Costly Cutbacks

The city's innovative Mental Health Court faces an uncertain future

Word of pink slips came in January. And by February, city prosecutor Laura Brynwood had said goodbye to five of her staffers, including three prosecutors.

Those cuts immediately rippled through Tucson's Mental Health Court, an innovative program that helps many offenders, mostly for petty offenses, avoid costly imprisonment.

Without enough prosecutors, the court would cease to exist. Indeed, the innovative program was rescued only in the 11th hour, after officials scrambled to rework schedules. Even so, its future in these austere times remains far from certain.

That troubles H. Clarke Romans, executive director for Southern Arizona's affiliate of the National Alliance on Mental Illness. Disbanding the court "would be penny wise and pound foolish—by a long shot," he says. "Even if you don't care anything about people, it's a stupid money move. The court has saved this community countless thousands of dollars."

The numbers back him up. According to statistics compiled by the Community Partnership of Southern Arizona (CPSA), roughly 7,000 misdemeanor defendants have gone through Mental Health Court diversion, opting for treatment rather than incarceration. Many participants are homeless or indigent, and not receiving the mental health care they need.

Without diversion, the system chews them up; the average jail stay for a mentally ill person is 21 days, compared to just three days for others held on the same charges.

Those long stints cost real money. According to the CPSA report, it costs $76 per day to house an inmate at the Pima County Jail, and the early release of defendants through the Mental Health Court saves taxpayers $1,219 per inmate, and approximately $97,000 per month. The city is also spared the cost of providing anti-psychotic drugs, which are the jail's mostly commonly prescribed medications. Then come the long-term savings of keeping people out of the system; according to the CPSA, the success rate for Mental Health Court nears 100 percent. Among Mental Health Court participants, charges for violent crimes drop by 73 percent.

All of which raises this question: If Mental Health Court saves so much money, why would it ever be sacked? The answer depends upon whom you ask.

Judge Michael Lex is largely credited with bringing the court to life, and just this month received a Ben's Bell for his advocacy on behalf of the mentally ill.

But after 10 years as the court's sole judge and chief cheerleader, Lex was recently reassigned by Presiding Judge Tony Riojas. That move fueled dark speculation among mental-health advocates.

However, Riojas says such speculation is unfounded; he recalls how he sat down with Brynwood's office to hammer out a deal. "I told them, 'Can't we sit there and play with the calendar in such a way that Mental Health survives?'"

In the end, the court was reduced from five sessions each week to four, which Judge Riojas admits "is not as robust as before. But we fully support Mental Health Court. It's a cost savings."

As for the replacement of Lex, Riojas says he simply needed to familiarize other judges with the program. "You don't want just one judge running something. Say he wins the lottery and moves to Tahiti. What are you going to do?"

Either way, says Riojas, the largest impact on the court comes from budget cuts at CPSA, which coordinates behavioral health services for Southern Arizona, and manages allocations from the Arizona Department of Health Services. Late last year, ADHS took a cut of nearly $14 million, and more reductions are expected. The result is that all behavioral health funds—except those for people enrolled in the Arizona Health Care Cost Containment System (the state's version of Medicaid), and those deemed seriously mentally ill—have been decimated.

But because of those exemptions, the cuts should actually hold minimal repercussions for Mental Health Court, says CPSA head Neal Cash. According to Cash, the majority of court participants are seriously mentally ill. "We have not lost funding (for them) at this point. That's not to say that we won't. And believe me, there are plans on the table right now (in the Legislature) for pretty drastic cuts for services to the population not enrolled in Medicaid that have a serious mental illness."

So the future of Mental Health Court remains anything but secure. That worries court champions such as Judge Lex, who have watched it help the vulnerable turn their lives around—even as it prods jurisprudence in a more progressive direction.

"With the Mental Health Court, you step away from just acting as a referee," Lex says.

"... And if people are in need of some sort of specific treatment—it might be for substance abuse or mental illness, or just behaving badly at stoplights—everything you do as judge is going to affect their behavior.

"In the case of mentally ill people, if the effect is to encourage people to seek treatment, that's a good thing, because people in treatment commit fewer offenses than people not in treatment."

Common sense or not, this marks a drastic departure. "Traditionally, we've just ignored all that stuff," he says. "So you might hold somebody in custody who is supposed to have a meeting with his case manager, and he misses it because he's in jail. Or you may have somebody in jail who doesn't receive his medications because the jail isn't aware of what the prescriptions are. Or the jail just doesn't want to provide them because they're expensive.

"The result is, when that guy gets out of custody unmedicated, he's more likely to return to criminality than if he is medicated."

Sometimes, the impact can be personal. Consider the 19-year-old woman who was hooked on drugs and kept getting busted for prostitution. After her third visit to Mental Health Court, treatment finally stuck.

Two years later, a well-dressed woman walked into Lex's courtroom. Initially, he didn't recognize her. Then she handed him a picture of her new baby. On the back of the picture, she wrote, "Judge Lex, thanks for saving my life."

He keeps that picture in his wallet to this day.

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