For Mental Health Defendants, a Path to Recovery Under the Court's Watch

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There’s a high bar for being found not guilty by reason of insanity – or NGRI, as it’s called. People who commit offenses have a mental illness so severe that they didn’t know what they were doing was wrong.

Joy Stankowski is a psychiatrist at Northcoast Behavioral Healthcare, a state psychiatric hospital. She says she sees patients who have committed a range of offenses.

STANKOWSKI: “We’ve got people here who have been found NGRI for very serious crime -- murder. And we’ve got people here who have been found not guilty for reason of insanity for trespassing or open container.”

What patients have in common is their sentence: They’re placed under court jurisdiction for the maximum amount of time they would have served had they been found guilty.

For the majority, that includes a minimum of 8 to 12 months in a psychiatric hospital, Stankowski says. Some spend years there.

Stankowski estimates that about 120 people found NGRI are committed here at Northcoast. She and her colleague Muhammad Momen take me to the Social Learning Center. It’s sort of a rec room.

STANKOWSKI: “It’s empty right now because the patients on the unit are all in their community meetings. But you can see that we’ve got fitness equipment, we’ve got arts and crafts equipment, there are games, pool tables, all for recreation.”

They go to therapy and take medication. They attend classes to learn social skills and to lessen the debilitating effects of diseases like schizophrenia. Some patients have jobs in the hospital -- as housekeepers, for instance. Patients can read books and watch TV -- but no Internet. They’re allowed to have visitors. They’re also kept under close watch.

Muhammad Momen says when a violent patient comes to the hospital, doctors might separate them from other patients for a day or two.

MOMEN: “Not in restraint or seclusion. We tend to keep them in a single room. We have some single rooms. We monitor them closely.…Sometimes every 15 minutes, every five minutes, for a period of time.”

When psychiatrists and the court decide a patient is stable enough to leave the hospital without endangering the community, that person is let go on what’s known as conditional release.

But some use a different word.

HERNANDEZ: “People will use the word, ‘probation,’ they’ll tell their family member they’re on probation. It is not probation.”

Aileen Hernandez is a psychiatrist at Recovery Resources, the agency that offers treatment and other services for people on conditional release in Cuyahoga County.

She says people on release must sign a personalized agreement -- no drugs or alcohol, and they will likely have to take medication. If they break these conditions, or if their symptoms worsen, they’ll go back to the hospital, Hernandez says.

HERNANDEZ: “The whole point of conditional release is to intervene before they get to the point where they will commit another offense. They’ve already proved that their mental illness will cause them to do something violent.”

Last fiscal year, 77 people were on release in Cuyahoga County, according to the county addiction and mental health services board. A quarter of them went back to the hospital from time to time for treatment. Nine of them had their release revoked and were ordered back.

Recurrence of serious violence is said to be very rare, but it has happened in the state. In 2011 in Springfield, Ohio, a man on conditional release shot and killed a sheriff’s deputy before dying in a shootout with law enforcement. That prompted a bill currently under consideration in the Statehouse in Columbus. It would allow police agencies to know who is on conditional release statewide.

Lottie Gray at Recovery Resources says some clients already must obey protection orders.

GRAY: “We have some clients who the court has ordered not to go to the facility where their offense occurred, or any contact with the victim. And that’s absolutely imposed.”

Most move into group homes. Some live eight to a home, some live with as many as 20 people. They meet with case workers regularly, and see a psychiatrist at least once a month.

Gray says some people struggle to come to terms with their offense.

GRAY: “I think some of our clients, before we would even talk to them about it, have a huge sense of responsibility and a huge sense of remorse.”

They work to recognize the symptoms of their mental illness, and they learn to take part in society again—riding the bus, doing the laundry, making meals, holding down a job. But some have trouble finding employment because of their past, and they look to Recovery Resources for help.

And after months or years of hospitalization and medication, Hernandez says, some do get better.

HERNANDEZ: “Maybe they just see that life can be different, life can be better. I don’t have to go in and out of the hospital all the time. Or I don’t have to suffer from the voices or the depression or whatever it was.”

Bill Denihan directs the county addiction and mental health services board that arranged treatment sites for people on conditional release.

He says as people move from the hospital into the community, he tries to accommodate the concerns of victims and their families.

DENIHAN: “Some have forgiven. Some haven’t and never will…I can’t speak for them, but I need to be sensitive that they’re as important a part as anyone else.”

For him, that means ensuring that they’re safe and, to the extent possible, that their grief is not worsened.

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