1.11 Medicating a Murderer

Book One / 11

One of the first items on the court’s calendar following the judge’s return from a brief vacation was the State’s motion to force a defendant to take psychotropic medications to restore his competency to stand trial.  The defendant had been arrested in January that year, following his confession to the murder of a young woman who had been walking to her apartment early on New Year’s Eve.

The woman had been an employee of the local Sierra Club, well-known in her community for her work on local environmental causes.  She had made two trips to neighborhood grocery stores and was returning home to prepare for a party that evening when she crossed paths with the defendant.

In a confession to the detectives the defendant had explained that he didn’t know the woman, that she had simply been in the wrong place at the wrong time.  He said he’d seen her walking along the street and “just wanted to kill her.”

Twelve years earlier the same man had been convicted of assault in the first degree for an unprovoked shooting of another man at a downtown bus stop.  He had served his time on that offense — ten years in prison — and been released under continuing supervision by the state’s department of corrections.

For purposes of the department’s supervision the defendant had been classified a ‘dangerously mentally ill offender.’  Conditions of his release included treatment and medication for his mental illness.  After a number of months back in the community, however, he began slipping out of compliance with those conditions, and eventually his rearrest was authorized.

On the eve of Halloween the previous year — a month after his rearrest and two months before he stabbed the young woman on New Year’s eve — the defendant appeared in our court for a hearing on the allegations of his probation violations.  According to his community corrections officer, the defendant had been found in possession of a butcher knife, and was threatening a resident of the house where he lived.

The officer then informed the court that similar conduct had caused staff at the defendant’s treatment center to bar him from the grounds of that facility as well.  Critically, the treatment center was where he obtained his counseling and medication.  As a result of being unable to attend the facility, he’d been rendered incapable of obtaining the court-ordered mental health services that were a condition of his release.  The violation of that condition had triggered the prosecutor’s request for his arrest.

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We had seen situations like this one before.  An inmate is released from prison having served his time, but is still mentally ill and at risk of reoffending as a result.  Mental health treatment is ordered as a condition of release, but the individual’s illness hijacks his ability to comply.  At that point, if the treatment agency isn’t diligent in its supervision of a client’s compliance, or if the client becomes too dangerous to be on the facility’s grounds, then his medication regime may lapse.  Without medication and counseling he becomes more dangerous, moves beyond the influence of professionals who can help, and eventually violates the conditions of his release.

If the system is continuing to function at some level, the noncompliance will be reported and the individual will be detained.  But if agency staffing levels are low, available resources insufficient, or other problems plague communication and reporting, the individual may remain free to reoffend as his mental condition deteriorates.

That same sequence of events had occurred with this man.  In a classic chicken-or-egg scenario, but involving either criminality or mental illness as the unknown original condition, he had become — and then remained — in persistent violation of the terms of his probation.  He was re-arrested and held in custody until a hearing in our court could be scheduled.  At the hearing he would appear before the judge, who would listen to the allegations of his conduct and impose an appropriate penalty.

When the defendant walked into our courtroom that late October morning, two months before he would kill the woman on New Year’s Eve, he had already been in custody for a month following his arrest for probation violations.  In an extended questioning of the attorneys present that day, the judge noted the irony of the man’s circumstances:  he’d been ordered to maintain his medication and counseling to treat his illness, but his illness caused him to behave in a manner unacceptable to the treatment facility.  Without a facility for treatment, his condition had deteriorated, creating behaviors that pushed him even further outside the reach of medication and counseling.

To make matters worse, as a result of being in custody for the past month he had lost his special housing that helped keep him off the streets at night.  As the judge now predicted, not realizing how accurate his words would prove, when the man is again released from jail, not only will he be without his medication but he’ll also be homeless, and he will pose an even greater threat to himself and to others.

The attorneys and the corrections officer all nodded as they stood with the defendant at the bar that October morning, agreeing with the judge’s assessment.  The corrections officer told the judge that he’d coordinate attempts to reengage the man with housing and treatment, and the judge accepted the officer’s assurance.  It was all he could do with the limited resources available.

At the conclusion of the hearing the judge ruled that the defendant had indeed violated the conditions of his probation.  He ordered as a sanction the longest jail term available under the law, two months.  The defendant was then returned to his jail cell to serve the remainder of his confinement.  When his term ended, the jail released him, as it was required by law to do.  Ten days later he stabbed the young woman on New Year’s eve.

In January the defendant was rearrested and charged with the woman’s murder.  A few months later he’d been found incompetent to stand trial.  Now, eight months down the road from his last appearance in our court around Halloween, he was back before the judge on the State’s pretrial motion to forcefully administer the medications he was refusing to take.  The medications were intended to restore his competency and allow the State to proceed with its latest prosecution against him.

The judge conducted a lengthy hearing spanning three days.  He took testimony both from the state hospital’s psychiatrist and from the defendant himself.  He heard argument from the attorneys and allowed the defendant to make a final statement to the court in his own defense.  Two days after the conclusion of the hearing he entered an order finding that the administration of anti-psychotic drugs would likely restore the defendant’s competency to stand trial.  The defendant was transported back to the state hospital to begin medications where he would remain until competency was restored.

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Later that year, in response to the New Year’s Eve murder, a state task force would convene to address the systemic failures of the state’s corrections and mental health systems in situations like the one involving this defendant.  Remarkably, as the task force members would learn, our state ranked last in the country in the number of community psychiatric beds available to either voluntary or involuntary commitments.  Whereas the national recommendation was fifty psychiatric beds per 100,000 individuals in the population, at the time of the report our state had only nineteen.

Moreover, even if the state were to fund more beds, its courts still would not have the laws required to reform the way they committed the mentally ill offender to one of the state’s hospitals.

The task force, including two dozen psychiatrists, corrections officers, police officers, mental health counselors, county and state executives, attorneys and legislators, developed fifty-seven recommendations to the county’s prosecuting attorney.  One recommendation involved changing the state’s involuntary commitment law to mandate commitment for mentally ill criminals with a significant history of violence.

A reform such as that could begin to reverse the dangerous trend of the past forty years to de-institutionalize the violent mentally ill.  The law would recognize that community treatment supervision can be too risky an option.

The task force concluded with a report of its findings and recommendations, and released the report to the media.  Somberly, as the media reported, all of the members agreed that far more resources would be required to address the problems than were presently available, and no one was optimistic about that.

1.12 Summer in the City