of the population of the nation. “A specific portion of the population of this country has been shifted from the psychiatric hospital system to the communities and usually into jails,” Glazer said. Assemblyman James Brennan, a longtime legislative advocate for the mentally ill, said New York lacks a holistic approach to addressing the twin societal problems presented through criminality and mental illness. “What’s lacking in this area is a broad systemic effort to deal with this, to put in the resources necessary to deal with so many thousands of mentally ill people who are constantly involved in the criminal justice system, many for extremely minor crimes,” Brennan said. Bert Pepper, a psychiatrist with The Information Exchange and former associate commissioner of the New York State Department of Mental Hygiene, said that a large proportion of the mentally ill who wind up in jail are drug abusers. “By the time someone ends up in prison, we have seen multiple system failure,” Pepper said, suggesting that schools, courts and other institutions have, in all likelihood, neglected to detect a mental problem that is far better addressed by health professionals than law enforcement. “Treatment works,” Pepper said. “But we are not doing it.” Nahama Broner, a psychologist and research director of the Mental Health Project at New York University School of Social Work, told the audience that diversion — or intercepting mentally ill people at the criminal justice intake level — can be successful, but without a formal effort that approach is entirely dependent on the individual police officer and lower court judge. Catherine Abate, a former State Senator and former New York City Commissioner of Corrections, said there is simply a different aim of the criminal justice and mental health systems, even though they so chronically overlap. “The mission of the jails is one of custody and control, primarily,” Abate said. “Security concerns often outweigh the concerns of care.” Abate said that while jail is an inappropriate and ineffective response to mental illness, judges frequently lack any other choice. What is needed, she said, is a better way of recognizing mental illness, and a much better response network that involves law enforcement, health professionals and the judiciary. “The good news is there is a coming together of the players in the system,” said Abate, who is now president and chief executive officer of Community Healthcare Network. She said the Community Healthcare Network is currently involved in an initiative with the Department of Probation to develop a multi-discipline team approach. Additionally, beginning with this summer’s judicial training seminars in Westchester County, a new component on mental illness will be included in the curriculum. EDUCATING JUDGES A program prepared by the Psychiatry and Law Institute of North Shore Long Island Jewish Health System will offer the insights and observations of a number of experts on crime and mental illness. One of them may be former Chief Judge Sol Wachtler, an active member of the institute. “This summer we are going to teach the judges of the State of New York, educate them with respect to the manifestations of mental illness so that they will understand,” said Wachtler, who served time in federal prison for harassing conduct he engaged in while suffering from a manic-depressive illness. He may address judges at this summer’s judicial institute. Wachtler recited the case of a delusional man who was convinced that abandoned automobile tires were somehow manifestations of Satan, so he kept setting tires on fire. Repeatedly, he was arrested on misdemeanor mischief charges, only to be sentenced to 30 days in jail — after which he would return to burning tires. “The state spent hundreds of thousands of dollars to discipline him, and not a cent to treat him, and that’s wrong,” Wachtler said. The former chief judge has become an outspoken advocate on behalf of the mentally ill, an epiphany resulting from his own experiences. “I hate being here,” he confided to the audience. “I hate talking about this because I have to preface it by saying what everyone knows, that I was in prison, and that is something no one can be proud of.” Judge Wachtler spoke of the insufficiency of the ancient M’Naghten rule, which stems from 19th century Britain and still provides the legal definition of “insanity,” a term not used in medicine. Consequently, he said, someone like Andrew Goldstein, who is clearly mentally ill but knows right from wrong and understands the consequences of his actions, ends up a ward of the criminal justice system. Goldstein was recently convicted of shoving Kendra Webdale in front of a subway, the incident that inspired New York’s Legislature to enact “Kendra’s Law.” New York is beginning an experiment with mental health courts, quasi-judicial forums where the mentally ill can be intercepted and diverted. Wachtler is encouraged by the experiment, but recognizes there is little political incentive to seek meaningful reform. “People in public office, recognizing that there is no great constituency for this, would rather talk about longer sentences and making hard time harder than talk about trying to do something with these people who will one day be out on the street, committing more crimes and destroying more lives — particularly their own,” Wachtler said. “We should remedy this situation, if not for our own protection, then because we are a civilized nation that concerns itself, or should concern itself, with the human condition.”

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