What happens when mental illness leads to charges being dropped?

For seven years, Timothy Jay Fowler has been navigating between prison, forced psychotherapy, and freedom.

In 2014, a Great Falls man was charged with assaulting two detention officers while in prison for theft. A mental health assessment concluded that Fowler, who was diagnosed with schizophrenia, was unfit to stand trial, according to court documents. After Fowler received psychiatric treatment for several months, the judge ruled that he was unlikely to become eligible any time soon. His case was dismissed, and after a stay in the state-run psychiatric hospital, he was released.

Almost eight months after the dismissal, Fowler was again arrested for allegedly hitting a stranger with a metal pipe. As before, he was found unfit to stand trial, charges against him were dropped, and he was eventually released.

No less than five times from 2014 through 2021, Fowler went through the same cycle: He was arrested on serious charges, mental health professionals declared him incompetent, and his case was dismissed. Fowler declined to be interviewed for this article. As of July, he has not faced criminal charges for over a year.

In the United States, criminal proceedings stop if the accused is found to be incompetent. What happens next varies from state to state. Nobody is tracking The number of times criminal charges are dismissed because the defendants’ mental illness prevents them from understanding court procedures to help in their defense.

Some states have policies in place to transfer hospitalized patients to Independence after criminal charges are dropped. But in other areas, like Montana, there are a few disembarkation places for such patients outside of a prison or hospital to help with this transition. Health professionals, county attorneys and criminal defendants said that people who are declared ineligible for trial may have a short stay in a psychiatric hospital before being released without additional supervision.

The vast majority of people with chronic disease Mental illness is not violentThey are much more likely to be victims of crime than the general population. Additionally, health professionals say most defendants who are determined to be incompetent become stable enough through treatment to continue their case.

Some don’t. The criminal justice system has long been a revolving door for defendants with mental illness. The National Non-Profit Foundation Therapeutic call centerwhich advocates making acute mental illness easier to treat, found that as of 2017, there are 21 states Make little or no effort To create programs that treat these defendants. This failure leaves individuals unstable, and some continue to harm themselves or others.

“They only receive emergency care, followed by no care,” said Lisa Dailey, the center’s executive director. She added that people aren’t treated until they face new charges: “You’re creating a system that requires a victim.”

Dr. Karen B. RosenbaumA forensic psychiatrist and vice president of the association American Academy of Psychiatry and the LawHe said that experiments like Fowler’s show a system that fails people who have been released from psychiatric care. “There should be a lot of steps before you go back into the community,” Rosenbaum said.

Some countries have created such steps. Colorado has a team of Navigators to help with coordination Care for people deemed ineligible for trial and recovery program to provide treatment to patients close to home. In Oregon, a psychological review board He works with the state hospital to supervise people who are found to be incompetent to reduce the risk of risky behavior in the future.

But even in states that have stabilization programs for people with serious mental illness, this treatment is not guaranteed, often because Limited availability of psychiatric services.

Minnesota has a process for identifying, treating and managing risks for people designated as “dangerously mentally ill.” However, maintaining appropriate staffing levels in treatment facilities has been a problem, as has finding adequate community options for people who need a higher level of care than typical group homes can offer. Last year, a statewide KARE 11 . investigation was conducted It found dozens of cases in which people accused of serious crimes – including assault, rape, and murder – were deemed mentally incompetent and released without treatment or consistent supervision. As a result, more people were infected, according to the investigation.

Forcing someone into psychiatric care is controversial, creating a tension between independence and public safety. For decades, mental health advocates have been pushing for local services, such as intensive outpatient treatment programs and transitional placements. But as psychiatric hospitals are scaled back, local options often do not have the resources to meet the need.

In Montana, when cases are dropped because defendants are ineligible, local officials must file a petition requesting a judge’s order to allow them access to psychiatric care. People May be required to attend treatment options on an outpatient basis, although lawyers and government officials said these services are often non-existent or too stretched. All too often, people are admitted to the understaffed state-run psychiatric hospital, which earlier this year lost federal funding due to unsafe conditions and patient deaths.

Court and state officials in Montana said cases that were dismissed because the accused was incompetent are extreme cases. However, the state has no way of tracking when this occurs or how many people in this condition receive additional treatment.

Lewis and Clark County District Attorney Leo Gallagher said people are sometimes released once their case is dismissed. Involuntary commitment to mental illness requires people to be an imminent threat to themselves or others. That’s a loud thing to meet, Gallagher said.

By the time a commitment motion is brought before a judge after someone is found to be unlikely to be fit for trial, the defendant could have been imprisoned or hospitalized for several months. This time frame makes it difficult to prove an imminent threat, Gallagher said, and a judge is likely to deny compliance.

“There is a loophole in the system,” he said, adding that he submitted requests knowing that they would be rejected because he could not bear the burden of proof.

Dylon Martin, a defense attorney in Great Falls, said that if clients whose charges were dropped because of their illness were taken to hospital, their discharge would often be the end of their care. “People are released back into society with the expectation that they will take their medication,” Martin said. “There has to be a better transition.”

government hospital He has a long waiting list. Virginia Hill, a recently retired psychiatrist who has worked at Montana State Hospital for more than 35 years, said Dr. Lawmakers this spring That a typical stay is two to four weeks, “a short commitment in the grand scheme of things when you are charged with a very serious felony.” She said the patient usually leaves the hospital with medication and books local appointments, but then the patient is out of the system.

“These are the revolving door residents we have,” Hill said. “The charges are dropped, and they are taken out. They are usually very ill.”

she Legislators are asked to consider Defining a method in state law for managing persons who are unlikely to become eligible. To understand the problems that exist, Hill said she’d like to see more data about who the state hospital treats, whether they receive care elsewhere, and the outcome.

Montana Lawmakers drafted a proposal For next year’s legislative session with the aim of strengthening treatment coordination for people who have been discharged from psychiatric care after being convicted of a crime. Matt Koontz, executive director of the Montana chapter of the National Alliance on Mental Illness, is pleased to see the proposal but said it does not include people whose charges have been dismissed over an efficiency issue.

“Sometimes people prefer to let the status quo continue, even if something is clearly not working,” Koontz said.

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